Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are among the most popular drugs in the pharmacy. Millions of people swallow ibuprofen (Advil, Motrin IB, etc) and naproxen (Aleve) that they buy without a prescription. Doctors also prescribe NSAIDs in large quantities. Some of their favorites include: celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin) and meloxicam (Mobic).
Despite their popularity, such drugs have the potential to do a significant amount of harm. Here are just some of the questions that we have received about meloxicam (Mobic) in particular.
Q. 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. Be careful if you take these types of drugs.
Q. My doctor prescribed meloxicam (Mobic) for a rotator cuff injury. My blood pressure was normal the day that I saw him.
Not long after I realized I was experiencing headaches. I happened to see my rheumatologist a week later and was told my blood pressure was high. I stopped taking the mobic a day later. I am hoping my BP return to normal.
Q. Is generic Mobic included in the category of NSAIDS possibly causing heart problems?
A. A little appreciated complication of meloxicam (as well as most other NSAIDs) is hypertension. For some, there may be only a little increase in blood pressure. For others, like Dee or I.H., the increase can be significant. Such drugs can cause fluid retention, which may in part account for the increase in blood pressure. This may be because such drugs can alter kidney function. But there may also be other cardiovascular risks.
Danish researchers identified nearly 100,000 patients over the age of 30 who had experienced a first-time heart attack sometime between 1997 and 2009. They were followed for up to 5 years after their initial heart attacks (Circulation, online, Sept 10, 2012). The scientists were especially interested in the post-heart attack use of nonsteroidal anti-inflammatory drugs
Heart attack survivors who took an NSAID-type pain reliever were at a substantially higher risk of having another heart attack or dying than those patients who did not take such drugs. In their first year following a heart attack, about one-fifth of the NSAID users died, compared to 12 percent of those not taking an NSAID-type pain reliever. Over the five years of the study, NSAID users were about twice as likely to die as non-users. They were also at increased risk for another heart attack. The investigators concluded:
“It would seem prudent to limit NSAID use among patients with cardiovascular disease and to get the message out to clinicians taking care of these patients that NSAIDs are potentially harmful, even 5 years after MI [myocardial infarction or heart attack].”
When most health care providers think about side effects associated with NSAIDs they think GI toxicity. Here is an example of such a problem:
Q. I have had arthritis for over a decade. I am on methotrexate, folic acid, and meloxicam. Just recently (2 months ago) I started to have problems with my stomach: nausea. I thought it was some kind of bug but I was not sick, sick.
I just recently had my 3rd major attack, and ended up in the emergency room. After 5 hours of tests, the diagnosis was inflammation of my esophagus. I have come to the to the conclusion that it is the medications that are making me sick.
A. NSAIDs can cause inflammation of the digestive tract. Symptoms may include nausea and bad heartburn. The distress can become unbearable and put people (like CLC) in the emergency department. Life threatening bleeding or perforated ulcers can result.
NSAID SIDE EFFECTS
• Heartburn, indigestion, abdominal pain, nausea, vomiting, constipation
• Headache, dizziness, drowsiness, disorientation
• Skin rash, sensitivity to sunlight, itching (potentially serious, so notify the MD!)
• Fluid retention, edema, high blood pressure
• Heart failure , heart attack, stroke
• Ringing in ears, hearing changes
• Visual disturbances
• Ulcers, bleeding ulcers, perforated ulcers
• Liver damage, kidney damage
• Blood disorders, anemia
• Worsening asthma symptoms
Q. I have burning in my legs. I do not have restless leg syndrome… but the burning is more noticeable at night. I do exercise and do stretches. I take meloxicam for knee pain but that has not helped. Rubs do nothing. Any other suggestions. Lorrie
A. We offer dozens of non-drug options in our book, Best Choices From The People’s Pharmacy. Herbs such as boswellia, spices such as cayenne or turmeric, supplements such as fish oil or vitamin D and foods such as grape juice with Certo, honey and vinegar, pineapple juice and tart cherries have all provided relief for some people with joint pain.
Incorporating anti-inflammatory foods into tasty recipes is another approach to managing pain relief while limiting side effects. In our book Recipes & Remedies From The People’s Pharmacy, we offer instructions for remedies like cherry spritzer (p. 62), curcumin milk (p. 60), ginger pickle (p. 50), pineapple-cherry cocktail (p. 65), virgin raisins (p. 64) or anti-inflammatory curcumin scramble (p. 103). Adding fish to the diet in dishes such as favorite fish platter (p. 106), fish tacos with radish & lime (p. 120) horseradish-crusted salmon with cranberry catsup (p. 127), pescado al cilantro (p. 137) salmon with fava bean & spring pea mash (p. 141) or spicy fresh tuna salad (p. 143) puts anti-inflammatory power into everyday meals, and adds heart benefits rather than risks.
You can find all our books and guides in The People’s Pharmacy Store. And please reconsider routine use of NSAIDs like ibuprofen, meloxicam, naproxen and diclofenac. Such drugs may ease pain a bit, but the list of side effects is scary. People who have had heart attacks are not the only ones at risk for serious, even life-threatening complications.
We would love to hear your story about the pros and cons of NSAIDs. Have they worked without problems? Have you experienced side effects? Have you tried non-drug approaches for pain relief such as acupuncture or one of the herbs we mention above?
Share your experience below and thanks.