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Advice on using painkillers safely

Reduce your risk of a heart attack, stroke, or death.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for relieving pain, reducing inflammation, and calming fevers. Some low-dose NSAIDs are available over the counter—for example, ibuprofen (Advil, Motrin) and naproxen (Aleve). This leads people to believe they are completely safe. But, since NSAIDs were first introduced, there were theoretical reasons to believe they might (infrequently) cause heart problems. This concern was amplified in 2004 when the prescription NSAID rofecoxib (Vioxx) was found to increase the risk of heart attack and stroke. Since then, Vioxx and several related NSAIDs have been taken off the market.

Other studies have found that all existing NSAIDs except aspirin pose some risk for people with heart disease. A study published in The American Journal of Medicine in January 2012 found that NSAIDs can raise blood pressure and interfere with blood pressure–lowering medications. A different study, published in Circulation on Oct. 16, 2012, found that among people who experienced a heart attack and regularly took NSAIDs after the attack, the risk of having a second heart attack increased by 41% over the next five years, and the risk of dying increased by 63% over the next five years.

The risk of heart attack and death with NSAIDs is likely due to the effect of these medications on blood cells involved in the formation of blood clots. Blood must maintain a constant balance between fluidity and clotting. “The ability to clot is helpful if you cut yourself, but if a clot forms where there is a narrowing in your coronary artery, you may suffer a heart attack. NSAIDs tip the balance toward clotting,” says Dr. Elliott Antman, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital and author of a 2007 American Heart Association scientific statement warning doctors about potential harm from NSAIDs.

Protect yourself

If you have heart disease, here is how you can lower your risk of suffering a heart attack or stroke from NSAID use.

  • Read the label on every drug you take to see whether it is an NSAID or contains an NSAID. This may prevent you from accidentally taking more than one NSAID, which would further raise your risk.

  • Before you take any NSAID, ask your doctor or pharmacist if there are any medications that should not be taken with it.

  • Learn the possible side effects of the NSAID you take.

  • Take the medication as directed.

  • Tell your doctor about any drug you buy over the counter.

Safer use of NSAIDs

With NSAIDs widely used for relief of muscle and joint pain and inflammation, the need for guidance on the safest way to use these medications became clear. To educate prescribers and users, several major medical organizations formed the Alliance for Rational Use of NSAIDs ( Their message is straightforward: take the lowest dose of NSAIDs for the shortest period of time needed to obtain relief.

In addition, the alliance recommends trying the least risky NSAID—naproxen—first, and moving to other NSAIDs only if it fails to work.

These instructions do not apply to aspirin. “Aspirin is a good NSAID. We want people with heart disease to take it regularly for cardioprotection,” says Dr. Antman. “The other NSAIDs may be taken for a few days for pain relief, but continuing to take them is not a good idea,” he says.

Posted by: Dr.Health

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