(NON-STEROIDAL ANTI-INFLAMMATION DRUGS)
THE DANGERS ARE LEGION
According to the March 11, 2015 issue of Medscape (Nonsteroidal Anti-inflammatory Agent Toxicity), "More than 70 million prescriptions for NSAIDs are written each year in the United States. With over-the-counter use included, more than 30 billion doses of NSAIDs are consumed annually in the United States alone." Stop and re-read that sentence, letting the sheer magnitude of it sink in. There are 30,000,000,000 doses taken by our nation's citizens each year, which calculates out to ten per person. This means that for every person who takes zero, someone is taking twenty. Do PRESCRIPTION HABITS such as this have consequences? As my dear, departed grandfather ("Pappy") would likely have answered, "Is a monkey's butt red?"
I've actually written about a few of these side effects in the past. NSAIDS not only dramatically increase your chances of getting CANCER --- itself considered an Inflammatory problem (HERE), but they dramatically increase your chances of death (HERE). Besides that, we know they do any number of things that won't necessarily kill you (at least not outright), but have the potential to turn you into an invalid or make your life a living hell. In fact, in the days when everyone loved Dr. Oz, he told us that no class of drug in America is more abused than this one (HERE). And this is after Vioxx was taken off the market (at that time, NSAIDS were a "Top 20" leading cause of death in the United States).
Thus, it should come as no surprise that the government has issued still another waring about the safety of this class of drugs. The warning that came out earlier this month, (FDA Drug Safety Communication: FDA Strengthens Warning that Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) can cause Heart Attacks or Strokes), stated that.....
NSAIDs are widely used to treat pain and fever from many different long- and short-term medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. NSAIDs are available by prescription and OTC. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib. The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.
Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs. The risk of heart attack and stroke with NSAIDs, either of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of the prescription drug labels. Since then, we have reviewed a variety of new safety information on prescription and OTC NSAIDs. Based on our review and the advisory committees’ recommendations, the prescription NSAID labels will be revised to reflect the following information:
- The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
- NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
- In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
- Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
- There is an increased risk of heart failure with NSAID use.
Like the warning reveals, none of this is new information. This latest warning is simply "strengthening" the warning that has been in place for a decade. I'm going to show you that despite everything you've been told by BIG PHARMA'S TV COMMERCIALS, these drugs have a wide variety of serious health risks associated with them. The studies are in no particular order and have been "cherry-picked" because of space constraints and readability. Also, because I only have access to abstracts most of the time, that's where this information comes from. When you're finished, you'll wonder why the FDA'S warning is not stronger than it is.
- NSAIDS DON'T MIX WELL WITH STATINS: While STATIN DRUGS have their own unique sets of problems, when you mix them with NSAIDS, certain aspects can be magnified. A Turkish study in the current issue of Prostaglandins and Other Lipid Mediators (Aggravating Effect of Atorvastatin on Indomethacin-Induced Gastric Injury) lets us know that the, "Proulcerogenic effect of atorvastatin are likely to be associated with decreased mucosal defense mechanisms and proinflammatory factors. Thus, atorvastatin therapy should be monitored in patients for an increased risk of gastric ulcer particularly when used concomitantly with NSAIDs." Especially interesting considering Statins have become the number one class of prescription drug in America.
- NSAIDS CAUSE LEAKY GUT SYNDROME: A study in this month's issue of the Scandinavian Journal of Gastroenterology (Effect of Oral Diclofenac Intake on Fecal Calprotectin) tells us something I have been warning patients about for at least a decade --- that taking Anti-Inflammatory Medications leads to LEAKY GUT SYNDROME. The study's conclusions tell us that, "Short-term oral diclofenac intake is associated with increased Fecal Calprotectin levels." I could write a whole post on this bullet point alone. If you want to freak yourself out a bit, just Google "Leaky Gut Syndrome Calprotectin" and count the numbers of diseases that you see.
- GI BLEEDS AND DIGESTIVE ISSUES: Although not the worst of the severe ADR's (Adverse Drug Reactions) that are associated with NSAIDS, by far the most common are problems with the digestive tract. We've known for decades that NSAIDS are the number one reason people get, are hospitalized, or die from GI Bleeds (bleeding ulcers). This month's issue of the Scandinavian Journal of Primary Health Care (Adverse Drug Reactions in a Primary Care Population Prescribed Non-Steroidal Anti-Inflammatory Drugs) concludes that, "Of the patients with musculoskeletal complaints prescribed an NSAID, almost one in 30 patients re-consulted their GP with a complaint likely or possibly associated with the use of this drug. Dyspepsia [GI pain] was the most frequent (34%). The burden of such consultations for non-serious ADRs should be taken into account by GPs when deciding whether treatment with an NSAID is appropriate."
- GI BLEEDS AND ATRIAL FIBRILLATION: In our society, A-Fib is extremely common. This month's issue of Expert Review of Cardiovascular Therapy (Nonsteroidal Anti-Inflammatory Drugs and Bleeding Risk in Anticoagulated Patients with Atrial Fibrillation) reinforces the idea that NSAIDS are related to heart problems by saying, "Nonsteroidal anti-inflammatory drugs (NSAIDs) have generally conferred increased gastrointestinal bleeding risk.... Recent evidence shows that concomitant use of NSAIDs in anticoagulated AF patients carries a real risk of serious bleeding, as well as thromboembolism. Thus, physicians should clearly exercise extra caution with NSAIDs in patients with AF, especially if they are anticoagulated."
- NSAIDS, CHILDREN, AND HYPERSENSITIVITY REACTIONS: The Spanish journal Annals of Pediatrics carried a study in this month's issue (Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs....) that sheds light on just how dangerous it is to give these drugs to kids. "Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions. More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity (the diagnosis was confirmed by oral drug provocation test)."
