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Is Your Pain Reliever Causing an Irregular Heart Rhythm?

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The bad news about the dangers of NSAIDs (non-steroidal anti-inflammatory drugs) for the heart and the cardiovascular system continues to accumulate. We're guessing that very few American health care providers noticed an article in the BMJ (formerly the British Medical Journal) that was published on July 4, 2011. Hey, it was a big holiday weekend!

The article was titled: "Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study." Even though this research disappeared without a trace into the giant black hole, it is incredibly important for tens of millions of Americans (as well as people all over the world).

The research was carried out on 32,602 patients in Northern Denmark who were diagnosed with A-fib (atrial fibrillation) or flutter. These can be serious arrhythmias with devastating consequences. Because the upper chambers of the heart are not beating forcefully, blood clots can form in the left atrium and travel to the brain, leading to a stroke. That is why people who are diagnosed with A-fib are often prescribed blood thinners such as warfarin (Coumadin). Although this anticoagulant can reduce the risk of developing a blood clot and a stroke, it carries its own risks. Visit our drug library to read about the dangers of various drug and food interactions with warfarin.

The subjects in the Danish study were matched with 325,918 control patients to compare the use of pain relievers such as ibuprofen (Advil, Motrin, etc.), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), etodolac (Lodine), ketoprofen (Orudis), meloxicam (Mobic) and naproxen (Aleve, Anaprox, Naprosyn, etc). The investigators reported that, "In this large population based case-control study, we found that patients starting treatment with non-aspirin NSAIDs were at increased risk of atrial fibrillation or flutter compared with those not using NSAIDs. The relative risk increase was 40-70%--equivalent to approximately four extra cases per year of atrial fibrillation per 1,000 new users of non-selective NSAIDs and seven extra cases per year of atrial fibrillation per 1,000 new users of COX 2 inhibitors. The risk appeared highest in older people." These investigators speculate that the irregular heart rhythms might be triggered through an adverse kidney effect.

Now, you might blow off the idea of 4 or even 7 cases of atrial fib per 1,000 users of NSAIDs, figuring that your risk is really low. That's probably true if you are young and healthy. But the risk goes up if you have kidney problems or are older. And keep in mind that an estimated 20 million Americans swallow a nonprescription NSAID each day. Add in prescription NSAIDs like Celebrex, diclofenac, ibuprofen, naproxen or meloxicam (total annual prescriptions for such NSAIDs is more than 60 million) and you discover an astonishing public health worry. According to our calculations, that could equal over 200,000 cases of drug-induced atrial fibrillation annually.

This isn't the first time NSAIDs have been linked to A-fib. A study of patients in the UK published last year also reported an association (roughly 44% increased risk) in patients taking such pain relievers (Arch. Intern. Med. 2010; 170:1450-1455).

We have been wondering why there seems to be such an epidemic of atrial fibrillation in the U.S. Over the last few decades we have heard of more and more middle-aged people being diagnosed with A-fib. We used to think of this as an older person's problem. Now we are starting to consider the possibility that it could be brought on in part by our love affair with NSAIDs.

As if all this weren't enough, we have increasing evidence that NSAIDs increase the risk of heart attacks.

So, what is someone with arthritis or bursitis or tendinitis or just about any other "itis" to do? Well, there is always aspirin. It is just as good as NSAIDs for relieving pain but instead of causing heart attacks, it reduces that risk. Of course, aspirin does increase the danger of serious stomach irritation or even a bleeding or perforated ulcer. That is not a trivial risk.

We are leaning more and more towards natural approaches for pain and inflammation. Should you be interested, we have a new book just out from National Geographic (The People's Pharmacy Quick & Handy Home Remedies) that offers lots of non-drug options for arthritis and other inflammatory problems. There are some of our classic home remedies (gin-soaked golden raisins and Certo and grape juice) plus great information about anti-inflammatory products like turmeric, pomegranates, ginger, boswellia, cherries, honey and vinegar, pineapple juice, vitamin D and fish oil.

Now that we know NSAIDs pose such a significant cardiovascular and heart risk, perhaps it is time for the FDA to reconsider promiscuous use of these drugs and warn people about some of these newly discovered dangers.

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What should be done if you need relief from pain of arthritis, etc and are alergic to aspirin?


Read through to the end of the story and you will see that there are many natural anti-inflammatories that don't increase the risk of heart problems.

I realized many years ago that NSAIDs caused me problems and I decided not take them. I already had heart fibs. I was diagnosed with atrial flutter, still have it Thanks for making it public.

I am on high blood pressure medication and was prescribed Meloxicam for a painful back sprain/strain from yard work. Within three days I was in the ER with extremely eleveated high blood pressure. Just be careful if you take these types of drugs.

