Do Your Patients Understand the Risks of NSAIDs?
Nonsteroidal anti-inflammatory drugs, commonly known as NSAIDs, are regularly prescribed and advised by physicians for the reduction of pain associated with conditions such as arthritis, headache, menstrual cramps, or pulled muscles. Some over-the-counter NSAIDs most people are familiar with include ibuprofen or naproxen, with brand names like Advil, Motrin, and Aleve. However, those in the medical community are aware that there is a significant, proven risk for certain problems, mainly cardiovascular and gastrointestinal issues, associated with the use of NSAIDs. As a pharmacist, you will want to be sure your patients are aware of any health risks associated with any prescription or OTC medications. Here are some things to consider with regard to NSAIDs.
Of the known NSAID side effects, cardiovascular issues such as heart attack or stroke are of serious concern to both medical professionals and patients, as they are potentially life-threatening. Occasional use of NSAIDs is not so much a concern as is regular, daily use associated with chronic pain. A recent study looked at clinical data of 600 medical trials of over 350,000 patients to conclude that cardiovascular risk increased by as much as a third in patients who took NSAIDs every day, as opposed to those taking a placebo. These numbers are certainly cause for attention. There is some talk recently, however, that naproxen may be less of a cardiovascular risk than other types of NSAIDs. Overall, the risk among all NSAIDs is small, but it is worth sharing with your patients.
Gastrointestinal Adverse Effects
Gastrointestinal effects associated with the use of NSAIDs can be quite serious, as well. According to the American Gastroenterological Association, 16,500 chronic NSAID users in the United States die each year due primarily to bleeding stomach ulcers, and over 100,000 are hospitalized. Again, these risks are small in comparison with the number of people who take the most common NSAID pain relievers each and every day.
Alternatives for Patients
If a person’s overall quality of life is being improved through the use of these drugs, physicians concur that the risk is more than likely worth the continuation of their use. However, some patients report that they are not seeing any improvement, but continue to take the pills out of habit or merely to follow their doctors’ advice. For these people, alternative treatments should be considered. Perhaps a topical medication could be applied to affected areas or another oral medication, such as paracetamol, could be prescribed. For patients who do see some improvement in their pain levels, but are concerned about known side effects, the lowest dose of NSAIDs could be tried and for the least amount of time possible. Consider the recommendation of naproxen over other NSAIDs due to the recent information indicating it is less likely to cause cardiac complications. Also, inform patients who are taking low-dose aspirin for heart issues that the use of ibuprofen can lessen the aspirin’s effectiveness. Finally, always discuss family history of gastrointestinal or heart problems with patients and refer them to their physician if there are concerns of either condition.
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