The People's Perspective on Medicine

Can You Wreck Your Kidneys With NSAID Pain Relievers?

Do NSAIDs increase the risk for damage to the kidneys? If you try to protect your stomach from NSAID damage with a PPI, will you increase kidney damage?

Most people take their kidneys for granted…until something bad happens. When your kidneys fail, though, your life hangs in the balance. Short of dialysis or a kidney transplant, kidney failure rapidly becomes a life-threatening condition. That’s why we need to treat our kidneys with respect. NSAID pain relievers can damage kidneys and lead to kidney failure.

Taking NSAID Pain Relievers for Granted:

If you come down with a headache or your back starts to hurt, the go-to drugs of choice are nonsteroidal anti-inflammatory drugs (NSAIDs). Millions of people rely on pain relievers like celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Advil, Motrin IB), meloxicam (Mobic) and naproxen (Aleve, Naprosyn) to get through the day.

We have heard from many people in pain that they can’t manage without an NSAID. Here are just a couple of comments from readers:

Angela in Portland, Oregon relies on ibuprofen:

“Advil is my go-to pain reliever. I only use it when it’s all that will work for me. I have tried through the years to find another pain reliever. If my pain is manageable I don’t take anything. I only take it when I don’t have a choice. I don’t know what I would do without Advil.”

Michelle in Marietta, Georgia, also depends on ibuprofen:

“I’ve been using 800 Motrin for as long as it’s been available. I remember seeing a Mayo Clinic TV Special and they used it as a first try against pain. It was their go to pain reliever. It ALWAYS helps my pain. After two shoulder surgeries I took two hydrocodone pills, then only 800 Motrin. The doctor couldn’t believe I wasn’t taking the hydrocodone. Same with my knee replacement.”

Vaudi in Fayetteville, North Carolina, loves Celebrex:

“I’ve taken Celebrex for years. When I had back surgery a year ago, I had to stop Celebrex for 3 months. I could barely move. I couldn’t wait till the day when my spinal neurosurgeon said I could take Celebrex again. At last I had a spring in my step and felt great.”

NSAID Pain Relievers and Kidney Function:

Researchers have discovered that NSAIDs are not as benign as many people think. Taking a pain reliever of this sort can put your kidneys and your heart at risk.

Most recently, a large study in BMJ (May 9, 2017) confirmed earlier reports that people who take NSAIDs are at higher risk for heart attacks.  This does not come as a great surprise, since other analyses have shown a link between NSAID use and heart attacks, strokes and cardiac arrest (European Heart Journal-Cardiovascular Pharmacotherapy, April 2017).

People who suffer from arthritis often rely on an NSAID to ease their joint pain. Within a week of starting to use this type of medicine, however, biomarkers of subtle kidney damage may start to climb (Nephron, Feb. 8, 2017).

A reader’s scary story:

“A scary scenario was presented by my nephrologist after my blood levels of creatinine (an indicator of kidney function) became mildly elevated. Further tests indicated I was in the early stages of kidney disease.

“He said there is a lifetime limit to the total amount of all NSAIDs taken, after which kidney damage occurs. It is not a set number, but varies by individual.

“I had been in health care 30 years and had never heard this before. Fortunately, the injury was caught early. After stopping all NSAIDs and discontinuing Nexium (another drug that might contribute kidney disease), my creatinine and other biometrics returned to normal over several months.

“I also eliminated caffeine and was put on a different blood pressure medicine. High blood pressure eventually can cause kidney damage also. My blood pressure is doing better, in part because ibuprofen can cause fluid retention and raise blood pressure.

“The last thing I want is to be on dialysis or needing a kidney transplant. Because NSAIDs are sold over the counter and so widely used, everyone thinks they are safe. Little is mentioned about long-term adverse effects.

“Because I exceeded the total number of NSAIDs that can be taken safely, I must avoid exposure to them. That includes aspirin. I now use acetaminophen (Tylenol), and it works surprisingly well. Anyone who has been taking NSAIDs long term should ask the doctor about this, as the consequences could be life altering and expensive. (By the way, eliminating ibuprofen also improved my heartburn symptoms.)”

Other Stories About NSAID Pain Relievers:

Bob in Chapel Hill, NC, on NSAIDs and Kidney Damage

“I had to stop regular use of naproxen because of kidney damage. I was an orthopedic surgeon for 40 years. I had to stop prescribing the NSAID butazolidin because it caused leukemia and a number of other side effects. Then I became more cautious about prescribing other NSAIDs because of the risk of heart attacks,”

HW on ibuprofen:

“I have had several experiences with side effects of a severe nature. A friend took Motrin for arthritis. It led to kidney failure. That led to a kidney transplant. My friend subsequently died from complications.

