9 Times
Ibuprofen Won’t Work—and Could Be Dangerous ( for clear reading it is reapited )
Joanne
Chen
Athletes call it “Vitamin I.” Women with
menstrual cramps depend upon it. But scientists are beginning to realize that
ibuprofen may not be as benign as we thought. Here’s when you should just say
no.
If you have heart disease
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While low-dose aspirin
can help prevent heart attack, other painkillers in the nonsteroidal
anti-inflammatory drug family (NSAIDs)—which include ibuprofen—have been
associated with an increase in the chance for heart attack or
stroke.
A 2017 British Medical Journal study reported
a 20 to 50 percent elevated risk of heart attack among people who used NSAIDs
daily for a week or more. The increased risk associated with ibuprofen could be
as high as 75 percent. The greatest danger occurred within the first month of
NSAID use and at high doses.
Those with heart
disease or at risk for heart disease should be especially mindful of these
findings, though the elevated risk affects everyone, says Catherine Sherwin,
PhD, chair of the clinical pharmacology track at the American Association of
Pharmaceutical Scientists PharmSci 360 Meeting. If you’re taking blood-pressure
medication, be especially cautious—NSAIDs could make them less effective.
Talk to your doctor about alternative
medications to treat your pain, whether it’s, say, a Tylenol for a headache or
physical therapy for back pain. Find out more about how ibuprofen can increase your risk for heart attacks.
If you’re on anti-clotting meds
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Anticoagulants (such as Warfarin) and
antiplatelets (such as Plavix) prevent blood from clotting easily.
Anticoagulants are typically prescribed for people at high risk for stroke
(such as those with atrial fibrillation or artificial heart valves), or those
who’ve suffered from a pulmonary embolism; antiplatelets are usually advised
for those who’ve already suffered a heart attack or stroke, as a way to prevent
it from happening again. The problem? “The combination of these drugs with
ibuprofen could significantly increase the risk for bleeding complications,”
says David Craig, PharmD, pharmacist lead at the Moffitt Cancer Center, and
American Pain Society E-News editor. So instead, discuss other options with
your doctor; for instance, you may consider celecoxib, which may be less likely
to induce bleeding.
If you have gastrointestinal issues
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NSAIDs not only irritate the lining of the
stomach and intestines, they can reduce blood flow in the area and impair its
ability to fix itself. So if you already have digestive issues, such as
inflammatory bowel disease, you probably wouldn’t want to pop an Advil or
Motrin or any other NSAID. They’re not effective for pain associated with IBD
and, in the cases where you’re suffering from other achy issues, you’re better
off talking to your doctor about alternative treatments. Acetaminophen may be a
good option for headache pain, for instance. According to Venkata Yellepeddi,
PhD, adjunct assistant professor in pharmaceutical chemistry the University of
Utah, if you have trouble with menstrual cramping, birth control pills could
help. Don’t miss how your ibuprofen habit could be keeping you weak.
If you’re pregnant
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NSAIDs have been found to harm the
fetus—raising the risk of miscarriage in early pregnancy and heart defects in
the third trimester. What’s more, a recent Human Reproduction study on fetal tissue suggests
an association between women who have taken ibuprofen during their first
trimester with a subsequent reduction in egg development in the fetal
ovaries—which could compromise a daughter’s future fertility. Ibuprofen is also
not a good idea during labor and delivery since it could lead to prolonged
bleeding. If you’re in need of pain relief at some point over the course of
your pregnancy, check with your doctor.
If you have a UTI
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A few years ago, researchers reported that
NSAIDs may be useful for treating urinary tract infections. Besides possibly
soothing pain, they may reduce recurrence, as well as help curb the use of
antibiotics—a good thing, given the threat of antibiotic resistance. The hitch?
NSAIDs might actually not do any of that: “There’s conflicting
evidence in the literature on the effectiveness of ibuprofen, and it’s
dependent on the antibiotic with which it’s compared,” says Sherwin. In
addition, a recent PLOS Medicine study reports
that women who took ibuprofen only to treat a UTI took an average of three days
longer to heal than those on antibiotics, and they had a slightly higher risk
of complications. Find out the best OTC pain relievers for every type of ache.
