NSAID warnings should be heeded

February 20, 2007

I hope to return to issues on which I began in the first two posts, but I should speak up a little on the underappreciated risks of taking NSAIDs, nonsteroidal anti-inflammatory drugs. Most adults who take aspirin have some idea that aspirin’s risks include adverse effects on the gastointestinal tract; far fewer, I believe, are familiar with the risks posed by other NSAIDs such as the popular nonprescription drugs naproxen and ibuprofen. Motrin and Advil are popular brands of ibuprofen; Aleve is a brand of naproxen. Both medications are sold under a number of brands, which include private label brands propriety to store chains.

NSAIDs as a class are the second leading cause of peptic ulcer, which can occur in the stomach or in the duodenum. The leading cause of peptic ulcer by far is the bacterium Helicobacter pylori, which is commonly abbreviated as H. pylori; nonetheless, complications of ulcers caused by NSAIDs result in tens of thousands of hospitalizations and thousands of deaths annually.

I am certainly no expert on any disease or on any class of medications, but my experience with a complicated peptic ulcer prompted me to start learning about peptic ulcer disease and its causes. I had thought that NSAIDs had a directly corrosive effect on the lining of the gastrointestinal tract, but I learned that is not the case; rather, NSAIDs inhibit synthesis of prostaglandins, substances necessary to maintain the mucousal lining that prevents our digestive juices from digesting our gastrointestinal tract. Where the mucousal lining becomes vulnerable, acid can cause an ulcer. When an ulcer results in significant bleeding, or when an ulcer perforates the wall of the gastrointestinal tract, medical care is urgently needed.

The bad news is that NSAIDs can have adverse effects. It is almost certain that their use will have some effect on the mucousal lining of the gastrointestinal tract. The good news is that NSAIDS are often effective in reducing symptoms they are intended to attack, and that in most users their effects do not become harmful enough to require medical treatment. The probability of experiencing a serious adverse effect may seem low, but it is high enough, and the consequences of such an effect serious enough, that much more care should be taken in deciding whether to use an NSAID on a prolonged basis. Consultation with a physician, who should be familiar with risk factors, would be best; many of us don’t seek that, though, in regard to what is “only” an over-the-counter (OTC) medication; the cost of physician visits can also be a consideration.

If you’re not going to consult with a physician about frequent or regular nonprescription NSAID use, at least read up on the possible adverse effects. Product literature that should be enclosed in the packaging, or available as printed information at a pharmacy, usually goes into detail, as do some online and hard copy resources. The medical jargon can be challenging, so a glossary or dictionary may be necessary for understanding what is being said. I’ve had to look up many terms.

Nonprescription NSAIDS do not all have the same level of risk. As to the two most commonly used ones aside from aspirin, ibuprofen falls into the low risk category, while naproxen falls into the medium risk category. The more effective is the medication in fighting inflammation, the greater is the risk of ulcer causation; that is due to the fact that the medications inhibit prostaglandin synthesis, and prostaglandins both produce inflammation and maintain the mucousal lining of the gastrointestinal tract.

It might be worthwhile to explore the possibility of taking another medication concurrently to minimize the risk of developing an ulcer if long-term NSAID use seems to be unavoidable.

The decision to take nonprescription NSAIDs regularly or frequently should be made after one is well informed as to the risks. Well, in my case, it’s the same old story: You know there is some risk, but you take your chances and proceed to take a medication; then, if you’re one of the ones who has a bad experience, you pipe up about it. Be that as it may, I don’t want other people to get harmed by something they’re taking in the effort to feel better.

A number of prescription medications are now advertised on television. In the USA, due to a federal requirement, each prescription medication commercial must include a statement of possible adverse effects. Nonprescription medication advertisements, despite FDA advisories in some cases, are not required to state possible adverse effects. Given the morbidity and mortality rates associated with the taking of some nonprescription medications, including NSAIDs, the public are being misled.

Age is a risk factor for nonprescription NSAID use, and for outcomes of complicated peptic ulcer. Yet Aleve commercials, which I find particularly appalling, pitch their brand of naproxen by using testimonials of persons who appear to be in their fifties, sixties, or older, without a spoken word about risks. Viewers who are at age-related risk may identify with a contemporary who in a commercial testifies that the medication is effective against aches and stiffness.

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