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Drug Cautions

Ibuprofen and NSAID Cautions

Ibuprofen and NSAID Cautions

(Sometimes spelled ibuprophen) This fever reducing, pain relieving, blood thinning compound was introduced in 1974 and is often used where pain relief is needed without a large anti-inflammatory effect. Ibuprofen is in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen works by reducing hormones that cause inflammation and pain in the body. Lower doses can control pain but higher doses are needed to treat inflammation.  It is inferior to aspirin as an anti-inflammatory as it may cause gastrointestinal irritation and the effective dosage is greater. It is an alternative for some persons, however, who cannot take aspirin, due to ulcers or other stomach maladies.

It should not be taken with aspirin because the combination can cause further stomach upset and also cause blood clotting impairment. If you are taking a normal regimen of aspirin it is not recommended to take ibuprofen. Patients taking both aspirin and ibuprofen had nearly twice the risk of death from any cause -- and a 73% increased risk of death from heart disease. There was no increased numbers of deaths among those taking aspirin with other painkillers similar to ibuprofen.

It's mode of action, like that of other nonsteroidal anti-inflammatory agents, is not completely understood, but may be related to prostaglandin synthetase inhibition.

Many athletes take this compound as part of their normal training routine or prior to major competitions such as marathons.

This popular pain reliever blocks the heart-protecting effects of aspirin, according to a new study. The results, if confirmed, would have major implications for millions of people who take a small dose of aspirin every day for their hearts, but who also take ibuprofen, widely known in North America under the brand names Advil and Motrin, to cope with conditions such as arthritis.

This particular NSAID has a more potent anti-inflammatory agent than aspirin. It, then is sometimes more effective for arthritic patients with fewer side effects. Food does delay the absorption but not the total drug intake. Ibuprofen is effective for mild to moderate pain. It works much the same as Aspirin. Pain relief should be expected in about 30 minutes. Ibuprofen is effective, also, as an anti-pyretic (reduces fever) much the same as aspirin.

Why to prescribe
Ibuprofen is used to relieve the pain, tenderness, inflammation (swelling), and stiffness caused by arthritis and gout. It also is used to reduce fever and to relieve headaches, muscle aches, menstrual pain, aches and pains from the common cold, backache, and pain after surgery or dental work.

Side Effects
The side effects related to Ibuprofen, though fewer in number, can be more intense in symptoms. The most common side effects are GI (gastrointestinal) in origin. They include complaints of nausea, vomiting, anorexia, diarrhea, and abdominal pain and occasionally even ulcers of the upper intestinal tract. There are other possible and less frequent side effects involving the central nervous system, liver and even allergic reactions like rashes. 

Heavy use of nonaspirin pain relievers does increase the risk for high blood pressure. In one groundbreaking study, women who took nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, 22 times a month or more were 86% more likely to have high blood pressure than those who did not take NSAIDs. Those taking acetaminophen were twice as likely to be hypertensive. Aspirin did not increase the risk.

If you experience any of the following serious side effects, stop taking ibuprofen and seek medical treatment or call your doctor immediately:
* an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
* muscle cramps, numbness, or tingling;
* ulcers (open sores) in the mouth;
* rapid weight gain (fluid retention);
* seizures;
* black, bloody, or tarry stools;
* blood in your urine or vomit;
* decreased hearing or ringing in the ears;
* jaundice (yellowing of the skin or eyes); or
* abdominal cramping, indigestion, or heartburn.

  • Antacids or buffered aspirin may have a      high salt content and can interfere with attempts to lower salt intake in      the management of high blood pressure.
  • Nonsteroidal anti-inflammatory      drugs      (ibuprofen, naproxen sodium, aspirin) occasionally can raise blood      pressure by causing the body to hold on to salt and water (instead of      expel them), and they can make the kidneys work less efficiently.

 

Frequent Use of Pain Relievers Linked To Hypertension

All of us experience pain, inflammation or fever from time to time, and when we do, most of us reach for relief in the form of acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). The most commonly used NSAIDs are aspirin, ibuprofen (brand names such as Motrin and Advil) naproxen (brand names Naprosyn, Aleve) and nabumetone (Relafen). Acetaminophen is sold under many brand names, including Tylenol, Anacin-3 and Panadol.

