The Food and Drug Administration (FDA) has just raised its existing warning first issued in 2005 that use of nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Motrin, Advil) and naproxen (Aleve) can increase your risk of stroke or heart attack.
Why the increased warning?
The FDA has collected more recent data and information that indicates these drugs can increase your risk of heart attack and stroke much earlier than once thought, even during the first weeks of treatment. According to Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products, “There is no period of use shown to be without risk.”
Karen M. Mahoney, M.D., deputy director of FDA’s Division of Nonprescription Drug Products, advises: “Take the lowest effective dose for the shortest amount of time possible.”
Who is affected by this warning?
When the FDA first issue this morning in 2005, they focused on people with cardiovascular disease, especially those who recently had a heart attack or underwent cardiac bypass surgery.
The recent data indicates these drugs lead to a risk of heart attack and stroke for all patients, including those lacking evidence of cardiovascular disease. “Everyone may be at risk – even people without an underlying risk for cardiovascular disease,” Racoosin emphasizes.
Avoid risks of combining medicines, such as combining cold medicine with pain relief medicines.
One area of special concern to the FDA is that many consumers don’t realize that many different types of over-the-counter (OTC) medicines include the active ingredients of ibuprofen (Motrin, Advil) and naproxen (Aleve).
By combining products, consumers can sometimes unwittingly take multiple doses of the same active ingredient.
A good example: Over-the-counter cold medicines often include NSAID ingredients to provide relief from cold and flu symptoms. It’s not an uncommon practice for consumers take a dose of either ibuprofen or naproxen in addition to these cold medicines, leading to a double dose and consequently upping the risk of stroke or heart attack.
What are some alternative pain relief medicines?
Aspirin, which technically falls in the NSAID category, is not included in this warning. In fact, aspirin is considered to be associated with lowering your risk of a heart attack or stroke. However, taking NSAIDs (like Motrin, Advil or Aleve) at the same time can interfere with that protective effect.
Acetaminophen (Tylenol) is another category of pain killer that was not included in this most recent warning about NSAID risks for stroke and heart attack. However, concerns over liver toxicity have caused the FDA to restrict Acetaminophen (Tylenol) dosages to no more than 325 milligrams (mg) per tablet. If you have old Tylenol prescriptions, these tablets may be over the current limit, so check. It’s also critical to not drink any alcohol on a day when you take Acetaminophen to avoid liver toxicity.
How to reduce your overall risk of Heart Attack and Stroke.
The NSAID group of drugs is effective at providing temporary pain relief and inflammation reduction. These drugs block the production of prostaglandins, which are thought to be associated with inflammation and pain in the body.
These drugs have been used to treat fever and pain with injuries, including tendinitis, sprains and strains as well as dental problems. NSAIDs have often been used to relieve pain associated with menstrual cramping. Patients with debilitating conditions such as osteoarthritis and rheumatoid arthritis often turn to prescription strength NSAID drugs to treat pain.
The new research indicates it’s important to take these NSAID medications for the shortest possible amount of time at the lowest possible dosage. If you find you need to take them for a period of longer than 10 days, you should consult with us here at the office.
Patients who have coronary artery disease (known angina or history of heart attack), or have high blood pressure, or those who have had a stroke are at greatest risk.
As always, eliminating smoking will reduce your overall risk of heart attack and stroke. Improved diet and daily exercise will help prevent onset of diabetes and help reduce heart attack and stroke risk as well.
If you have not been able to take aspirin in the past due to stomach upset, you can try to lessen the chance of stomach irritation by taking medication with a meal. We can also look at other forms of aspirin that may be less irritating..