How Serious are NSAIDs Side Effects?
“The U.S. Food and Drug Administration (FDA) warns that people using NSAIDs may have a higher risk of having a heart attack or stroke.”
“Even at normal NSAID dosages, people with compromised kidney function can develop NSAID toxicity” (1).
“Adverse effects of NSAIDs cause 103,000 hospitalizations and 16,500 deaths per year in the United States” (2).
“In patients with such a history, however, use of NSAIDs (aside from low-dose aspirin) was associated with more than 10-fold increase in heart failure” (3).
” You may as well wear a sign, ‘Please kill my kidneys’” (4 Rice University).
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The use of non-steroid anti-inflammatory drugs (NSAID) has commonly resulted in internal bleeding and stomach ulcers. Every year over 100,000 individuals are hospitalized and over 15,000 people die as a direct result of NSAID consumption. In America alone 50 people die every day as a result of medicating with common NSAIDs like Ibuprofen.
Common side effects of NSAIDs:
- Stomach ulcers and gastrointestinal bleeding
- Increased blood pressure
- Delayed digestion
- Tinnitus (ringing in the ear)
- Kidney damage
- Erectile dysfunction
The major problem:
Dr. Walter Peterson, the professor emeritus of medicine at the University of Texas Southwestern Medical Center at Dallas, stated, “consumers usually have no idea of the toxicity of OTC [over-the-counter] drugs”, he went on to say, “They believe that because they are OTC, they are safe”
How NSAIDs work
“Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since prostaglandins protect the stomach, support platelets, and reduce blood clotting, NSAIDs can cause ulcers in the stomach and promote bleeding. NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs. The most common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. NSAIDs may also cause fluid retention which can lead to edema. The most serious side effects are kidney failure, liver failure, ulcers, and prolonged bleeding after an injury or surgery.
NSAIDs may increase the risk of potentially fatal stomach and intestinal adverse reactions (for example, bleeding, ulcers and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.” (8)
Athletes and NSAIDs:
Two of the most common side effects of NSAIDs are severe damage to the renal (kidneys) and gastrointestinal (GI) systems. Renal damage can be reversible and has been known to occur as a result of short and long term consumption of NSAIDs. Dehydration can increase the chance of renal damage as well as being diabetic NSAIDs also change the water and sodium balancing function which can have a severe impact on intense athletic situations with high heat and prolonged activity. GI damage like stomach ulcers can be potentially lethal. Bleeding ulcers have resulted due the inhibited platelet formation which also impacts other internal and external injuries.
Individuals who consume NSAIDs also have an impaired response to viruses and bacteria which decrease the body’s ability to combat infectious diseases. This is a result of neutrophils (one type of white blood cell) deficiency.
“I strongly recommend against the routine use of NSAIDs during training and racing. They will not make you faster, nor help you recover quicker. The use of these medications during very challenging conditions, such as an Ironman, is particularly dangerous. You may as well wear a sign, “Please kill my kidneys”’, says Sports Medicine at Rice University
High mortality and morbidity rates:
307,590 calls to US Poison Control Centers were made as a result of NSAIDs in 2007. This means that over 80,000 calls a day are made, according to the American Association of Poison Control Centers National Poison Data System (AAPCC NPDS).
The New England Journal of Medicine published an article in June of 1999 that stated, “It has been estimated conservatively that 16,500 NSAID-related deaths occur… every year in the United States” More deaths occur every year from NSAIDs than acquired immunodeficiency syndrome, cervical cancer, or Hodgkin’s disease.
Despite the severity of NSAID toxicity, it remains a silent epidemic. The numbers are equivalent to the 15th leading cause of death (10).
