Over-the-counter pain relievers have significant potential side effects

Over-the-counter pain relievers are a two-edged sword

It may seem like ibuprofen (sold as Advil and Motrin), aspirin, and naproxen (Aleve) are miracle drugs but they deliver a lot more than pain relief.  Many of the other things they deliver can be very, very bad, especially for those over age sixty.  NSAIDs (non-steroidal anti-inflammatory drugs) work by decreasing prostaglandins.  That’s not a small matter – the body needs these chemicals to help create the protective lining of the stomach, for proper blood pressure control and for kidney function.

Because NSAIDs interfere with formation of the gastrointestinal tract’s crucial lining, irritations and ulcers can develop.  The GI side effects are more likely in older adults, those on higher doses, and those that take NSAIDs on a regular basis.  And injury to the GI tract, including ulcerations, is relatively common.  Taking NSAIDs with food DOES NOT prevent GI irritation or ulcer formation.

Ulcers in the GI tract, especially in the stomach with its rich blood supply, can lead to hemorrhage and even death from severe blood loss.  Sad to say, such severe GI bleeding can progress very rapidly.  Those that take blood thinners or  corticosteroids are more prone to severe GI bleeding.  Use of aspirin makes platelets less likely to stick together and form a blood clot if bleeding does start.  Research reported in a medical journal suggest that when drugs from a class of anti-depressants called SSRIs are taken with NSAIDs, the risk of GI bleeding is also increased.

Bleeding in the GI tract is just one side effect that makes NSAIDs the drug class most likely to send people to the ER.  It can increase the blood pressure and interfere with medicines for blood pressure control from working properly.  Liver and kidney injury can also develop with regular NSAID use.  People that drink alcohol are more likely to experience liver injury with NSAIDs.  Because damage to the liver and kidneys isn’t always very obvious, so people taking NSAIDs on a regular basis often have blood tests done to monitor for liver or kidney damage as well as GI bleeding or other blood loss.

The newer, more selective NSAIDs, such as Celebrex, still pose some risk of bleeding.  Those with coronary artery disease, the very old and people that are



debilitated may be more likely to experience clot formation while taking a such a selective NSAID.   If a clot forms in an area with plaque (a formation typical of atherosclerosis) it could totally obstruct the artery.  Arterial obstruction causes the tissue the artery serves to die resulting in a stroke in the brain or myocardial infarct in the heart.

NSAIDs that are over-the-counter are easily available and that makes overdosing much more likely.  That is a very common problem.  In this case, more is definitely not better.  This article is not intended to replace your health care provider. The intent is to make important information about medications available.

This article was reviewed by Dr. Armon Neel, the PharmD (a pharmacist with a doctorate degree) who is co-author of Are Your Prescriptions Killing You?




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