Why no mention of dosages? How much is too much?

Was there any indication in the study of whether or not occasional use of NSAIDS is just as bad for you as regular use? Any information on dosage?


Is OTC Tylenol (acetaminophen) a NSAID? And should this research also be applicable to this pain killer?

What are the indications or signs of atrial fibrillation? And is there any need to be concerned if one is taking only an aspirin daily? The article stated "non-aspirin nsaids" - doesn't that exclude aspirin?


How many pain killers must you take for this to show up?

My dad was recently diagnosed with this and he only took less than 5 advil total about two months ago.

The irregular heartbeats are still showing up on his tests (and he has high blood pressure).

People's Pharmacy response: It seems unlikely that his very small exposure to the drug triggered this complication.

Well doesn't that just frost ya. I went in last week with what I thought was heart related quiver; GP determined it was a pulled muscle, so he prescribed taking 800 mgs. 3 times a day. can't win for losing.

I was a victim of Vioxx (a COX 2 inhibitor similar to Celebrex) ten years ago this month, nearly died from it. I am still suffering from the a-fib and the effects of the drugs to control it.

Do the risks go away when you stop taking the NSAIDs? I only take them for pain, even then very rarely. However, just wanted to know if the risk from them becomes cumulative, or if it goes away once you stop taking them.


Please list the common, over-the-counter NSAIDs - Do they include: Advil, Tylenol, Aleve?


Is there any research to indicate a relationship between use of Acetaminophen and Atrial Fibulation/Flutter?? I've used Acetaminophen daily for years and do have both AF and AF. Rek

How much dosage of NSAIDs are you talking about? For example, is taking one Advil in the morning and one at night enough to cause a person problems? Thank you.

I have been taking diclofenac for some years due to severe osteoarthritis from scoliosis. I have had a couple of bouts with SVT in the past 2 - 3 years. I had never had anything like this before. After an echocardigram and stress test, nothing was found to be wrong with my heart. My primary physician put me on Cardizem to regulate my heart rhythm. In your report, a-fib is mentioned. Is there any reference to NSAID's causing SVT? I also have had multiple ulcers due to the NSAID's, so I have been prescribed Omeprazole for this side effect.

I'm confused. Is ibuprofen an NSAID? How about Tylenol?


Ibuprofen is a classic NSAID.
APAP (acetaminophen or Tylenol) is not considered an NSAID. It has its own side effects.

You give alternatives for arthritis pain, but what about menstrual cramps? I used to have writhe-around-on-the-bed-with-a-heating pad cramps and I vomited if I swallowed anything the first day or two of my period. Aspirin was totally useless! None of the herbs "for women's functions" did much, either. And the "it will go away after you have a baby" advice from my doctor was only partially true, just the vomiting stopped.

I thought I'd died and gone to heaven when Motrin first came out. I used to pop ibuprofen or naproxen like candy the first couple of days of my period to get me through. I have not bought any since menopause, so I'm no longer taking it, but I guess the damage is done...

Although I have taken Mobic without problems, when I was given diclofenac I got an irregular heartbeat. Would never take any of them again!

Have always used asprin for pain! Be warned-the high doses recommended for arthritis years ago may have caused ringing in the ears and may have contributed
to deafness.

My husband is on these medications. Have printed out the article and will discuss it with Doctor on next visit. Thank you for information.

Your article did not discuss frequency of use. Does the danger result from frequent use or is the occasional use of an NSAID also a serious problem?


Everybody's body and condition is different!!!!! What one person can tolerate who
perhaps has a hardy stomach, could make another sick.

That being so, it would seem that research that could determine risk would also determine acceptable dosages. I take two Advil a day. Does that compare in risk to mega-doses of some of the the other drugs mentioned? Otherwise, this article is nothing but hysteria.


Thanks for all you do !!

Say, your article would imply that aspirin is not an NSAID. If that is the case, then why does every bottle of every brand of aspirin at the Walmart Pharmacy say that is IS. I checked just today.



Just wondering when you might be responding to the questions.

I take meloxicam and tylenol 50 for osteoarthritis 1 time a day for years and a baby aspirin for heart. I have so much pain I don't know how I could stand myself w/o pain meds. I would love to get off the NSAIDS. I've tried the raisins, alfalfa pills, Certo/grape juice,cherries, Vit D and and fish oil 2x's a day.

Why do I have to notify Dr. if I decide to stop? I take Levoxyl and spironlactone and amlodipine and herbs and other natural minerals. Help?


Have been listening to radio show from day one. Very informative. Thank you for great info! A concern about aspirin, have asked heart specialist and family doctors if plain ole aspirin can cause high blood pressure in women. At any age or is it in older women if it does? I just get a run around that it's a big no, and no studies have been done.

