Are You Taking Too Much Anti-Inflammatory Medication?

These medications are widely used for their pain-relieving properties, addressing issues like back pain, headaches, and arthritis. Medically, they are referred to as “NSAIDs,” an acronym for nonsteroidal anti-inflammatory drugs. Regardless of the name or the reason for consumption, NSAIDs rank among the most frequently utilized medications globally. It’s estimated that approximately 15% of the U.S. population takes NSAIDs regularly, encompassing both over-the-counter and prescription-strength variants. Considering occasional users, over 30 billion doses of NSAIDs are consumed annually.

Common examples of NSAIDs include ibuprofen (found in Motrin), naproxen (found in Aleve), and celecoxib (found in Celebrex).

Why are NSAIDs so popular?

There are several reasons:

1. Effectiveness: For many conditions, NSAIDs work quite well. In addition to being pain relievers, they can reduce fever and inflammation.

2. Affordability: They are relatively inexpensive, with generic versions available for most of them.

3. Accessibility: They’re available over the counter or, in higher doses, by prescription.

4. Safety Profile: NSAIDs have a good safety profile.

The downside of NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are not without risks, and potential side effects should be considered. Primary among these are digestive issues such as stomach upset, heartburn, and ulcers. Kidney injury, easy bruising or bleeding, and mild allergic reactions, like rash, are also common. While less frequent, severe allergic reactions and liver injury are more serious potential side effects. Additionally, NSAIDs can elevate the risk of heart problems, though this varies depending on the specific NSAID and the individual.

For pregnant women, there are concerns about the use of NSAIDs, as the FDA has updated warnings, advising avoidance of NSAID use during the latter half of pregnancy due to potential risks to unborn babies.

Despite these risks, the majority of individuals taking NSAIDs at recommended doses, with proper monitoring, such as periodic blood tests, typically experience no major problems.

It’s easy for things to go wrong

The widespread availability and favorable safety record of nonsteroidal anti-inflammatory drugs (NSAIDs) can contribute to their misuse. With over 20 different NSAIDs available, individuals may unintentionally take more than one without realizing it. Moreover, several NSAIDs 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) and over-the-counter products like Advil PM (ibuprofen plus the antihistamine diphenhydramine). This makes it easy for individuals, whether intentionally or accidentally, to exceed recommended doses.

A recent study sheds light on the magnitude of this issue. Among over 1,300 people taking ibuprofen:

• More than one-third also took a second NSAID.
• Less than half of these “double NSAID” users were aware that both of their medications were NSAIDs.
• Up to 15% exceeded the recommended dosage.

The study found that exceeding the recommended maximum dose was particularly common among men, individuals with chronic pain, those with limited knowledge of dosing recommendations, and those who believed in “choosing my own dose.”

The bottom line

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be highly effective, but they come with risks, especially when taken in higher than recommended doses. With the exception of low-dose aspirin, which is often taken to prevent heart attacks or strokes, NSAIDs are primarily used to relieve pain or reduce fever. If you feel that your NSAID is not providing the expected relief or you are unsure, it’s crucial to discuss it with your doctor. It might be advisable to discontinue the medication if there is no apparent benefit. In some cases, an alternative like acetaminophen (found in Tylenol) may be a safer option.

Maintaining an up-to-date list of all medications, including over-the-counter drugs, is essential. It’s important to carefully read labels and follow instructions, taking medications only as prescribed. When in doubt, seek guidance from your doctor or pharmacist.