Ouch — common painkillers increase your risk of heart failure

Prescription Medicine

Common prescription painkillers could lead to heart failure. (URUPHONGK/GETTY IMAGES/ISTOCKPHOTO)

Yet another common painkiller could possibly kill you.

Prescription-strength ibuprofen, naproxen and other anti-inflammatory drugs may raise your risk of heart failure almost 20%, according to a new BMJ report.

Previous studies noticed a correlation between non-steroidal anti-inflammatory drugs, commonly called NSAIDs, and patients being hospitalized for heart failure. Related anti-inflammatories called COX-2 inhibitors were also implicated.

So Italian investigators set out to estimate the actual risk by analyzing almost 10 million NSAID users from four European countries between 1999 and 2010. And they found that several traditional NSAIDs (including diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide and piroxicam) and two COX 2 inhibitors (etoricoxib and rofecoxib) were related to higher heart failure rates. And very high doses of ibuprofen and diclofenac even doubled those odds.

More research is needed to determine absolute risks, cause-and-effect, or whether lower over-the-counter doses of these drugs are also dangerous.

Doctor with Prescription Medication

Prescription-strength anti-inflammatory NSAIDs like ibuprofen and naproxen are linked with heart failure. (DOLGACHOV/GETTY IMAGES/ISTOCKPHOTO)

“Although over-the-counter NSAIDs are typically used at lower doses and for shorter durations, they are sometimes available at the same doses as prescription NSAIDs and they may be inappropriately overused,” warned study author Andrea Arfe, a Ph.D. student at University of Milano-Bicocca. So users should follow dosage directions carefully when taking these drugs.

“NSAIDs pose a clear risk to some patients and tighter regulation is justified,” wrote two Danish heart experts in a linked editorial. And their wide availability over the counter “further fuels the common misconception that NSAIDs are harmless drugs that are safe for everyone.”

This comes on the heels of repeated reports that the pain reliever acetaminophen, which is used in more than 600 over-the-counter medications and prescription drugs including Tylenol and DayQuil, carries dangerous side effects. They include liver failure when taken too much, usually by mixing different medicines containing the drug. And recent studies warned can cause behavior problems in children when taken by nursing mothers.

– Nicole Lyn Pesce, New York Daily News
September 29, 2016

Follow Prescription Advisory

What prescribers can do to safely and effectively use opioids for CNCP (includes the following)

  • Screen for prior or current substance abuse/misuse
  • Do not use concomitant sedative–hypnotics or benzodiazepines
  • Track daily MED using an online dosing calculator
  • Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances

Neurology, 2014; 83; 1277-1284, September 2014

Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients.

Qualitative data were collected through online focus groups and telephone interviews.

Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry participated.

Thirty-five clinicians from nine states participated.

We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion–crystallization strategy for identifying key themes in the resulting transcripts.

Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns, avoiding discussion altogether, and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing.

Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.

Pain Medicine, Volume 15, Issue 7, July 2014 
Rick Bunker

Rick Bunker

Rick Bunker is a co-founder, and the CEO of Prescription Advisory Systems and Technology (P.A.S.T.). In this role, he is responsible for capital formation and corporate development.
Rick Bunker
Prescription Advisory Systems & Technology

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