What Is the Deal With NSAIDs?

As someone with heart failure, you are likely aware of the recommendation to avoid taking non-steroidal anti-inflammatory drugs, also known as NSAIDs. This is a class of drugs used to reduce pain, fever, and inflammation. They include ibuprofen (Advil), naproxen (Aleve, Anaprox), diclofenac (Voltaren), indomethacin (Indocin), and mefenamic acid (Ponstel), and more. Many people rely on these drugs on a daily basis to alleviate pain.

NSAIDs and the heart

NSAID use has been associated with an increase in heart complications, predominantly heart attacks, and stroke. Other complications include heart failure, blood clot formation, and an increase in blood pressure. The increased risk is observed in the first few weeks of NSAID use but decreases when the drug is discontinued.1

Risk factors

The extent to which NSAIDs cause harm depends on a couple of factors: the person taking the drug and the drug itself. For example, the risk is highest in people who already have heart disease. Prolonged NSAID use at high doses also poses a greater risk.

Drug factors

Every NSAID has a different dose, meaning that a 50 mg diclofenac tablet is not necessarily equal to a 50 mg indomethacin capsule. When in doubt about what is considered a high dose, ask the pharmacist. The dose is also dependent on the frequency that the medication is taken and the duration of use. There are no major differences between NSAIDs in terms of heart risks.2

Individual factors

There are various factors that might put someone at a higher risk of a serious complication from an NSAID. These include:

  • Having diabetes, high blood pressure, and/or high cholesterol
  • Previous heart attacks or strokes
  • Smoking
  • Older age
  • Male sex

What can you do?

It is very likely that you may need a pain killer at one point in your life. There are several approaches that you can take to reduce the harmful impacts of NSAIDs, but still derive the intended benefit:

Low dose, short duration

Use the lowest dose possible and the shortest duration of time. For example, it is very common to be prescribed ketorolac for pain following a dental procedure. I have seen prescriptions written to take the medication three times daily for 7 days. However, for most people, it should be prescribed as needed. When a pain medication is prescribed for you, always confirm with your doctor that you are intended to take it as needed.

Use other pain relievers

Whenever possible, use other pain relievers. Other pain agents include acetaminophen (Tylenol), or topical products such as capsaicin. In some cases, a heating pad may be more effective than NSAIDs.

OTC doesn't mean safe

Just because some NSAIDs are available over-the-counter, does not necessarily mean that they are safe.

Be cautious with aspirin

It is important to be extra cautious if you are on baby aspirin or low-dose aspirin. Combined with NSAIDs, aspirin can increase the risk of stomach bleeding. This also applies to some other anti-clotting drugs, such as rivaroxaban (Xarelto) and apixaban (Eliquis).

Blood pressure

If your blood pressure rises when you take an NSAID, discontinue or reduce the dose as recommended by your doctor.

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