OTC Painkillers: How Dangerous Are They?
Non-steroidal anti-inflammatory medications or “NSAIDs” are sold over the counter in grocery stores, gas stations and pharmacies, even though research has long shown that they can be dangerous for people with kidney disease, heart failure or high blood pressure. NSAIDs can also produce adverse reactions when they interact with other medications, both prescription and non-prescription, including antidepressants, antihypertensives, alcohol or aspirin.
However, two new studies, one from BMJ and the other from the European Heart Journal of Cardiovascular Pharmacotherapy have shown again that NSAIDs may be associated with increased risk of heart failure and cardiac arrest. In BMJ, Arfe et all utilized healthcare databases from four European countries to find adults who began NSAID treatment between 2000-2010. The authors found that the use of any NSAID was associated with a 19% increase of risk of hospital admission for heart failure, with some variation for the type of NSAID and the dosage.
Sondergaard et al utilized the Danish Cardiac Arrest Registry to identify patients with out-of-hospital cardiac arrest and identified patients who had used an NSAID within the 30 days before their cardiac arrest. They found that ibuprofen and diclofenac were associated with a significantly increased risk of cardiac arrest.
This new evidence, along with other studies that have shown the potential for gastric damage and impaired ability to recover after myocardial infarction in pigs, has prompted some doctors to argue, controversially, that NSAIDs should be available by prescription only. In the U.S., ibuprofen was moved from prescription-only to OTC in 1984. However, proponents of this view do point out that people with no known heart disease or risk factors could continue to use NSAIDs on a short-term basis at recommended OTC doses with little concern, and the recommendation to make NSAIDs prescription-only, or at least behind-the-counter, would be mainly to insure that patients are screened for contraindications or adverse reactions. It’s important to re-evaluate the public benefit to having an affordable treatment widely available over-the-counter against the risk of dangerous side effects as new evidence is published.
If we no longer have easy access to ibuprofen, we can always give the I.V. hangover cure a try.
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