NSAIDs - Pain Popping Pills
Americans probably swallow more NSAIDs (nonsteroidal antiinflammatory drugs) than vegetables. There are over 50 types of NSAIDs out there, including aspirin, ibuprofen, Celebrex, naproxen, and acetominophen. Personally, I love veggies because they’re so healthy, fresh, and tasty– and I’m talking about un-fried veggies (I know, not very Southern of me). Fresh vegetables are good for your heart (as is exercise), although taking a daily aspirin seems to be easier for most Americans to reduce the risk of a heart attack.
Over 17 million Americans take NSAIDs everyday for pain or their heart. Look at how many NSAID commercials are vying for your attention (and money). “Headache, backache, heartache? Take our NSAID!” Sure, no one likes to be in pain (well, almost nobody), but as with all good things, there are side effects of NSAIDs.
“Through the lips and past the gums. Watch out, tummy, here it comes.” The most common complaint of NSAID users is “It’s tearing up my stomach.” Gastric and duodenal ulcers can develop with NSAIDs because these anti-inflammatory medicines inhibit production of prostaglandins– something that protects the stomach lining from acid.
I know when I take NSAIDs, I feel like a habanero pepper is having a fiesta in my stomach. Ole, ouch! If the ulcer gets too bad, it can bleed, which can be deadly. Five to seven percent of hospital admissions are due to adverse effects of NSAIDs, and GI bleeds are one of the big complaints.
Acetominophen (Tylenol) does not cause ulcers and is different from the other NSAIDs. But it’s not an anti-inflammatory like the others. The COX-2 inhibitors like Celebrex and Mobic don’t decrease the prostaglandins as much as the other NSAIDs, but still ulcers and gastritis can occur. That’s why many NSAIDs users take an antacid like Prilosec to reduce the risk of ulcers. But not everyone with ulcers or even bleeding ulcers has symptoms such as stomach pain or nausea, which presents a problem.
Platelets don’t clot up as easily in the presence of NSAIDs, so there’s increased risk of bleeding. Petechiae, spot-like bruises, can occur– it looks like a rash. Some NSAID users ask me, “Why do I look like an extra from a Jackie Chan movie?” Some of the NSAIDs can fatally stop the bone marrow from working, so red and white blood cells aren’t produced.
Some people are allergic to NSAIDs and can get nose polyps, rashes, or a type of pneumonia. I’m telling you, being allergic to pain medicine is worse than being allergic to Simon Cowell, because you can’t sing your pains and inflammation away like on American Idol.
Although aspirin has been shown to reduce heart attacks and the main type of stroke, the other NSAIDs might actually reduce the effectiveness of aspirin. So there’s a slightly increased risk of heart attacks for NSAID users who rely on aspirin for their hearts. Also NSAIDs can drive the blood pressure up in hypertensive folks.
Think someone is talking about you? Well, that ringing in your ears (tinnitus) might be from using too many NSAIDs. Worse than tinnitus is having psychosis and cognitive problems from NSAIDs, particularly evident in the elderly.
So many people abuse over-the-counter NSAIDs, thinking, “More is better.” They take NSAIDs like eating M&Ms and end up with liver and/or kidney toxicity. I’m amazed to hear how many NSAIDs pills people use due to misinformation. Talk to your pharmacist or doctor first!
NSAIDs are safe to use, in particular if used correctly. But it isn’t as safe as chicken soup, so watch out for those side effects. I think I have NSAID enough.
© Dr. John Hong, Inc.
Notes: NSAID bad effects: >17 million Americans use nonsteroidal antiinflammatory drugs (NSAIDs) on a daily basis. But there can be bad side effects, in particular to the GI system, kidneys, liver, cardiovascular system, nerves, allergic reaction, and bone marrow. 5-7% hospital admissions due to NSAIDs adverse effects. Overdose usually is not lethal (though acetaminophen, like Tylenol, overdose is very toxic).
GI bleeds from ulcers are most common side effect of NSAIDs. NSAIDs inhibit production of prostaglandin – which protects the stomach lining from acid. Cyclooxygenase (COX) has 2 forms: COX1 and COX2, and NSAIDs block them. However, you might have heard of COX2 inhibitor, like Celebrex & Mobic. The COX-2 inhibitors supposedly have less ulcers because unlike other NSAIDs that block both COX1 and COX2 to reduce prostglandins, Celebrex blocks only COX2.
Cardiovascular (CV): NSAIDs can raise BP in hypertensive people. Of all the NSAIDs, only aspirin has been shown to save lives from heart attacks by preventing platelets from forming clots. Other NSAIDs like ibuprofen and naproxen also inhibit platelets so there is increased risk of bleeding, but some NSAIDs have been shown to reduce the cardiac effectiveness of aspirin
Liver failure is quite rare but there can be inflammation due to NSAIDs. A blood test can detect this. More likely to have liver toxicity if NSAIDs are used with other liver-toxic drugs, such as in the treatment of rheumatoid arthritis. Sulindac has increased risk of liver problems compared to other NSAIDs. Diclofenac can cause drug hepatitis as well as false ANA blood test. ANA can indicate autoimmune hepatitis or lupus. Lupus patients actually have increased risk of liver problems with NSAIDs.
Lungs: coughing, wheezing like in asthma. Pulmonary infiltrates with eosinophilia – an immune cell related to allergies – so looks like pneumonia on chest x-ray. There is a fever with shortness of breath.
Skin: allergies here as well. Toxic epidermal necrolysis (TEN) and the Stevens-Johnson syndrome (SJS). These can be deadly but fortunately very rare.
Bone Marrow makes red blood cells and immune cells. Bone marrow failure can be deadly and has been related to NSAIDs like phenylbutazone and indomethacin.
Nervous System: Tinnitus (ringing in ear), aseptic meningitis, psychosis, and cognitive dysfunction. Elderly are more at risk for mind problems. Lupus is associated with aseptic meningitis. Vision can become cloudly from cornea involvement.
Pregnancy: best not to use any NSAIDs but if needed aspirin and acetominophen have been used. Other NSAIDs can induce miscarriage. NSAIDs are minimally excreted in breast milk