I have a mild heart murmur forever, is that a factor? I do take low thyroid med. for the last 35yrs. can combination of both, or single of these raise blood pressure? No other meds are taken. thank you! BG.

I will be 89 next month. Some 25+ years ago I was diagnosed with atrial fibrillation and put on coumadin which I detested. I decided there had to be another way to go and when I found out about Nattokinase, I took that in addition. After several years, I decided to drop coumadin, notifying my physician I was doing so.

He is very accepting of my idiosyncrasies if not approving. It is now almost five years and the atrial fibrillation is no longer a factor in my life, this in spite of the fact that I have CHF, and am on oxygen 24/7. I had my first heart attack November 16, 2002 and was told by eminent cardiologists at Rex Hospital and Duke Hospital in North Carolina that if I didn't have open heart surgery, my life expectancy was 5 months and with surgery it would be 4 years.

I didn't have the surgery and almost nine years later I am having the distinct pleasure of watching my four grandchildren grow and thrive. Medical practitioners are not any more infallible than the rest of us and going with my gut feelings in all things has so far worked out for me.

I am a devoted listener to your Saturday morning broadcasts and read your columns in the News and Observer. Thanks for all the info I have received.

A February 2011 blood test showed me to be deficient in Vitamin D (level 16). A 50,000 UNT CAP PLIVA was prescribed for twelve weeks. Pre-op cardiogram for a D and C in June revealed a wondering atrial pacemaker which was not present on my last cardiogram December 2010. Can a massive dose of a vitamin cause this?

Sometime while taking Vitamin D., I began feeling my heart beating throughout the night in what feels like a jerky rhythm, but I made no connection to the vitamin until after seeing the cardiogram result. At times, I still feel the abnormal rhythm, day time as well as night time. How serious is this?

Thanking you in advance.

It was a true pleasure reading your comment. I sincerely hope you continue to hang in there and I hope you have many more years watching over your grandkids.

I am not surprised but happy to confirm that my decision to stop taking Meloxicam -after 4 or 5 years of taking one daily pill -was the right one. In addition to reducing the side effects mentioned in the article my heartburn is gone and I feel so much better!

In the late '90's I took some Aleve; one or two only and found I didn't tolerate them well, so have never taken them again. A few months later I started having A-fib attacks that got progressively worse. Finally in 2003 had an electro-physical ablation that ended the problem. I wonder if that occasional use is what triggered the A-fib?


You mentioned boswellia . . I can attest to it working. I had terrible hip/joint pain which made it difficult to do stairs, sleep, even walk sometimes. I started on boswellia serrata and within two weeks I was VASTLY improved. I can now sleep - and lay on my hips to do so, have much more movement and even stairs do not make me hurt. It was a miracle for me.

what is boswellia? How is it taken?

Ironic that you should mention Boswellia. This herb, also known as Frankinsense, can cause immediate and severe episodes of Atrial Fibrillation (irregular and rapid heart beat). I know that from experience because I tried it.

I am looking for a healthy alternative to Metoprolol which am taking for my AF. If anyone out there knows of one, let me know.

Ian, I had atrial fibrillation for many years and coumadin was what was prescribed for me - I hated every moment of use. Then I came across an article about nattokinase and started taking it with the coumadin and then dropped the coumadin about seven years ago - my atrial fibrillation is gone, the clots I had in my left leg disappeared and I am a happy camper.

Just for the record, I am 89 years old, have CHF and was given 5 months to live without heart surgery and 4 years with surgery. I declined surgery, went for chelation therapy and am here to disprove the theory that surgery is always the answer - read up on nattokinase - it might help you too. Good luck.

I just had AF diagnosed during screening for a vitrectomy and was incredibly surprised because I am very low on risk factors other than maybe age (I'm 63). I was suspicious in that my previous PCP used regular ECGs as part of her physicals and there had never been an indication in the past. I'm a non-smoking vegetarian with normal range BP; excellent LDL and HDL numbers; no other serious medical conditions and am only slightly overweight.

I have, however recently been taking meloxicam on a daily basis to help with a tendon inflammation in my foot. The doctor had also put me on a course of Medrol and later a steroid injection when I resumed the meloxicam. I will certainly discuss this with the cardiologist when I see him this week.

Thank you for the informative article.

I've been taking high-doses of ibuprofen for over 2 years now and in the last few months I've had very uncomfortable heart palpitations. I'm going to print out this article and take it with me to my doctor's visit this week.

I can confirm that NSAID's cause my A-fib. I had bouts with A-fib for several years that got progressively worse. My cardiologist carried out a cardioversion about three years ago and the A-Fib completely went away. But about 6 months ago I strained my back working at my parents house. My mom gave me a COX2 drug and I also took some ibuprofen that night. My A-fib came back the next day and lasted for a couple of days. I suspected a causal relationship and asked my doctor but he didn't think it was necessarily connected.

