Nonsteroidal Anti-inflammatory Drugs And Safety

Are NSAIDs safe?The FDA recently ruled that available evidence does not prove that the painkiller Naproxen, often sold under the name Aleve or Naprosyn, is linked to greater reduction in heart disease than other nonsteroidal anti-inflammatory drugs (NSAIDs) on the market. A previous study suggested Naproxen was less dangerous to the heart than NSAIDs like Ibuprofen or Celebrex, but the FDA advisory panel did not find enough evidence to corroborate the statement.

The science of nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen, Naproxen, and Celebrex is quite complex. The mechanism and effect on the heart attack risk is not really fully understood. These drugs reduce inflammation in the body by blocking enzymes known as COX-1 and COX-2. The newer drugs in this group were a bit more selective in blocking COX-2 enzymes, which led to a reduction in stomach discomfort. However, the overall effect of all these drugs is that they may disrupt the balance of other enzymes in the inflammatory cycle throughout the body and actually lead to more hardening of the arteries and an increased risk of heart attack and stroke. That said, the increased risk is similar to the risk of a poor diet, smoking, genetics, and diseases like diabetes.

The risk of all NSAID medications seems to be that they may increase the risk of hardening of the arteries and heart attack or stroke. The newer COX-2 drugs like Celebrex, and previous ones Vioxx and Bextra, made this more evident since they became very widely used. Once the effect was found with the more selective COX-2 drugs, further studies have shown all these medications have the same potential risk.

NSAID Use In America

The use of NSAIDs is widespread. The medications can be very helpful in controlling pain related to injury and chronic inflammation due to degeneration of joints and neck and back problems. Many people do take these medications on a long-term basis to control pain levels. These medications can be taken fairly safely, but knowing that they can cause problems, a person should work at reducing all their other risks to prevent heart issues.

The main issue with NSAID medications is not heart attacks with most people, but stomach irritation and bleeding and kidney injury. All these drugs are very well known as significant causes of gastrointestinal bleeding due to the enzyme affects of the COX system on the lining of the stomach. Severe bleeding is a common side effect from these drugs. The COX enzymes and other affected enzymes also can lead to damage to the kidneys. In reality, these drugs have hurt more stomachs and kidneys than caused heart attacks.

The take home message on all medications is that any drug has risks and can have bad side effects on the body. Whenever taking a medication, one has to decide whether the benefit going to outweigh the risk. If you can change your lifestyle such that a drug is not needed, that would be the best option. If changing your lifestyle options is not sufficient, then discussing the risks and benefits with your healthcare provider is the next step with regards to any medication.

Related source: Reuters

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Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).

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