While we tend to see these over-the-counter drugs as fairly harmless, a recent study has cast some doubt on that assumption.

The study, reported last year in the Archives of Internal Medicine, concluded that the use of NSAIDs and acetaminophen was significantly associated with an increased risk of hypertension (high blood pressure). The study did not show the same increased risk with the use of aspirin.

Women Had No History of High Blood Pressure
For two years, researchers at Brigham and Women's Hospital (BWH) and the Harvard School of Public Health monitored over 80,000 women between the ages of 31 and 50 who had no previous history of hypertension. The overall health of the women was monitored by questionnaires that asked about their lifestyle practices. Participants answered questions about their age, weight, smoking, oral contraceptive use, alcohol use and other issues that can have an impact on blood pressure. They were also asked about their intake of sodium, potassium and magnesium, since these minerals can also affect blood pressure.

After two years, a total of 1,650 women in the study had developed hypertension. Those taking NSAIDs at least 22 days per month were 1.86 times more likely to develop hypertension as those not taking NSAIDs, and those taking acetaminophen at least 22 days per month were twice as likely to develop hypertension as those not taking acetaminophen.

"We decided to study these drugs because they are so widely used and could affect blood pressure," said Gary Curhan, MD, of BWH. "Up until now, however, little has been done to assess their long-term impacts on blood pressure, particularly when they are taken with any kind of frequency."

Short-Term Analgesic Use Also Associated with BP Increase
Even infrequent use of the painkillers increased the chances of hypertension. Women who took NSAIDs like ibuprofen one to four days a month were 14% more likely to have high blood pressure than women who did not take the drugs. A woman taking the same regimen of acetaminophen experienced a 19% risk increase. Dr. Curhan said that women typically take acetaminophen and ibuprofen more often than men.

Clarence Grim, MD, Professor of Medicine in the Medical College of Wisconsin Department of Cardiovascular Medicine, advises a dose of common sense regarding the use of NSAIDs or acetaminophen. “Watch your blood pressure if you’re taking analgesics,” he says. “I would recommend that anyone taking large doses get a blood pressure cuff of their own so they can monitor it closely.”

If you are not currently taking analgesics regularly but intend to start, Dr. Grim recommends having your blood pressure checked before starting and checking it frequently so you can tell if your numbers are changing. If your blood pressure does begin to rise, keep the link between analgesics and hypertension in mind, but don’t make any hasty decisions. Speak with your physician and switch to plain aspirin as a replacement if needed. “Because we didn’t see the same problems with aspirin, it would be a good replacement choice,” Dr. Grim says. “The only way to tell if your current analgesics are influencing your blood pressure is to stop taking those medications and see if your pressure goes back down.”

Like All Drugs, NSAIDS and Acetaminophen Call for Caution
Analgesic use is extremely common in the US, with billions of dollars spent each year on over-the-counter remedies for pain, inflammation and fever. A significant number of hypertension cases could be attributed to the overuse of NSAIDS and acetaminophen. And it’s possible that women are not the only ones at risk, says Dr. Grim: “We have known for a long time that NSAIDS can cause hypertension in some people. Although women were the population studied in this case, there’s no reason that men’s’ reactions would be different.”

Although not proven by this research, Dr. Curhan said it is thought that these drugs may increase blood pressure by inhibiting production of prostaglandins, a hormone-like body chemical that widens blood vessels for improved blood flow.

While the researchers in this study did not recommend that anyone discontinue the use of NSAIDS or acetaminophen, they did see the study as a starting point for further research. Possibly the most important thing to remember about this study is that every drug has an effect on our bodies.

“Even though they can be purchased over-the-counter,” Dr. Grim reminds us, “NSAIDs, acetaminophen and aspirin are medicines and – like all medicines – can have serious side effects. Always tell your physician that you are taking analgesics, and be sure not to take them for more than two weeks at a time unless your physician recommends it.”

Common Pain Drugs Up High Blood Pressure Risk

Tylenol, Ibuprofen Linked to High Blood Pressure in Women

The pills in your medicine cabinet may be raising your blood pressure.