“My husband took aspirin, then Motrin and other NSAIDS for arthritis. He developed a severe allergy that caused serum sickness. Just because these drugs are available over the counter does not mean they are harmless.”

The Liver Can Also Be Affected by NSAID Pain Relievers:

George on liver function:

“I have been taking NSAIDs in high doses since 1997. I was diagnosed with arthritis. Now I am told that my liver is border line. Are there any medications that I can take for pain that won’t hurt my liver that are not NSAIDs?”

The Quandary: NSAID Pain Relievers or?

Occasional use of NSAIDs for a headache, back spasm or other temporary aches and pains is probably not a problem for most people. When it comes to arthritis or other chronic inflammatory conditions, however, people may need to search for safer options. Older people may be especially vulnerable as kidney function often declines with age.

Louise has few options:

“I began to show decreased kidney function after years of taking Aleve twice a day to alleviate hip and back pain. I also have arthritic pain in both hands.

“Now I use a little Aspercreme on my hands until they get ‘warmed up.’ It helps a little.

“Tart cherry juice at bedtime helps me to sleep more soundly and seems to help my hands a bit. For hip-back my Dr. prescribed Tramadol as much as 3 times a day but I will take only once with a Tylenol which she said will boost effectiveness.

“IF ONLY someone would come up with an NSAID that includes something to protect kidney function! Not many options left for those of us wanting to avoid the heavy-hitter pain meds.”

Topical NSAIDs may not prevent problems as Errol notes:

“I quit NSAIDs several years as my doctor advised because of early stage kidney disease. After a bad knee injury a specialist put me on Voltaren Gel for 9 months. Now I am in stage 4 kidney disease. I had been stable for several years before the daily use of Voltaren Gel.”

NSAIDs and PPIs: A Double Whammy for Kidneys?

Here is a dilemma. NSAIDs are known to be irritating to the digestive tract. That may be an understatement. Some people develop bleeding ulcers after using NSAIDs.

Rochelle in Coopersburg, PA shared this story:

“I’ve been taking NSAIDS for years. Last June, I had bleeding ulcers. It was so bad I was admitted to intensive care for 5 days. I thought I was having a heart attack. I lost sooo much blood and had to have numerous blood transfusions.

“In conclusion: I would like to state: my doctor never informed me of the dangers of NSAIDS. That is no excuse. So now I am very skeptical of taking any drug.”

We can understand Rochelle’s caution. A bleeding ulcer like hers can be a life-threatening situation. Not infrequently, physicians prescribe proton pump inhibitors (PPIs) to try to counteract the nasty NSAID effect on the stomach. These are drugs like esomeprazole, lansoprazole and omeprazole. A systematic review of the medical literature concluded that PPIs can help protect against stomach ulcers when patients require NSAIDs (Current Medical Research and Opinion, Jan. 25, 2017).

An Unanswered Question:

The trouble is that PPIs, like NSAIDs, have been linked to kidney damage (Kidney International, Feb. 22, 2017). What we do not know is whether taking a PPI together with an NSAID will cause double trouble to the kidneys. As far as we can tell, that questions has not been asked and has not been answered.

Put another way, is a PPI plus an NSAID equivalent to 1+1=2 (double the risk to kidneys)? Or could this combo be equivalent to 1+1=3? Could there be synergistic damage to the kidneys from this dual action? Or is there no problem from such a combination? Someone should do some research fast to resolve what we think is an important question.

Learn more about PPIs and kidney damage at this link:

People in Pain Are Caught in the Middle:

Natural approaches such as sensible exercise, acupuncture, bromelain from pineapple, turmeric, tart cherry juice, grape juice with pectin or gelatin may offer some people relief without endangering their kidneys or their hearts.

Norma in North Carolina compares turmeric to NSAIDS:

“After a rotator cuff injury, I was in lots of pain. The NSAIDs did not help much. I started taking turmeric after a couple of friends recommended it. The improvement was amazing. I ran out and did not take it or a couple of weeks. The pain was back as badly as before. I started taking turmeric again yesterday and the improvement is again amazing!”

Karen also found the active ingredient in turmeric helpful:

“I have very painful arthritis in my thumbs and my knees. My knees need to be replaced but I just don’t want surgery.

