By Mary Jane Dittmar
This information is for anyone who relies on over-the-counter or prescription non-steroidal, anti-inflammatory drugs (NSAIDs) to lower fever or get through a headache, a muscle ache, and other “common, ordinary, temporary” pains. As we investigate to try to determine what could cause heart attacks or strokes—in our case, particularly in connection with responder line-of-duty deaths and medical “injuries”—it is important that we consider every possible potential causal factor. NSAIDS fit this category. Assessing the risks is as crucial in the health arena as it is on the fireground (see below).
The FDA, yesterday, moved to strengthen the warning of a heart attack and stroke risk on the labels for prescription and over-the-counter (OTC) products containing NSAIDs,
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm. (This new warning does not apply to aspirin, which has its own specific side effects. (http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/SafeDailyUseofAspirin/ucm291434.htmsee)
Common OTC NSAIDs include ibuprofen (Motrin®, Advil®) and naproxen (Aleve®). In addition, some combination medicines, such as multi-symptom cold products, contain NSAIDs. Check the list of active ingredients in the Drug Facts label (http://www.fda.gov/Drugs/ResourcesForYou/ucm133411.htm).
These serious side effects, says the FDA, can occur as early as within the first few weeks of using an NSAID and might increase as the time of use increases. “There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products.
Following are some FDA recommendations you can follow to help protect yourself (or loved ones) against the risk of a heart attack or stroke related to NSAID use:
- Many prescription and OTC medicines contain NSAIDs; therefore, be very careful about taking multiple remedies that may have the same active ingredient.
- At greatest risk for cardiovascular adverse events associated with NSAIDs are people who have cardiovascular disease, particularly those who recently had a heart attack or cardiac bypass surgery.
- The risk is also present in people without cardiovascular disease. “Everyone may be at risk – even people without an underlying risk for cardiovascular disease,” notes Dr. Judith A. Racoosin, FDA deputy division director.
- You can still take NSAIDs, but be aware of this increased risk of heart attack or stroke, especially at higher doses. Carefully read the Drug Facts label for all nonprescription drugs. Carefully consider whether the drug is right for you, and use the medicine only as directed. Take the lowest effective dose for the shortest amount of time possible. When using prescription NSAIDs, read the Medication Guide attached to your filled prescription it provides important safety information.
- If you have heart disease or high blood pressure, consult your health care provider before using an NSAID.
- Balance the benefits of NSAIDs with the possible risks; weigh your options. If you take low-dose aspirin for protection against heart attack and stroke, be aware that some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect.
- Stop taking NSAIDs, and seek medical help if you experience symptoms that might indicate heart problems or stroke, such as chest pain, trouble breathing, sudden weakness in one part or side of the body, or sudden slurred speech.
- Reduce your risk factors for heart disease and stroke. “Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for these conditions. See your doctor regularly to find out if you have these other strong risk factors. Commit yourself to taking care of them and of your health.
- Available scientific data don’t suggest an increased risk of serious cardiovascular events for short-term, low-dose use of OTC NSAIDs. But be aware that the OTC labeling states that if you take an NSAID for longer than 10 days, you should see your doctor. Use the lowest effective dose for the shortest time.
Mary Jane Dittmar is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communications.