Over-the-counter painkillers: the risks of ibuprofen, naproxen and other NSAIDs
Risky SubstancesKey points
- All NSAIDs studied were linked to a 20% to 75% higher risk of heart attack.
- The risk appears within the first week and rises with dose.
- Other risks: stomach bleeding, kidney damage, higher blood pressure.
- Take the lowest effective dose for the shortest time.
What the research shows
A Bayesian meta-analysis of health records from more than 446,000 people in Canada and Europe found that all NSAIDs studied, including ibuprofen, naproxen, diclofenac and celecoxib, were linked to a higher risk of heart attack, roughly 20% to 75% higher depending on the drug. Risk appeared within the first week of use and was highest in the first month and at higher doses (Bally et al., 2017). The FDA strengthened its warning about heart attack and stroke risk from NSAIDs in 2015.
Other risks
- stomach ulcers and bleeding;
- kidney damage, especially with dehydration;
- higher blood pressure and fluid retention;
- interactions with blood thinners and some blood pressure drugs.
Back and joint pain
For low back pain, guidelines emphasize staying active and exercise over long-term medication (Foster et al., 2018).
How to take them more safely
- Use the lowest dose for the shortest time.
- Take with food.
- Do not combine two NSAIDs (for example, ibuprofen and naproxen).
- Read labels: many cold and flu products contain NSAIDs.
- Ask your pharmacist if you take other medications.
Frequently asked questions
Is acetaminophen (Tylenol) safer?
It does not carry the same heart and stomach risks, but too much can cause serious liver damage. Do not exceed the label dose, and check combination products for hidden acetaminophen.
Does low-dose aspirin count?
Aspirin is also an NSAID but is used differently. Taking ibuprofen can interfere with aspirin’s heart-protective effect; ask your doctor about timing.
Sources
- Bally et al. (2017). Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ :j1909. doi:10.1136/bmj.j1909
- Foster et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet 391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6
- Glass et al. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331(7526):1169. doi:10.1136/bmj.38623.768588.47
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