Over-the-Counter Pain Medications: What Are the Cardiovascular, Renal and Other Effects?

A new review of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) lays out recommendations and strategies for practitioners to individually tailor these common treatments to patient profiles.

The paper, published in the Journal of Cardiovascular Pharmacology and Therapeutics, pointed out that nearly 29 million Americans use over-the-counter NSAIDs to treat various sources of pain. NSAID use, the paper, notes, is responsible for approximately 100,000 hospitalizations and 17,000 deaths annually. Deciding which NSAIDs to use for which patients to treat what kind of pain has become a complex task for clinicians. The research team, from the Florida Atlantic University Schmidt College of Medicine, looked at the risks and benefits of common over-the-counter medications as well as some common prescription medications. Some important information from their report is listed below.

Gastro, Cardiovascular and Kidney Effects of Over-the-Counter NSAIDs

• Aspirin: Decreases inflammation, coronary events, and stroke; increases gastro symptoms and bleeding. No hepatic consequences.
• Traditional NSAIDs: Decrease inflammation; linked with major adverse coronary events and stroke with long-term use; upper gastro and renal problems; electrolyte imbalances (possibly resulting in heart failure in some cases). Examples: ibuprofen (Advil or Motrin), naproxen (Aleve), diclofenac (Voltaren; prescription only)
• Cyclooxygenase 2 (COX2) inhibitors: Favorable gastro profile vs. aspirin and non-aspirin NSAIDs; confers adverse CV, renal, and hepatic effects. Example: celecoxib (Celebrex)
• Acetaminophen (Tylenol): no clinically relevant anti-inflammatory properties; accounts for more than half of drug overdoses related to liver failure and 20% of liver transplant cases.

“With respect to the benefits and risks of pain relievers, the totality of evidence suggests that health care providers and their patients should make individual clinical judgements based on the entire risk factor profile of the patient,” said Manas Rane, MD, lead author and a third-year internal medicine resident at Schmidt College of Medicine, concluded in a press release. “The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.”

Another paper co-author went on to urge that clinicians take care not to limit their analysis to one or two kinds of side-effects.

“The factors in the decision of whether and, if so, which drug to prescribe for relief of pain and inflammation, should not be limited to risks of cardiovascular or gastrointestinal side effects.,” said Charles H. Hennekens, MD, DPH, corresponding author and the Sir Richard Doll Professor and senior academic advisor at Schmidt College of Medicine, said in in the news release. “These considerations should also include potential benefits including improvements in overall quality of life resulting from decrease in pain or impairment from musculoskeletal pain syndromes.”