The Food and Drug Administration suggests even higher figures, estimating NSAID use accounts for 10,000 to 20,000 deaths a year. These figures are comparable to Hodgkin’s disease or acquired immunodeficiency syndrome and represents a serious problem.” (12)
In spite of this knowledge, the FDA did little to warn consumers. Over time certain NSAID medications that were especially toxic were withdrawn or banned. Research has slowly progressed to find less toxic NSAIDs or to find other medications that will counteract the damage being created, but there was no large-scale public alert about the potential hazards of these drugs. Instead the FDA opted to simply provide a warning label on NSAIDs.
1 http://www.lef.org/protocols/appendix/otc_toxicity_01.htm (Whelton A et al 1991).
2 An estimated 10-20% of NSAID patients experience dyspepsia, and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits. Many of these events are avoidable; a review of physician visits and prescriptions estimated that unnecessary prescriptions for NSAIDs were written in 42% of visits. Kearney, Pm; Baigent, C; Godwin, J; Halls, H; Emberson, Jr; Patrono, C (June 2006). “Do selective cyclo-oxygenase-2 inhibitors and traditional nonsteroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials” (Free full text). BMJ (Clinical research ed.) 332 (7553): 1302–8. doi:10.1136/bmj.332.7553.1302.ISSN 0959-8138. PMC 1473048. PMID 16740558
3-Page, J; Henry, D (March 2000). “Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an under recognized public health problem” (Free full text). Archives of internal medicine 160 (6): 777–84.doi:10.1001/archinte.160.6.777. ISSN 0003-9926. PMID 10737277.
5 The main adverse drug reactions (ADRs) associated with use of NSAIDs relate to direct and indirect irritation of the gastrointestinal (GI) tract. NSAIDs cause a dual assault on the GI tract: the acidic molecules directly irritate the gastricmucosa, and inhibition of COX-1 and COX-2 reduces the levels of protective prostaglandins. Traversa, G; Walker, Am; Ippolito, Fm; Caffari, B; Capurso, L; Dezi, A; Koch, M; Maggini, M; Alegiani, Ss; Raschetti, R (January 1995). “Gastroduodenal toxicity of different nonsteroidal antiinflammatory drugs”. Epidemiology (Cambridge, Mass.) 6 (1): 49–54. doi:10.1097/00001648-199501000-00010. ISSN 1044-3983. PMID 7888445.
6 NSAIDs can cause kidney problems, especially in the elderly and those with kidney disease… Any sudden weight gain or swelling should be reported to a physician. Anyone with kidney disease should avoid these drugs. – NY Times Health http://health.nytimes.com/health/guides/disease/acute-gouty-arthritis/treatment:-acute-gout-attack.html
7 A 2005 study linked long term (over 3 months) use of NSAIDs, including ibuprofen, with a 1.4 times increased risk of erectile dysfunction.^ Shiri et al (Received 2005-05-21). “Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Incidence of Erectile Dysfunction”. Journal of Urology 175 (5): 1812–1816. Retrieved 12 June 2011. And “Non-steroidal anti-inflammatory drugs linked to increased risk of erectile dysfunction”. sciencedaily.com. 2 March 2011. Retrieved 7 June 2011.
8 — Medicinenet.com
9. Singh Gurkirpal, MD, “Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy”, The American Journal of Medicine, July 27, 1998, p. 31S
10. Wolfe M. MD, Lichtenstein D. MD, and Singh Gurkirpal, MD, “Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs”, The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889.
11. Wolfe M. MD, et al, The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889.
12. Fries James F., “NSAID Gastropathy: The Second Most Deadly Rheumatic Disease? Epidemiology and Risk Appraisal”, Journal of Rheumatology, 1991, (Supplement 28), Vol. 18, pp. 6-10
13. Paulus Harold, “FDA Arthritis Advisory Committee Meeting: Risks of Agranulocytosis/Aplastic Anemia, Flank Pain, and Adverse Gastrointestinal Effects with the Use of Nonsteroidal Anti-Inflammatory Drugs”, Arthritis and Rheumatism, May 1987, Vol. 30, No. 5, pp. 593-595