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). According to our calculations (based on the Medical Expenditure Panel Survey), the most prescribed NSAIDs are ibuprofen (roughly 12 million people annually), naproxen (5.8 million people taking 14.2 million prescriptions annually ) and meloxicam (5.6 million people taking 21.6 million prescriptions annually).
NSAID Popularity Waxes and Wanes:
Over the years we have watched as one NSAID after another became popular and then lost its luster as the newest one was aggressively marketed to physicians. Turn back the clock to the mid 1960s and indomethacin (Indocin) was king. It was followed by sulindac (Clinoril). Then piroxicam (Feldene) captured the limelight. These days meloxicam appears to be highly popular with physicians.
How good are NSAIDs against the pain of arthritis? We had the opportunity to interview Steve Nissen, MD (February 4, 2017). He is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. Dr. Nissen was the lead author on a huge NSAID trial involving celecoxib, ibuprofen and naproxen. It was called the Precision Trial.
We suggested to Dr. Nissen that maybe NSAIDs were not as good at relieving pain as we might have been led to believe:
He confided to us that:
“They’re not as good. In fact we measured pain relief in the study and we measured it on a 100 point scale and the actual reduction in pain was about 13 points out of a hundred. So call it 13% if you will. It’s very modest…”
That is a surprisingly candid response. We suspect that most physicians and patients expect far greater benefit than 13%.
Despite their popularity, such drugs have the potential to do a significant amount of harm. Here are just some of the comments that we have received about meloxicam (Mobic) in particular.
Dee shared this story:
“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.”
This from I.H.:
“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 will return to normal.”
Another visitor asked:
“Is generic Mobic included in the category of NSAIDS possibly causing heart problems?”
People’s Pharmacy answer: Yes.
Beverly in Virginia experienced side effects that persisted:
“I started on Mobic three years ago for severe arthritis in my right hand thumb joint. Around six months ago I went to my GP complaining of strange symptoms such as ringing in my right ear along with painful pressure. Pounding headaches. Hoarse throat. Painful dry choking cough. Constant sleepiness. Upper chest burning with pain along with painful ‘belching’ (almost like dry-heaving). And soaring blood pressure.
“After six months of sub-standard care, I changed GPs. I am so glad I did! Immediately I was taken off Mobic! But by now water and herbal tea were the only things I could get down without pain. The dizziness from my ear and head pressure had worsened to the point that I was temporarily not driving. I could barely stay awake during the day.
“Right now I am scheduled for an upper barium dye contrast test so he can see how the esophagus reacts. I’m also having a brain scan to see about the headaches, ear pressure and noise and constant fatigue. Then I will have an endoscopy! The only common denominator to all these problems is Mobic. I am frightened that all this damage might be permanent. I am angry that my first GP never even tried to look for the source of my symptoms and never monitored me during my three years on Mobic. I pray this nightmare will be over soon!”
High Blood Pressure
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.
Repeat Heart Attacks
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:
“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.” CLC
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, 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
Other Ways to Relieve Pain
“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
We offer dozens of non-drug options in our newly revised and expanded Guide to Alternatives for Arthritis. 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. The new guide is around 50 pages long and contains practical tips along with video links that will demo the preparation of our favorite home remedies.
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.
Please use NSAIDs like ibuprofen, meloxicam, naproxen and diclofenac cautiously. 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 in our new guide?
Share your experience with meloxicam or Mobic below and thanks.