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At What Age Do NSAID Pain Relievers Become Deadly?

It took the FDA 50 years to realize NSAID pain relievers cause heart attacks and strokes. The FDA just strengthened its warning. What will you do now?

Q. I heard the FDA issued a stronger warning about cardiac risks associated with NSAID pain relievers. Is this correlated with age?

If older persons are at greater risk of heart attack and stroke from NSAIDs, at what age does the danger increase? In persons older than 50? Older than 65?

A. FDA’s announcement in July, 2015, did not specify any age at which the hazard of heart attacks and strokes increases. The agency did say that the risk from NSAID pain relievers rises within the first weeks of taking a drug such as ibuprofen (Advil, Motrin IB), naproxen (Aleve), diclofenac (Cataflam, Voltaren) or celecoxib (Celebrex). It is higher for people who have already had a heart attack or stroke and for those with risk factors for these conditions.

In the FDA’s Own Words:

Here are a few select quotes from the FDA’s Drug Safety Communication:

“The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke…

“Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech…the prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
  • The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.

Patients and health care professionals should remain alert for heart-related side effects the entire time that NSAIDs are being taken.”

Decades Without a Warning:

Do you not find it somewhat disconcerting that it took the FDA 50 years to discover and then warn the American public that NSAID pain relievers could cause heart attacks and strokes? As the FDA itself points out: “either of which can lead to death.” And yet the FDA still believes that such drugs are so safe they should be available over the counter at any pharmacy, grocery store or gas station. It is hardly surprising that the American public finds it hard to take warnings of heart attacks, strokes and death seriously when they or their children can by such drugs at any convenience store.

The Worst Double Bind Ever

People with chronic joint pain are now faced with a very difficult dilemma. How can they get relief without increasing their chance of a cardiovascular catastrophe? The FDA itself states that NSAIDs like ibuprofen, naproxen, diclofenac and celecoxib can increase the risk of heart attacks and strokes “as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.”

People with arthritis are faced with years and years of chronic pain and yet they have just been told by the FDA that the longer they use NSAID pain relievers the greater the likelihood they might experience a deadly vascular complication. If they are under a doctor’s care there is a decent chance that they will be getting a prescription for higher-dose NSAID pain relievers than found in products available over the counter. Remember, the higher the dose the greater the risk!

What Else Can You Do?

A number of non-drug approaches to controlling inflammation might be worth consideration. Some people get relief from herbs such as boswellia or turmeric, while others include foods such as pineapple or tart cherries in their diets.

Readers Stories:

Alton’s Experience:

“Bromelain is the enzyme in fresh pineapple. Bromelain is available in a capsule form and you can avoid the calories and sugar that you get in the fresh fruit. It is inexpensive and it works for me.

“There are lots of good anti-inflammatory natural supplements to block the Cox-1 & Cox-2 enzymes that lead to inflammation. Just search and listen to your body and it will always tell you what works for you and what does not.

“I am 84 and was told 15 years ago that I was ready for a shoulder replacement. Then 8 years ago I was told that my right hip was gone and I was ready for a hip replacement. Then I was told that both knees would be right behind that.

“I sought a second opinion on the shoulder replacement and an honest orthopedic surgeon suggested that as long as I could control the pain I should avoid the surgery. His reasoning was I should suffer some pain before surgery because he could stop the pain but unless I did physical therapy after that his work was wasted. I understood that and have taken his advice.

“I try to research the natural remedies as much as possible and my lab numbers are perfect for my age. Good care is available if you are willing to do your own research and learn to listen to your body. It will always tell you what’s right. Since all of our bodies are different you may have to try different things. My theory is if I don’t have a good response at first, give it 3 weeks before giving up.

“Consider a good Ginger Complex, Turmeric/Curcumin, Fish Oil, Boswellia, and many other remedies in the People’s Pharmacy publications. Maybe you can avoid all pain blocking drugs as I have.”

Joe’s Story:

“I was led to curcumin and a blend of it with boswellia which is sold as capsules in drug stores by an acupuncture doctor with a masters degree in Chinese Medicine. Boswellia is major anti-inflammatory. This has kept my pain levels on a bad ankle to hardly noticeable…and it also dropped my blood pressure into a great range for the past 4 years. No doctors can explain it.”

Fred on Gin-Soaked Raisins:

“I have been doing gin-soaked raisins for two years. (They MUST be golden raisins and soaked in gin for THREE days…two days doesn’t work… I’ve tried.)

“My mom – generously – gave me horrible osteoarthritis in my fingers (all those knobby finger joints and they hurt). I’m waiting for a cure as each little finger joint gets bigger and bigger. BUT, the gin-soaked raisin thing is for real. Tried, true, tested for two years on my own fingers. I hate when I don’t have 9 (or 10 or1…who’s watching). I eat golden raisins soaked in gin every morning before breakfast (trust me, it’s not psycho-somatic. My fingers TOTALLY know the difference.)

“I have told so many people who ask, “Will they work on my hips? My knees?” I have no idea. I DO know that my fingers are not getting any better… but the raisins take most of the ache away. You will not feel the gin… the raisins somehow turn into an anti-pain thing. Golden raisins… gin…. soaking for 3 days … my fingers feel better.”

You will learn about all such options in our Guide to Alternatives for Arthritis or Quick & Handy Home Remedies. Share your own story about NSAID pain relievers or home remedies for arthritis below. And please vote on this article at the top of the page.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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