If you have arthritis
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Arthritis sufferers
have long taken ibuprofen and other NSAIDs for arthritis pain. But because of
its negative effects on the gastrointestinal and cardiovascular system, certain
patients—particularly if they had a history of stomach or heart issues—should
probably think twice before popping an ibuprofen. A 2017 European Heart
Journal paper compared
the blood pressure effects of different types of NSAIDs (ibuprofen, naproxen,
and celecoxib) on osteoarthritis and rheumatoid arthritis patients. The
verdict? All the drugs were associated with an increased risk of
hypertension—and ibuprofen had the worst impact, with 23.2 percent of patients
on the drug going from normal to hypertensive, compared to 19 percent for
naproxen and 10.3 percent for celecoxib.
What’s more, for those with rheumatoid
arthritis, NSAIDs are not able to control the
inflammation enough to prevent further joint damage. What
can? Disease-modifying anti-rheumatic drugs (DMARDs) as well as
biologic-response modifiers (or simply, biologics). Non-drug options—like
exercise, physical therapy, and warm baths—can also offer some pain
relief.
If you enjoy wine or cocktails
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We’ve been there. You’ve got plans to meet a
friend for drinks, and you’ve got an awful headache. But think twice before
popping an Advil just before running out for that cocktail. Alcohol can
irritate the stomach and so can NSAIDs. Put the two together, and you just
compounded your chances damaging your tummy. “Alcohol should be avoided due to
increased risk of stomach ulcers,” says Sherwin, who is also division chief of
pediatric clinical pharmacology at University of Utah School of Medicine.
Making matters worse, the one-two punch can also up your risk of liver damage.
If you’re about to tackle a really tough workout
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Die-hard athletes
sometimes take an Advil before, say, a long run. But that may be, at best, a
waste of time and potentially harmful. “Painkillers are a chemical Band-Aid,”
says Lillie Rosenthal, DO, a medical advisory
board member at MedShadow Foundation, a nonprofit group
that educates patients on long-term drug safety and efficacy. “You have to
listen to the body and figure out the cause,” says Dr. Rosenthal, who specializes
in physical medicine and rehabilitation. With ibuprofen muting the pain, you
may not know if you’re overexerting yourself or it may prevent you from slowing
down or getting help when it’s needed.
What’s more, if you’re
working out extremely hard—as in ultramarathon hard—taking ibuprofen can
exacerbate the kidney damage that’s sparked by rigorous exercise. In a 2017BMJ Emergency Medicine paper, ultramarathoners who took
ibuprofen over the course of 50 miles (for a total of 1200 mg), were about 18
percent more likely to experience acute kidney injury than those who took a
placebo. Extreme workouts tax the kidneys by drawing blood to the muscles for a
prolonged period of time; taking ibuprofen—which reduces prostaglandins, which
then, in turn, diverts blood flow from the kidney—exerts a double whammy on the
kidneys
What’s more, an ibuprofen may not even be that
helpful. In a small 2015 study published in the Journal of
Athletic Training, researchers rounded up experienced
runners, had them do a baseline workout, and then induced muscle pain in their
legs through strenuous exercise (ouch!). Later, the subjects were either given
ibuprofen or placebo and then told to do a follow-up workout. The difference?
Essentially, none. One possible reason, say the researchers, may be that the
drug’s effect on the heart may compromise oxygen uptake and negate any gains in
pain reduction.
If you have asthma
Dmitry Galaganov/Shutterstock
Ibuprofen and other
NSAIDs quell inflammation by inhibiting an enzyme that reduces the production
of substances called prostaglandins, which help with healing. The issue is that
interfering with prostaglandins could exacerbate asthma. That’s why the insert
in your ibuprofen packages warns asthma sufferers to exercise caution, says
Marilyn E. Morris, PhD, SUNY Buffalo distinguished professor and chair of the
department of pharmaceutical sciences.
“Asthmatics who have a demonstrated
sensitivity to NSAIDs, like ibuprofen, could have a life-threatening
bronchospasm event,” explains Craig. “These patients should talk to their
doctors about alternative options to manage pain.” Next, learn the 24 secrets pain doctors aren’t telling you.
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