“I saw a Curcumin post on the Peoples Pharmacy site and thought I would look into trying it… since I was in such agony.

“Well, I can say that after 3 weeks, I am amazed at how my pain is minimized. I can use my thumbs again and it has helped my knees immensely. I was very skeptical because I have no cartilage in my knees anymore. Only bone on bone.

“I swear by curcumin and will continue with it because of the astonishing results I have had with it. It has anti-inflammatory properties and I am amazed at how well it works. I take the capsules with food to avoid stomach upset. I would advise anyone who has unbearable arthritic pain to give this a try. I am even thinking of trying to get off of Celebrex, and just use the curcumin instead. I don’t like to take prescription painkillers as they make me too groggy and sleepy.

“Thank you Peoples Pharmacy for providing such a wonderful site where people can find and try natural remedies, on their own, eliminating prescription drugs, with all their side effects and contraindications. ♥”

A word of caution from The People’s Pharmacy. Some people are allergic to turmeric and its active ingredient curcumin. This can show up as a bad itchy rash. Others get digestive tract upset. Anyone on a blood thinner should not take this supplement. We have heard from readers that warfarin and turmeric may lead to an increased risk of bleeding (high INR levels).

We have provided much more information about the pros and cons of non-drug approaches for arthritis and joint pain in our book, Quick & Handy Home Remedies.

Share your own experience with NSAIDs and/or PPIs in the comment section 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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Well, I’ll add a scary story. My cousin who is young , healthy, does not smoke and drinks occasionally was working out and pulled a muscle. He grabbed his bottle of Advil and took it as prescribed, but for almost three weeks straight (past the 10 day recommended time frame).

He suddenly wasn’t feeling well and then starting vomiting. When he got to the hospital, he was in complete, acute kidney FAILURE. These are powerful little OTC pills. Take them sparingly. Look into natural alternatives for pain. They are out there (and currently Legal) and exist, I just don’t feel it is my place to name specifics. I’ll just hint that one of them starts with a “K”.

Wondering if when you stop using Nsaids, does the kidney damage get better, or should I ask CAN it get better?

So, I am not dead yet, after reducing unknowingly, the function of my poor innocent kidneys. I warn all of you,insidious and transient signs came and went unheeded over the years. Tests included ultra sounds, urine samples, blood tests, poking and prodding. Never once did any doctor, and there were many, suggest to lay off the NSAIDs. The condition was mostly treated by them effectively, more or less. It was advanced spinal stenosis, with collapse of cervical spinal discs,one imbedded in the cord. Frankly, I have confidence I stopped in the nick of time after losing over half of my kidney function and retaining water weight that responds to a loop diuretic by dropping 8 one night. Fear not pain. Fear doctors.They are too busy and over-trained in most areas, leading to some big boo boo’s.

I’ve read everything I can find on NSAIDs but nowhere is it stated how much is too much. Is 2 – 3 Aleve taken a week, w/food, too much?

Why don’t we have the stats? In other words, just how many have died taking NSAIDs? AND, how many were taking more than what was told for them to take? Seems to me there is a lot of information that is being held back.

Aspirin has been taken by millions of people for centuries, and I’m one of them, BUT I don’t over do them. WHERE are the stats for Aspirin that PROVES it will KILL you?

With the facts that prove it why isn’t Aspirin taken off the market? I’ll tell you why. Aspirin, when taken as is told on each pill bottle, you don’t have to worry. I’ve been taking them for decades without ANY type of negative results. OH, and there aren’t any stats….PERIOD!!!!!!

Aspirin isn’t technically an NSAID. Some say it is, others say it isn’t. I don’t know, but Aspirin used to work fine for people before Advil, Motrin and Tylenol hit the shelves. Tylenol works well for me. I use Voltarin Gel, and I also have Celebrex. Now I am scared to use either one. Both are NSAIDS. I was told to space them, and that was it!

I was excited to try liquid turmeric drops for arthritis which has developed over the past year, but after reading the label, I saw “do not take if you have a history of kidney stones.” Further reading indicates turmeric is high in oxalate and should be avoided in people like me who have stones. So many people have this problem that it would be worth pointing out that they can’t take turmeric.

I suffered kidney damage from extended use of ibuprofen. Uva ursi tea daily for a year helped restore normal function

I would like to know whether aspirin has the same problems as other NSAIDs. I’ve had doctors tell me that aspirin is an NSAID with the same potentially dangerous side effects as any other NSAID. My doctor told me that aspirin can cause holes in the stomach, but I wonder if it is worse than other NSAIDs? I have read some articles that suggest aspirin does not have the same magnitude of problems as other NSAIDs. It seems difficult to get a straight answer. Perhaps no one funds research on aspirin because there is no money to be made in marketing it.

