Q. Like most people, I take an over-the-counter painkiller for aches and pains. Now, recent headlines say that these can cause a heart attack. Can you clarify this and suggest any safe alternatives?
A. Warnings about these painkillers are not new. In 2005, the US Food and Drug Administration (FDA) warned that taking common, widely available non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen (both available without prescription), increase the risk of having a heart attack or stroke. They may also raise blood pressure and cause heart failure.
The warning followed the revelation that Vioxx, a prescription NSAID, had caused 140,000 heart attacks in the US over five years. It was withdrawn in 2004. NSAIDs were first launched over a century ago and most of them were registered at a time when there were few requirements for safety documentation. However, since the Vioxx scandal, there has been much more research, which showed that the risk is linked to all NSAIDs.
In 2015, the FD A strengthened its warnings, emphasising that the risk increases even with short-term use and, although greater for people with heart disease, may affect those without it, according to Harvard Health Publications. (Aspirin is an NSAID, but is not included in the warning.)
The latest research was based on data from almost ten million NSAID users in four European countries, which found that, commonly, NSAIDs raise the risk of users being admitted to hospital for heart failure. NSAIDs have also been known to cause stomach problems from digestive upsets and heartburn to bleeding ulcers and, most seriously, stomach cancer.
Because we can buy them so easily and there is no explicit warning about potential risks, it ‘fuels the common misconception that NSAIDs are harmless drugs that are safe for everyone’, says the British Medical Journal, which published this latest study. Many experts are calling for regulatory authorities to restrict their availability.
Taking the occasional NSAID is unlikely to cause problems for most people. However, people with diagnosed heart disease, gastric ulcers or bleeding are generally advised not to take NSAIDs at all. They may also exacerbate other conditions. If in doubt, consult your doctor or a pharmacist.
Many doctors recommend paracetamol as an alternative painkiller, but only one in three users or fewer are likely to benefit. Studies show that it is minimally effective for joint pain and the National Institute for Health and Care Excellence (Nice) does not recommend paracetamol for lower back pain. Plus, taking more than the recommended maximum dose can cause serious liver complications in otherwise healthy people.
One option for some aches and pains is to use a topical NSAID, which minimises the risk of harm as your system absorbs less than it would with oral formulations. Ask your pharmacist for advice.
If you prefer natural products, pharmacist Shabir Daya recommends the following:
- For headaches: Life-Flo MigraZap Magnesium Roll-On (£9.50).
- For neck and shoulder pain: Napiers Capsicum & Ginger Warming Cream (£9).
- For lower back pain: Better You Magnesium Oil Sensitive Spray (£12.20).
- For joint pain: Superior Joints (£30 for 60 capsules).
- For period pain: Bio-Health Periagna Agnus Castus Fruit (£10.75 for 60 capsules).
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