EVERY year, tens of thousands of people in Britain turn to drugs like ibuprofen to ease the agony of arthritis, back pain and sports injuries.
It belongs to a class of medicines known as NSAIDs – or non-steroidal anti-inflammatories.
Since it was first developed over 50 years ago by scientists in a lab in Nottingham, ibuprofen has emerged alongside aspirin and paracetamol as the drug of choice for those who want a fast and effective over-the-counter solution for pain.
But NSAIDs have had a troubled few years.
In 2005, the US Food and Drug Administration first alerted patients and doctors to the fact that these drugs could significantly increase the risk of heart attacks.
One drug, called Vioxx, was withdrawn from the market completely after evidence emerged that it had caused as many as 140,000 heart attacks in the US during the five years that it had been on the market.
Soon it became apparent that this side-effect was not confined to Vioxx but was a class effect – in other words, all drugs with the same mode of action were likely to have similar effects.
Now, a decade on, the FDA has strengthened warnings about taking the drugs on a prolonged basis after a panel of experts reviewed new evidence and decided further alerts were necessary.
Aspirin is an NSAID but it does not pose a risk of heart attack or stroke and is not covered by this new warning. The new warnings from the FDA point out that the risk of heart attacks and strokes increase even with short-term use. In fact, the risk may begin within a few weeks of starting to take an NSAID, and the longer someone is on it the greater the dangers.
The FDA says the risk is greatest for people who already have heart disease, though even people without heart disease may be vulnerable to cardiac problems too. The panel also decided naproxen – another type of NSAID – should be included in the alert. It had been thought it was safer than others in the same class but experts have now ruled that there is not enough evidence to say that for certain.
The general advice now is only to use drugs like ibuprofen or naproxen for a few days rather than weeks or months. Use the lowest dose that works and never take more than one NSAID at a time.
People with heart disease should probably avoid NSAIDs altogether.
It’s important to take the lowest effective dose, and limit the length of time you take the drug.
Never take more than one type of NSAID at a time.
Try alternatives to NSAIDs such as acetaminophen – better known as paracetamol. It relieves pain but does not appear to increase heart attack or stroke risk. However, it can cause liver damage if the daily limit of 4,000 milligrammes is exceeded, or if you drink more than three alcoholic drinks every day.
If nothing else works and you need to take an NSAID for arthritis or other chronic pain, try taking week-long ‘holidays’ from them and taking paracetamol instead.
If you experience chest pain, shortness of breath, or sudden weakness or difficulty speaking while taking an NSAID, seek medical help immediately.
by Pat Hagan