When ibuprofen (Advil, Motrin IB) was initially introduced as an over-the-counter pain reliever in 1984, it was advertised as “advanced medicine for pain.” The implication was that this drug, previously available only by prescription, was better than the currently available pain relievers. Aspirin had been around since the turn of the 20th century, and acetaminophen (Tylenol) went over the counter in 1955.
In 1994, when naproxen was switched from prescription (Naprosyn) to nonprescription status (Aleve), it was advertised with the slogan “all day long, all day strong.” The pitch was effective; Aleve has become a household name, just like Advil, Motrin IB and Tylenol.
By the way, none of these drugs has been proven more effective than the lowly aspirin when it comes to easing pain.
Americans swallow a lot of pain pills. Over 20 million take an over-the-counter NSAID (nonsteroidal anti-inflammatory drug) every day. Millions more take prescription products like celecoxib (Celebrex), diclofenac (Cataflam, Voltaren) or meloxicam (Mobic). Do people realize the risks they are taking along with their pills?
Too many of us assume that if the FDA has decided a drug should be available over the counter, it is safe enough to take without any concern. Studies have shown that many people taking OTC pain relievers are unaware of any risks and not worried that they will experience side effects (Journal of Rheumatology, Nov. 1, 2005; Proceedings of the National Academy of Science of the U.S.A., April 21, 2009).
Even doctors don’t always know just how risky such drugs might be. A recent study published in the BMJ (online, July 4, 2011) shows that NSAIDs can increase the chance of developing heart rhythm disturbances called atrial fibrillation and atrial flutter.
The extra cases (4 to 7 per 1,000 patients) may not seem like a lot, but the additional risk could add up to as many as 200,000 people each year developing atrial fibrillation. This heart rhythm abnormality can lead to strokes, and heart failure, and significantly increases the risk of dying prematurely (Journal of the American Medical Association, May 25, 2011).
The BMJ study of NSAIDs is not the only one showing that these drugs may disrupt heart rhythms. A study of British patients last year also showed a 44 percent increase in the risk of atrial fibrillation among people taking NSAIDs (Archives of Internal Medicine, Sept. 13, 2010).
Taking an NSAID pain reliever, whether prescription or over the counter, also increases the likelihood that a person with high blood pressure or heart disease will have a heart attack or a stroke (American Journal of Medicine, July, 2011).
Unfortunately, older people with arthritis often have heart problems or hypertension. This poses a terrible double bind. Do they put up with pain that seriously impairs their quality of life, or do they take a painkiller that threatens to shorten their lives?
We discuss this dilemma and offer some options for non-drug approaches to easing inflammation in our Guide to Alternatives for Arthritis.