I would like to see drug companies come up with a Darvocet replacement. It was my ultimate pain reliever. After a major surgery they tried to send me home with a Oxycontin Rx. I declined it and opted for Darvocet post-surgery which worked fine. Not for regular use of course.

I’ve found having acupuncture treatments to be very helpful for my back pain.

I took Aleve twice a day for a little over a year due back and hip pain. Got off after slight kidney damage was detected. Since then after four hip surgeries I have taken arthritis strength Tylenol and several times a week take one Tramadol which works well. I do have to take Omprazole daily which I have taken ever since it came on the market. Do I have a triple whammy going for me? My gastroenterologist, orthopedic surgeon, infectious disease specialist and PCP are all aware and see no problems. Maybe I’m just too wary of anything now!

Having stopped taking prescription NSAIDs some time back (I took them for years for arthritis) because every one of them upset my stomach, I have been systematically trying every natural, homeopathic, and other suggestion (and yes, I have the People’s Pharmacy printout) for arthritis pain and stiffness.

For me, nothing — nothing — helps.

I am waiting, stiff, painful, and walking with a cane, for someone to come up with anything that actually works for me…without side effects or gastrointestinal problems.

Maybe South Carolina will eventually legalize medical marijuana. I’d be willing to try.

P.S. re: Back pain… occasional lumbar epidural is a life saver when getting up and down becomes a real factor. Find a good Physical Medicine M.D.

A recent study I heard about on the morning news said Tylenol was the least effective treatment for back pain. There is such panic about opioids I think this may have some influence about other drugs. I do find Tylenol (acetaminophen if you don’t want brands mentioned) ineffective. I have fought lumbar pain for more than 50 years.

Chiropractic helped for many many of those years, until the stenosis, disc bulges, and a vertebrae pushed forward became a real problem. An unexpected fall caused thoracic area fracture just as I had been scheduling lumbar surgery, requiring 2 surgeries instead of one. My age was a factor by this time and surgeon resisted the surgery and so did I. If you are one of those people who don’t have an addictive gene (and how does the dr. know) I think you can take a low dose of an opioid at the worst times.

I can take one 5-325 Lortab and get some relief once in awhile. I am not tempted to keep taking it. A prescription for 60 lasts for a year. It’s the people who tend to be addictive who get in trouble. I wouldn’t dream of taking Fentanyl or heroin ever. I will say that back pain has a huge effect on your lifestyle. Do you exercise ? is a really dumb question. When there is a structural problem it fixes nothing but mild muscle pain perhaps. I am trying some cherry juice now because there is more arthritis all the time.

We get the message. People’s Pharmacy is on a campaign to ban NSAIDS from the market except with a prescription. If it kills, then it should be in a class with opiods and other pain killers.

Hi LouisJanet,

We’re not on a campaign to ban NSAIDs from the market. We recognize that 1) they are helpful for many people and allow people in pain to function and 2) people want access to these drugs without restrictions.

We would like Americans to better understand the risks of these over-the-counter pain relievers. Many people assume that if the FDA approves something for OTC sale then it must be safe. For many, safe means without serious side effects. Clearly, NSAIDs can potentially cause some pretty serious adverse reactions.

As we have pointed out on several occasions, if a natural product (an herb, spice or dietary supplement) was linked to heart attacks, strokes, atrial fibrillation, hypertension, kidney or liver damage, the FDA would ban it instantly and the media would turn it into a huge big deal, as in “how did that product ever get into health food stores in the first place.” Just because NSAIDs like Advil and Aleve are advertised on TV does not make them safe for everyone.

We would actually favor a model we saw in Australia, where you can buy smaller quantities of NSAIDs (rather than bottles with hundreds of pills). We also think people should consult their pharmacist to access larger amounts. This “behind the counter” sale seems like a decent model. It applies to drugs here that contain pseudoephedrine (Sudafed). Why not encourage pharmacists to consult patients about the pros and cons of NSAIDs? That way people might have a more realistic idea about the benefits and risks of these widely used drugs.

Finally, we would like to see drug companies come up with better pain relievers. Right most people rely on either acetaminophen (Tylenol), NSAIDs or a prescription for opioids. None of these options is ideal. We need much more effective analgesics with substantially fewer risks.

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