Q. You have pointed out the dangers of NSAIDs but offer absolutely no suggestion about the effectiveness of going back to aspirin, the drug of choice for many years.

What does long-term use of aspirin do, other than possibly make you bleed more easily? I would love a conversation on this topic.

 A. You have raised a fascinating question. Aspirin has been available for more than 100 years. One of the first non-aspirin NSAIDs (nonsteroidal anti-inflammatory drugs) was indomethacin (Indocin), initially marketed in the U.S. in 1965. Since then we have seen a lot of similar drugs including:

  • Celecoxib (Celebrex)
  • Diclofenac (Cataflam, Voltaren)
  • Etodolac (Lodine)
  • Flurbiprofen (Ansaid)
  • Ibuprofen (Advil, Motrin, etc.)
  • Ketoprofen (Orudis)
  • Meloxicam (Mobic)
  • Nabumetone (Relafen)
  • Naproxen (Aleve, Anaprox, Naprosyn)
  • Piroxicam (Feldene)
  • Sulindac (Clinoril)

The name “nonsteroidal” anti-inflammatory drugs implies that such medications are safer than steroids such as cortisone and prednisone. Doctors were burned by steroids during the 1950s. Initially hailed as miracles for arthritis (and other inflammatory disorders), such corticosteroids were prescribed promiscuously for a range of conditions. After a decade or two, though, it became apparent that there was a high price to pay for pain relief with such medications: cataracts, glaucoma, weight gain, high blood pressure, muscle weakness, ulcers, irregular heart rhythms, diabetes and osteoporosis.

That’s why there was such a love affair with NSAIDs. Doctors thought the drugs were relatively safe, except for the occasional case of heartburn. In the worst case, a patient might develop ulcers. The FDA thought NSAIDs were so safe they allowed both ibuprofen and naproxen to go over the counter in lower doses than doctors were prescribing. On any given day, an estimated 20 million Americans swallow one of the NSAIDs listed above to ease a headache, soothe a sore joint or relieve the inflammation of tendonitis, bursitis or back pain.

But here’s the rub. There is no evidence that any of the NSAIDs on the market have proven themselves superior to aspirin when it comes to pain relief or anti-inflammatory activity. Nevertheless, both physicians and patients perceive these drugs as stronger pain relievers than aspirin. There is also the belief that aspirin is tougher on the tummy. People seem to think that NSAIDs are less likely to cause ulcers, but there is a paucity of data in this regard. Both NSAIDs and aspirin can be quite irritating to the digestive tract and can cause serious complications including life-threatening bleeding ulcers.

Here is where it gets interesting. Aspirin has some fascinating advantages. Not only does it appear to reduce the likelihood of blood clots that can cause heart attacks and strokes, it also seems to have anti-cancer benefits.

NSAIDs, on the other hand, have some serious cardiovascular complications. A study this spring in The Lancet (May 30, 2013) reveals that NSAIDs such as ibuprofen or diclofenac increase the risk of heart attacks. They may be comparable to the now discredited drug Vioxx (rofecoxib) when taken in relatively high doses for long periods of time. Celebrex, a highly advertised drug in the same category as VIoxx, also increases the risk of a heart attack.

Naproxen seems less dangerous to the heart than other NSAIDs, but it appears to be just as toxic to the digestive tract. All NSAIDs can raise blood pressure and may increase the risk for congestive heart failure and atrial fibrillation. This heart rhythm disturbance can lead to blood clots that can escape the heart and cause a stroke.

Here are some other NSAID-related complications:

      NSAID SIDE EFFECTS

  • Heartburn, indigestion, abdominal pain, nausea, vomiting, constipation
, diarrhea

  • 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

 That is why if we were banished to a desert island and could only take one pain reliever, we’d choose aspirin. Not only is it a gold standard for pain relief, it eases inflammation, lowers a fever, reduces the risk for heart attacks and strokes and may be one of the most powerful anti-cancer drugs ever discovered. Of course no one should ever take aspirin for long periods of time without medical supervision. Like all NSAIDs aspirin can cause ulcers and it may also interact with certain prescription drugs. It deserves respect for both its benefits and its risks.

Here is what readers have to say about their experiences with NSAIDS:

“I hate it that I started having pounding fast heartbeat after being on diclofenac several days. My doctors (both family and cardiology) told me there was no connection between diclofenac and heart rhythm problems. The cardio did a heart monitor test, and found my heart was skipping beats and running as fast as 400 beats per minute. Both doctors assured me it was fine to continue taking the high doses of diclofenac, even though I knew better.” C.A.


“I never had a blood pressure problem or any side effects as a result of ibuprofen until last month. My pressure climbed to 220/110 with headache and dizziness during the night. I had to seek emergency care.

“My blood pressure improved until last night when I again took ibuprofen for back discomfort during the night. When I woke this morning my BP had climbed to 135/97 with headache and dizziness and has stayed somewhat elevated even though I took amlodipine (Norvasc). It seems clear that I have developed a reaction to ibuprofen. I had not taken any since the first incident until last night.” Anne


“I am a gardener and take ibuprofen occasionally for back pain. Mostly, though, I try to think about how I am working and avoid stupid maneuvers.

“My main question is what about the impact of an anti-inflammatory diet? I have read about ginger tea, but I have not memorized the items I might be eating that can cause inflammation, nor the ones that reduce it. I’d like to know more about foods/drinks to reduce inflammation. I know that the whole inflammation issue also impacts cardio-vascular as well as joints and many other parts of the body.” Bruce


Bruce, you are absolutely right that diet can affect inflammation. Cutting back on sugar and refined carbohydrates is the first step. Trans fats must be eliminated completely and we would encourage you to reduce omega 6 fatty acids found in corn oil, safflower oil and other popular vegetable oils.