- NSAIDS INHIBIT BONE GROWTH IN CHILDREN: In another study done this month (Nonsteroidal Anti-Inflammatory Drugs Cause Inhibition of the Growth Plate in Cultured Rat Metatarsal Bones) from the Journal of Pediatric Orthopedics, it was revealed that, "NSAIDs caused a dose-dependent growth retardation of cultured metatarsal bones. Both nonselective and COX-2 selective NSAIDs inhibit longitudinal bone growth. We found that NSAIDs suppressed the proliferation of chondrocytes [cells that produce cartilage] and production of PGE2, and increased the apoptosis [death] of chondrocytes. Supplemental PGE2 could not reverse the effects of NSAIDs on the growth plate. The data from the present study suggest that deleterious effects on the growth plate by chronic NSAIDs use should be considered for children who have chronic inflammatory diseases." Scary! For a list of CHRONIC INFLAMMATORY DISEASES, just click the link.
- NSAIDS IMPAIR TENDON HEALING: If you have been on my TENDINOSIS PAGE, you are already aware that not only is Tendinitis very rare (many experts believe it does not exist at all), but that it sometimes takes some POTENTIALLY HARSH TREATMENT to stimulate the cells that make collagen (FIBROBLASTS). According to a study found in the July, 2015 issue of the Journal of Applied Physiology (COX-2 Inhibition Impairs Mechanical Stimulation of Early Tendon Healing in Rats by Reducing the Response to Microdamage) NSAIDS do exactly what the name of the study implies. "Early tendon healing can be stimulated by mechanical loading and inhibited by COX inhibitors (NSAIDs). Because loading might infer microdamage, which also stimulates healing, we also investigated if this effect is inhibited by parecoxib. Mechanical testing showed that there was a significant interaction between loading and parecoxib for peak force at failure. This effect of microdamage [of critical importance for the healing process] was almost abolished by parecoxib. This suggests that COX-2 inhibition impairs the positive effects of mechanical loading during tendon healing mainly by reducing the response to microdamage." Why do you think I have asked my PATIENTS UNDERGOING TISSUE REMODELING to refrain from taking these drugs while treating, unless they feel it's absolutely necessary?
- NSAIDS LINKED TO DEMENTIA: The July issue of the European Journal of Neurology (Patterns of Anti-Inflammatory Drug Use and Risk of Dementia: A Matched Case-Control Study) looked at dementia rates in people taking NSAIDS and CORTICOSTEROIDS vs people not taking these drugs. Their findings? "NSAIDs and glucocorticoid drugs were associated with higher risk of Vascular Dementia."
- MIXING ANTIDEPRESSANTS AND NSAIDS CAN LEAD TO BRAIN HEMORRHAGE: We've known for at least 15 years that mixing ANTIDEPRESSANT MEDS and NSAIDS leads to far more GI problems than NSAIDS alone. Without going into details, take a look at the title of a study published in this month's issue of the British Medical Journal (Risk of Intracranial Hemorrhage Linked to Co-Treatment with Antidepressants and NSAIDs).
- NSAIDS CAN FIRE UP THE COMBINATION OF HEPATITIS AND VASCULITS: I would not bother to mention this one, but because my closest friend is dealing with this very problem, here it is. The current issue of SpringerPlus (Nimesulide Induced Leukocytoclastic Vasculitis and Hepatitis) showed a link between a certain NSAID that is not used in the US due to its harsh ADR's (Nimesulide) and the ADR COMBINATION of Hepatitis and Vasculitis. Because numerous NSAIDS carry similar molecular profiles, my guess is that this problem could possibly be related to any number of NSAIDS besides the one discussed in the study.
- NSAIDS CAUSE KIDNEY PROBLEMS IN PEOPLE WITH HIGH BLOOD PRESSURE: The July issue of the journal Hypertension (the official journal of the American Heart Association) published a study (Use of Nonsteroidal Anti-Inflammatory Drugs and Risk of Chronic Kidney Disease in Subjects With Hypertension: Nationwide Longitudinal Cohort) that plainly concluded, "NSAID use is associated with increased risk of Chronic Kidney Disease in subjects with hypertension." As common as HIGH BLOOD PRESSURE is in the US, this hits very close to home.
- THESE DRUGS ARE SO UBIQUITOUS THEY ARE NOW BEING FOUND IN OUR WATER SUPPLY: I recently showed you that medications based on Female Hormones have made their way to the water supply (HERE). Now this. A Japanese study published in the September 2015 issue of the Journal of Environmental Toxins and Health (Monitoring the Concentrations of Nonsteroidal Anti-Inflammatory Drugs and Cyclooxygenase-Inhibiting Activities in the Surface Waters of the Tone Canal and Edo River Basin) "Environmental pollution by pharmaceuticals has become a major problem in many countries worldwide. We demonstrated that COX inhibitors in surface water may influence aquatic organisms more than was expected based on NSAID concentrations." Not surprising considering they have a one third our population crammed into an area roughly the size of my home state of Kansas --- mostly situated in huge metro areas.
Here's what I really want you to notice about this post. The studies I discussed today were from the most current issues of the journals they were found in. If I would have kept going, this article would have been a book (or one volume of a series). Bottom line; these drugs are dangerous, and if you are not aware of this fact, it could come back to bite you in a harsh way. And for those who would rather take ACETAMINOPHEN or ASPIRIN, just follow the links. If you are serious about finding solutions to your Chronic Pain and Chronic Illnesses, just take a look at THIS SHORT POST. And if you are a parent who is worried about not having the right drugs for your child's fever, you can set your mind at ease with THIS POST.