Anti-inflammatories: The side effects of common pain medications we all should be aware of.

Written By Guest User

 By Carmel  Safranko + Amber Minette 

AFP Early Career Pharmacists

Download our NSAIDs information pamphlet

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Download our NSAIDs information pamphlet 〰️

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, inflammation, and fever. NSAIDs are routinely recommended for short term use, and in the absence of suitable alternatives may also be prescribed in chronic pain. NSAIDs are commonly considered as ‘safe’ due to their ready availability over-the-counter and are therefore frequently started or continued without consultation of a doctor or pharmacist.

However, NSAIDs can interact with other medications. They have a range of side effects, and can affect the management of preexisting medical conditions.

You may be familiar with the common side effects of NSAIDs, listed in the table below, such as gastrointestinal upset. You may be less familiar with the serious adverse cardiovascular effects that can be associated with NSAIDs, particularly in long term use. It is important to note that people with existing cardiovascular conditions are at the highest risk of these side effects.

Patient factors increasing risk for cardiac side effects(5)

  • Prior cardiovascular disease

  • History of systemic inflammatory disorder

  • High blood pressure

  • High cholesterol

  • Male gender

  • Older age

  • Diabetes

  • Smoking


Jack, one of our Early Career Pharmacist talking through all the information on this page!

Some things people don’t realise:

  • Higher doses, frequency of use and established cardiovascular disease increase the risk of heart attack(6, 7) (8) (4).

  • NSAIDs should be avoided for 5 years post heart attack as they increase the risk of recurrent heart attack or even death(2).

  • Using aspirin with ibuprofen at a high dose; 1200mg daily dose post heart attack had a 2.2 fold increased risk of mortality despite a relatively short duration of use (37 days)(3).

  • Risk of adverse cardiovascular events including stroke and heart attack are extremely small with limited exposure over a short course of therapy i.e., in acute limited musculoskeletal injury. For patients with established cardiovascular disease, use an alternative where possible; topical NSAIDS, paracetamol, topical capsaicin.

  • Different NSAIDs have different side effect profiles.

  • Naproxen and ibuprofen are generally regarded as having the best cardiac risk profile, while diclofenac has a higher cardiovascular risk compared to other NSAIDs. However, meta-analysis ( this type of research combines lots of research together to make an overall standing) identified ibuprofen as having the highest risk for stroke(6).

  • Celecoxib has a good profile with regard to gastrointestinal risk (1).




TABLE of Side effects related to NSAIDs (4)

CALL TO ACTION

To reduce the risk of adverse effects: use the lowest effective dose for the shortest duration possible for the indication.

Questions to ask your doctor or pharmacist about your medications:

1.   Is this medication suitable for me?

2.   What are the side effects?

3.   What can I do about the side effects?

4.   Are there other things I can do to manage my condition?

CONCLUSION

Medication availability does not equate to universal safety or suitability. If you require an NSAID for short- or long-term use, speak to your doctor or pharmacist about the best options for you.

We have created a free handout for you, your friends or family or people you care for to help improve the community awareness of these medications. NSAIDs- Helping you be aware of your medication

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