Are you taking too much anti-inflammatory medication?

Robert H. Shmerling, MD

Faculty Editor, Harvard Health Publishing

Follow me on Twitter @RobShmerling

You might call them pain relievers. You might take them for back pain, headache, or arthritis. Your doctor calls them “NSAIDs,” which stands for nonsteroidal anti-inflammatory drugs. Whatever you call them and for whatever reason you take them, NSAIDs are among the most popular medications worldwide. In fact, estimates suggest that about 15% of the US population takes an NSAID regularly (including those that are over the counter and prescription strength). Along with sporadic users, more than 30 billion doses are taken each year.

Some of the most common NSAIDs include ibuprofen (as in Motrin), naproxen (as in Aleve) and celecoxib (as in Celebrex).

Why are NSAIDs so popular?

There are several reasons:

  • For many conditions, they work quite well — in addition to working as pain relievers, they can reduce fever and inflammation.
  • They are relatively inexpensive, with generic versions available for most of them.
  • They’re available over the counter or, in higher doses, by prescription.
  • They have a good safety profile.

The downside of NSAIDs

No medication is completely safe, and that’s certainly true of NSAIDs. At the top of the list are digestive problems including stomach upset, heartburn, and ulcers. Kidney injury, easy bruising or bleeding, and mild allergic reactions (such as rash) are common as well. Less common side effects, including severe allergic reactions and liver injury, can be serious. NSAIDs can also raise the risk of heart problems, though this risk varies depending on the particular NSAID and the person taking it. Still, the vast majority of people taking NSAIDs in the recommended doses who have appropriate monitoring (such as the occasional blood test) have no major problems with them.

It’s easy for things to go wrong

The widespread availability and good safety record of NSAIDs makes it easy to misuse them. For one thing, there are more than 20 different NSAIDs, so you could be taking more than one of them without realizing it. In addition, several of them are available over the counter and are included in combination with other medications. Examples include prescription drugs like Arthrotec (a combination of the NSAID diclofenac and misoprostol, a medication that helps protect the stomach) and products available on the drugstore shelf, like Advil PM (ibuprofen plus the antihistamine diphenhydramine). So whether intentionally or by accident, it’s easy to take more than recommended doses.

A new study finds that this may be a bigger problem than anyone realized. Among more than 1,300 people taking ibuprofen:

  • More than one-third also took a second NSAID. Less than half of these “double NSAID” users realized that more than one of their medications was an NSAID.
  • Up to 15% took more than the recommended dosage.
  • Exceeding the recommended maximum dose was especially common among men, those with chronic pain, those with poor knowledge of dosing recommendations, and those who believed in “choosing my own dose.”

The bottom line

NSAIDs can be remarkably helpful medications, but they can cause trouble. The risk of serious side effects goes up when taken in higher than recommended doses.

Except for low-dose aspirin (commonly taken to prevent heart attack or stroke), NSAIDs are taken primarily to relieve symptoms of pain or fever. If you don’t think your NSAID is helping you (or if you aren’t sure), talk to your doctor about stopping it — even minor risks aren’t worth taking if there’s no benefit. Or there may be a better option, such as acetaminophen (as in Tylenol).

Keep an updated list of all of the medications you take, including over-the-counter drugs. Read the labels and instructions and take them only as prescribed. When in doubt, ask your doctor or pharmacist.

Comments:

  1. Fredrick Welfare

    Low dose aspirin is not about anti-inflammatory or pain medication. Talking about the 81mg aspirin in this context is a non sequitur. It is not clear that it has any effect whatsoever except perhaps for those recovering from a cardiovascular disease. Ibuprofen however, and other OTC pain relievers, are taken by many at doses of 400-600mg for pain several times a day. The writer was addressing the problem of taking more than the recommended daily limits and by implication overdosing, which varies between persons depending on age, weight, gender, and particular symptoms.

    The underlying and rarely discussed issue is why so many people are in pain!!

  2. Frank

    I have been taking 81mg aspirin along side simvastatin for the past 40 yrs a at bed time. Just yesterday I got my blood test result from my Doctor. He said that every thing is OK from kidneys to liver to the heart etc. I am 81 yrs old

  3. Arlene

    To Henry Gotlob,

    Your use of viscous is incorrect in saying low dose aspirin “…makes your blood flow easier…”

    The meaning of viscous is “having a thick, sticky consistency between solid and liquid; having a high viscosity. ” Unlikely that viscous blood would therefore flow easier.

  4. Miah

    @Jon,
    I will assume that any chemical that is not a part of the body chemical is harmful, in the long run, to the body. However, due to the dynamic complexity (cause and effect separated by time and space) of the system by which the body works, it may be very difficult to pinpoint the adverse effect of such chemicals.

  5. Margaret

    I’m interested in learning of the maximum, “probably- safe” per-day (or week) of ibuprofen. Does height/weight factor into the picture?

    Appreciate your answer!

  6. A Carey

    I took low dose aspirin for a bit until a blood test revealed anemia. More tests confirmed it was from internal bleeding caused by the aspirin, and it could have killed me 🙁

    AC

  7. Venkat Warren.M.D.

    A good physician will ALWAYS listen to his patient! Through his talking, the patient is not only expressing his health concerns but also giving the physician great clues about the possible diagnoses !! Low dose aspirin , 85 Mg or less is well proven to be very beneficial for secondary prevention for subsequent heart attacks but as primary prevention for MI’s, it’s value remains to be documented ! Even low dose aspirin theoretically could cause significant side effects in some patients ! Cheers. Venkat Warren.M.D.

  8. DB

    The risk is low with low-dose ASA. Generally it’s not very harmful to the kidneys, but the risk of GI bleeding is present, though to a much lesser extent than with a full OTC dose of NSAID such as ALEVE or IBUPROFEN.

  9. john ayres

    As Azure says, there are many reasons why a quick chat with your doctor is only an option when you decide there is a serious problem, and of course, he needs to get you out of there in record time.
    That’s why I whish sites like this would go little further to give specific information – numbers for example . instead of just an alarming essay on the dangers and pitfalls ,no real guidance and ” get down to your doctor”

  10. Henry Gotlob

    Low dose aspirin is taken to keep your blood more viscous. It flows easier, in order to lighten the load on your heart and to make it easier for your blood flow throu narrowe arteries. You should be taking them for sure.

  11. Carlis

    Oh, always take the enteric coated baby Aspirin. As I said, 10yrs now and no problem, along with 75mg Plavix.

  12. Carlis

    No its not. I have taken it for yrs no problem. Always take with food.

  13. azure

    “If you don’t think your NSAID is helping you (or if you aren’t sure), talk to your doctor about stopping it.”

    Information/data I would’ve liked to have seen provided in this article:

    of the people engaging in any or all of the disapproved of/risky behaviors how many: (1) don’t have a PCP; (2) have such a high deductible they & immediate family members only see their health care provider (not a MD usually but a PA or NP) maybe once a year if they’re really ill and so probably won’t remember to ask hey is it ok if I take both of these OTC meds? Or this much of the OTC med? Particularly when the health care provider will spend about 15 minutes w/him or her and spend 5 minutes of that 15 minutes doing data entry.

    Will the health care provider even be listening if the question’s asked?

  14. John

    I have read many benefits to taking low doses of aspirin (less than 100 mg/day). Is aspirin in low doses taken on a daily basis as harmful as other NSAID’s?

    John

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