Women who take a lot of acetaminophen (Tylenol) have nearly twice the risk of high blood pressure as those who don't use the drug. Those who take a lot of ibuprofen (Advil, Motrin) or naproxen (Aleve) up their risk by as much as 78%.

The study did not link aspirin to high blood pressure in women. However, there was a trend toward more high blood pressure in women who frequently used aspirin.

The findings come from two studies that collected detailed information on more than 5,000 registered nurses aged 34 to 77. Harvard researcher John P. Forman, MD, says the findings mean women should think twice about taking common pain relievers.

"We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain," Forman tells WebMD. "These medications, by virtue of their availability over the counter, are viewed as being safe or without risk. By pointing out risks associated with these drugs, [we hope] more informed choices can be made by women and their doctors."

The Headache Factor

In earlier studies, Forman's team found a link between the use of common painkillers and high blood pressure. However, it wasn't clear whether one major reason for taking the drugs -- headache -- was itself behind the link to high blood pressure.

The current study finds that whether or not a woman suffered from headaches, the drugs still increased her risk of high blood pressure.

The study, which appears in the September issue of Hypertension, lumped ibuprofen, naproxen, and similar drugs into a single category: NSAIDs. About 80% of the women using NSAIDs were taking ibuprofen. Taking more than 400 milligrams of NSAIDs per day upped the risk of high blood pressure by 78% in older women and by 60% in younger women.

Daily use of more than 500 milligrams of acetaminophen raised the risk of high blood pressure by 93% in older women and by 99% in younger women.

Using 'Greater Caution'

"High blood pressure affects about one in three adults in the U.S.," Forman says. "As the two most frequently used drugs in this country, acetaminophen and NSAIDs may substantially contribute to the disease burden of high blood pressure. On an individual level ... these agents should be used with greater caution."

What does "greater caution" mean? Laurence S. Sperling, MD, director of the risk reduction program at Emory Heart Center in Atlanta, says it means that people can't just pop pills without thinking about the consequences.

"Medicines we can buy over the counter and use without a doctor's advice may not be as safe as we think," Sperling tells WebMD. "People think Tylenol, especially, is pretty innocuous. We have to realize that any substance has risks if we use it on a regular basis."

So what's a person with pain supposed to do?

"What I tell people is we have to look at what's right for you," Sperling says. "If we can find something else that is safer, great. If not, we have to accept a higher risk because quality of life is part of the equation. The risk here is not phenomenal. It is not as if taking these drugs guarantees you will have a heart attack or stroke."

 

Painkillers and High Blood Pressure

Patients and doctors alike seem to have their backs against the wall when it comes to the treatment of chronic pain. The nonsteroidal anti-inflammatory drugs (NSAIDs) have two or three strikes against them. And now there are concerns about acetaminophen (Tylenol).

Two of the potent and effective COX-2 inhibitors, rofecoxib (Vioxx) and valdecoxib (Bextra), were removed from the market because they are associated with an increased risk of heart disease. Similar concerns have been raised about another COX-2 inhibitor, celecoxib (Celebrex), which has just barely avoided a ban by the U.S. Food and Drug Administration. And a couple of months ago the FDA warned about the possible cardiovascular dangers of all prescription and over-the-counter NSAID drugs, except for aspirin.

So what is left for the treatment of pain? Aspirin, acetaminophen (Tylenol), and ibuprofen (Advil, Motrin) are the three most commonly used drugs in the U.S. Acetaminophen may not be quite as effective as NSAIDs like aspirin and ibuprofen, but it doesn't carry the risks of gastrointestinal bleeding and possible cardiovascular complications now attributed to all NSAIDs.

Recently, disappointing results were published on Tylenol use in women between the ages of 34 and 77 from the Nurses' Health Study. Compared with women who took no chronic medication for pain, women who took more than one extra-strength Tylenol (more than 500 mg) daily for pain other than headaches had twice the risk of developing high blood pressure within 3 years. The women who took more than 400 mg of ibuprofen daily had an almost 80 percent increase in developing high blood pressure over this time period.

The authors of the report concluded that aspirin was the safest medicine to take for chronic pain. But if any of my patients had a history of intestinal bleeding, I would recommend Tylenol at the smallest effective dose and check their blood pressure regularly.

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