Foods and drinks to embrace include pomegranate, green tea, pineapple, curry, garlic, almonds and broccoli in addition to ginger. You will be glad to know that cherries, walnuts and grape juice also have anti-inflammatory activity. You can learn more about our favorite remedies (Certo and grape juice, gin-soaked raisins, gelatin, honey and vinegar, cayenne pepper and fish oil) in our book, The People’s Pharmacy Quick & Handy Home Remedies. We also include some wonderful anti-inflammatory recipes (Curcumin scramble, curried sweet potato fries, curry soup, golden milk with curcumin, cherry spritzer, Joe’s Brain Boosting Smoothie and spicy fresh tuna salad) in our book, Recipes & Remedies from The People’s Pharmacy. You can get a 50% discount on Recipes & Remedies when you buy both

Join Over 54,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. joe h
    Reply

    Is aspirin a NSAID?

  2. Carol
    Reply

    Please answer questions #2 and 4 above – this is important information that has not been communicated to us in this article. Thanks!

  3. Aspirin for Offspring and / or safety related to aspirin and alcohol consumption...
    Reply

    OK, I agree…. “if we were banished to a desert island and could only take one pain reliever, we’d choose aspirin.”
    I have what I believe are two important questions regarding aspirin use:
    1. Can you also please talk about use of aspirin by our offspring. My sons are now 28 and 31 years old … I understand children should not be given aspirin, but I have enjoyed small, rare use of aspirin all my life. It simply works best for me. At what age can I let my sons use aspirin as well?
    2. Also, please comment on the use of aspirin and alcohol. Are there dangers?
    Thank you for your very informative reporting.
    People’s Pharmacy response: Once young adults are into their 20s (by 22 or 23) the risk of Reye’s is so low it doesn’t interfere with them taking aspirin.
    Aspirin and alcohol together are especially hard on the digestive tract. Not recommended.

  4. nb
    Reply

    After a long fight with many illnesses my husband passed away recently. He had several doctors – one for each illness. Each one prescribed many prescriptions. While I worried about all the side effects, my husband trusted the doctors. Since his passing I have used the internet more to check. Perhaps he was meant to die when he did at 80 but I can’t help but wonder if his doctors had paid more attention to the list of medications he was taking and gave them at each visit, that his last year or two at least might have been more comfortable.
    People’s Pharmacy response: We are so sorry to learn of your husband’s death. You are right that patients need to be paying attention to the big picture, because the doctors don’t usually know what the others have prescribed.

  5. SalW
    Reply

    Last year I had a terrible reaction to the generic NSAID etodolac while visiting my daughter out of town. Just before leaving on my trip, my doctor prescribed me to take 500 mg twice a day for one week and then reduce to 500 mg a day for an old torn lateral meniscus injury.
    On day seven and late at night, I had a horrible measles-like rash over my entire body, welts on the back of my neck, beet red and itching skin into my scalp, and a very rapid heart beat. I guess I should consider myself lucky that I did not have any more serious or lasting problems. Unfortunately, I am now very sensitive to any NSAID that I take, so I avoid them entirely.
    My medication was made by Eon Labs out of New York who pride themselves with this statement, “The company focuses on drugs that are difficult to make and it strives to introduce the generic equivalent of brand name drugs on the first day patent protection expires.”
    Perhaps this is one of the problems with all generics in that there is too big a rush to corner the market on a certain drug without verifying its quality.
    I am 74 and this is one drug that is listed on the Beers List as a potentially inappropriate medication to use in older adults (and my doctor is a geriatrist). Thank you for introducing me to the Beers List (my Target pharmacist thought he had heard of it)!
    In any event, I reported my reaction to the FDA MedWatch. I wonder if my doctor took the time to make a report? Please continue to keep us informed on these very important medical topics so vital to our survival!

  6. JAS
    Reply

    Can you further define what is considered “high doses for a long period of time…” ??? Can we assume that “high doses” is equal to above the maximum dose as per the manufacturing label? And what is “long period of time” roughly speaking? Does this mean for more than 2 weeks? 4 weeks? 3 months or more? Especially as “time” is relative to all of us, especially those of us in pain. Thank you for all you do! I get more helpful info from your website than I do from my own doctors…

  7. Jim V
    Reply

    You seem to have a blind spot on the dangers of aspirin. You ignore any published study on the dangers of aspirin. For example the 2012 study published in the Journal of the American Medical Association on the serious risk aspirin poses for major stomach and brain bleeding. Personally I take Advil simply because it relieves my pain better than aspirin. Advil has potential side effects but so does aspirin.
    People’s Pharmacy response: Every drug has dangers, and aspirin is no exception. We also worry about it raising the risk for wet macular degeneration. We think it makes sense for people to know the risks that they are running with each drug they take.

  8. Grace
    Reply

    Thank you for your article on aspirin vs NSAIDs. However in reading, I can’t locate your response to the initial question… What does long-term use of aspirin do, other than possibly make you bleed more easily? Please address the possible dangers of aspirin use such as age related macular degeneration. Thanks.

  9. t.n.
    Reply

    Under Doctors supervision, I take 325 mg aspirin as a blood thinner. I use the SAFETY COATED (not ooated) type to mitigate potential stomach problems. 3-4 years with no negative effects.

What Do You Think?

Share your thoughts with others, but be mindful of protecting your own and others' privacy. Not all comments will be posted. Advice from web visitors is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. In posting a comment, you agree to our commenting policy and website terms and conditions.