Cycling Wed General Medicine Healthy Living

CW: More on the dangers of NSAIDs

Your knee hurts.

Your back aches.

Your muscles are soooo sore the day after trying that new exercise.

I get this; I race bikes.

Yet I urge you to avoid seeking relief in the form of the pain-relievers called Non-Steroidal-Anti-Inflammatory Drugs, or NSAIDs. You have heard the names before: ibuprofen (Advil), naprosyn (Aleve), diclofenac (Voltaren), celecoxib (Celebrex.) There are others.

An occasional reader of this site can attest that inflammation lies at the root of most disease. The irony here is that pills purported to be anti-inflammatory may be worse than the inflammation itself–a classic example of how treatment can be worse than the disease.

It’s also ironic that it takes a prescription to get one of the safest medicines on planet Earth, any beta-blocker, but with only a couple of dollars, you can buy a bottle of NSAIDs. And, in doing so, greatly increase your risk of heart attack, internal bleeding and kidney failure.

I urge you not to swallow these pills.

I urge my enlightened orthopedic and primary care colleagues to more vigorously spread the word about the dangers of these drugs. I’m sick of fighting with patients, and surprisingly, with other doctors, about stopping them.

And to you endurance athletes who run around in a chronically dehydrated inflamed state as a matter of routine, you are especially at risk from NSAIDs.

Sure, I have another study: As published ahead-of-print, in the high-impact journal Circulation, researchers from Denmark showed that patients with a history of prior heart attack that took NSAIDs—even in the short term—had a greater risk of death, or another heart attack.

Though you may think this study does not apply to you because it looked at patients with prior heart attacks, I suggest it is important for three reasons:

  • Like the legions of prior studies, they too report that NSAIDs increased the risk of death and heart attack.
  • Contrary to prior consensus statements, which state that short-term use of NSAIDs are less risky, this study showed that taking NSAIDs of any duration was dangerous.
  • Specific NSAIDs may differ in their risks. The prescription-strength diclofenac (Voltaren) increased the risk of problems immediately, and its risk persisted throughout the follow-up period. Strikingly, diclofenac conferred a higher risk than Vioxx—which was pulled from the market because it caused heart attacks. Ibuprofen looked bad as well. Naprosyn (Aleve), however, looked to be the best of the worst, which is also consistent with prior reports.

I cannot stress it enough. These pain relievers are dangerous.

Be careful.

Be informed.

Be mobile.


9 replies on “CW: More on the dangers of NSAIDs”


Thanks for taking the time to write–and for RTing so many of my posts.

Ah…Such a question approaches giving specific medical advice, which of course is a social media no-no. I will say this: acetaminophen, the active ingredient in Tylenol, seems far safer from a heart perspective. But keep in mind that Acetaminophen does have a well documented dose-related liver toxicity.

Do I think an occasional Aleve, Advil, Tylenol or aspirin is hazardous? No…obviously not.

But it’s amazing how many patients and doctors remain unaware of the hazards of NSAIDs.

YIKES! The 200mg Celebrex tab I was going to take with lunch is still in my pocket. I suppose it’s back to ice packs and heat packs from here forward.

Does this mean that taking an 81mg aspirin once per day as a “preventative measure” might not be such a good idea?

@Dr. John
This was not intended to elicit medical advice. It would have been better said if I’d worded my question as, “Could this mean that my current practice of taking an 81mg aspirin daily might warrant further consideration and discussion with my family doctor and cardiologist?” I would never change my regimen without consulting them.

Which patients benefit from taking 81mg of aspirin is a frequently contested argument. To be clear about my post, I did not mean to include once daily doses of ASA in the group of dangerous NSAIDs.

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