Then last week I tore my Achilles tendon while traveling overseas. They gave me some diclofenac rub to help with the pain and it really seemed to work. I didn't realize that diclofenac is also a COX2 drug. After using it a couple of days, my A-fib came back again and is now very persistent. After a week, I still have it and now have to go back to the cardiologist. I'm guessing another cardioversion may be in order.

I would like to thank the drug makers for all of the extra money I'm going to have to spend to get my heart back in rhythm. And who knows how many years these drugs have taken off of my life. I would think they would do a better job of warning their customers about this very serious side effect, especially those with a history of A-fib.

I was diagnosed with afib by wearing a monitor three months ago. I take Toprol xl 25 generic twice daily and I also take Coumadin. I had taken goody powders for years until my stomach would not take them anymore. I started taken tylenol otc but the most I have ever taken is 4 a day. Someone told me that Tylenol could cause heart flutter. Is that the same as the afib?

I was put on naproxen twice a day for tension headaches. I started getting PVC's & fluttering after 3 weeks which I have all day everyday. I'm only 32 & discontinued that medication when the heart thing started about a month ago. I was very healthy & no prior health problems. Is their a way to stop the heart problem from continuing? Does it go away on it's own?

I will be 61 tomorrow and have been living with diabetes for about 15 years (2-3 untreated/undiagnosed) as well as hepatitis-C since the mid-80's. A recent liver biopsy revealed only minimal damage which I and my gastroenterologist found to be pretty phenomenal. I work as a self-employed professional and hold a part-time job which is extremely physical.

Last weekend, I attended all hours of a 3-day music festival. So, overall, I considered myself to be in fairly good shape. Today, I had a regular check-up with my physician & she discovered I now have a heart murmur. It later occurred to me that I forgot to mention that I take ibuprofen on an almost daily basis for joint pain. Since I have never been told I have a heart murmur, I can only conclude my long-term use of ibuprofen may have contributed to this condition.

In the beginning of April 2013 I had periodontal surgery (crown lengthening) and was given an RX for 600mg Ibuprofen for initial swelling and pain. I took as directed but the pain got very bad. Checked out ok and told pain should ease up and to add benzocaine topical to area. Took ibuprofen 400-600 mg and coated gum with benzocaine frequently--my fault, more frequently than I should. Didn't think I'd have a problem as I had never had a reaction to ibuprofen and/or benzocaine. One day a few weeks later (still taking the ibuprofen and benzocaine) after being in the yard (hot and humid), I experienced an unusual flip-flop in my chest.

After 4 hours I went to the ER and was diagnosed with AFIB. I mentioned the ibuprofen use and questioned if this could have caused it. ER Doctor, Cardiologist both said "no", "never heard of that". Well, I am still convinced that this was a cause. Now I have paroxysmal afib and on an anticoagulant daily as well as medication for when I have an episode.

Now, unfortunately, I have arthritis pain and have nothing to take except acetaminophen--and we know about that drug......


I was finally diagnosed after having an MRI scan on whole of back and it was decided that pain was so severe that I would be put on naproxen 500mgs twice a day with co-codamol smaller dose for day time and if required large dose for bed time, after being on this for 6 weeks approx I have been suffering from a.f. just feel that I am not getting enough o2 at times not a nice feeling.

I was given diclofenic last year for almost the same time that I have been on naproxen I suffered strange pain in top of head and had the common sense to contact pharmacy who said to stop taking them as there is concern with the usage of diclofenic? g.p sent me for echo-cardiogram/and carotid scan both negative but cardiologist found heart murmur for the 3 months that I was not taking nsaid I was fine now I have pain almost every day in top of head.

I can tell you if I didn't require this drug for the severe nerve pain in back I would stop it tonight.
also has anyone found a problem with muscles in eye while taking this drug?

What concerns me about this study which will surely worry many of us who depend on controlling the pain of chronic illnesses such as osteoarthritis is that the article does not state whether the rather small increases in risk were statistically significant using the basic scientific rule of thumb p

Also the study does not show cause and effect it does not show that NSAIDS do cause AF (although of course they might). Definitely one where more research is needed. Are there any further studies planned?

My pulse slowed to 55-60 beats per minute (resting), with up to 12 long pauses, time for a 'missed' beat, since I was prescribed 70mg per day aspirin 5 months ago. I stopped taking aspirin a few days ago and my pulse is almost back to normal, with not more than 1 missed beat per minute and up to 70 beats per minute (resting). I think I will do without aspirin in future.

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