Cutting Through the NSAID Confusion

Cutting Through the NSAID Confusion

News about the FDA warning that NSAIDs (nonsteroidal anti-inflammatory drugs) can be heart risky has made lots of you worried about taking those pain-relieving pills for everything from a once-in-awhile headache or sore muscles to chronic arthritis pain. Here’s the detailed scoop you’ve been asking for, so you can stay safe and pain-free.

It’s true. NSAIDs -- those ache-reducing drugs that include over-the-counter ibuprofen and naproxen as well as prescription versions like celecoxib (Celebrex), oxaprozin (Daypro) and diclofenac (Cataflam, Voltaren etc.) -- can increase your risk for heart attack, stroke or heart failure. Studies have actually been shining a light on this serious side effect for about 15 years now.

There seem to be two reasons why these meds are risky: First, they reduce painful inflammation by inhibiting an enzyme called COX-2. But COX-2 also is beneficial; it relaxes arteries and encourages blood platelets not to form clots. So dialing down this enzyme’s activities can increase blood pressure and the risk for clots. Second, NSAIDs interfere with the heart-and brain-protecting action of daily, low-dose aspirin. NASIDs block aspirin’s ability to reduce the risk of blood clots that can lead to heart attacks and strokes.

We’ll know more about safest NSAID doses when results from a study of 24,000 people taking NSAIDs regularly are released next year. In the meantime, these strategies can keep you comfortable while keeping risks low:

Try aspirin. If your doctor says you’re not at risk for gastrointestinal bleeding or ulcers, try taking the dose recommended on the package with a half-glass of warm water before and after. (Warm water helps dissolve the pills faster, decreasing chances for damage to your stomach lining and intestines.) That’s how we take daily, low-dose aspirin (two 81mg aspirin, a total of 162mg per day). Having your aspirin with a meal may also help.

Studies show that if you’re at high risk, low-dose aspirin can cut your chances for a first heart attack by at least 22 percent and at the same time lower risk for blood-clot triggered strokes (the most common kind) and for the leg pain associated with peripheral artery disease. Aspirin also reduces - by up to 40 percent - the risk and severity of cancer of the bladder, colon, breast, esophagus, kidneys, lungs, pancreas, prostate and stomach. If you need to take another nonsteroidal anti-inflammatory pain reliever (like ibuprofen), do it 24 hours before or after your aspirin.

Think low-dose/shortest time. If you really need an NSAID, go with the smallest dose for the shortest period of time. We think that means the occasional dose may be OK for most people…but read on for an important warning.

At risk for a heart attack or stroke? Think twice about NSAIDs. The FDA says risk for problems is higher in people who already have heart disease, or have high LDL cholesterol, high blood pressure or other issues like diabetes. It’s also risky if you have already had a cardiovascular ‘event’ like a heart attack. In one study, heart-attack survivors who took NSAIDs were more likely to die in the next year than those who didn’t.

Find ways to ease arthritis pain, headaches and sore muscles without taking NSAIDs. Research shows physical activity can slash aches and prevent worsening problems for many people. So try the Arthritis Foundation’s “Arthritis Self Help” program (at, proven to reduce pain by 20 percent. Practice stress reduction with mindful meditation -- it really does work. Rely on warm Epsom salt baths for sore muscles. Eat an anti-inflammatory diet that includes lots of fruits, veggies and good fats.

Try a topical pain-reliever or acupuncture. Creams and gels that contain capsaicin (derived from red peppers) can reduce joint pain 40 percent if used regularly. If you need more help, ask your doc about NSAID creams or gels, which ease pain for about 60 percent of those who try them. Acupuncture works for some of these conditions as well.

Medically reviewed in January 2020.

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