Is it safe to take Advil and related medications?
Advil (aka ibuprofen) and related medications are called NSAIDs.
So what are NSAIDs?
NSAIDs, meaning Nonsteroidal anti-inflammatory drugs, are mainly used to treat pain and/or inflammation and can reduce fever as well. There are over 20 different NSAIDs available, and most of them do not require a prescription. Examples include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), indomethacin, and a very powerful one named ketorolac (Toradol), which is typically given in a hospital. Ketorolac can be given intravenously, intramuscularly, or intranasally, allowing the drug to take effect immediately. And if you were wondering, yeah, Toradol is the same drug that was given excessively in NFL football players.
Some of them come in the form of gels and creams, that are applied to the skin, which is particularly useful for treating osteoarthritis and lower back pain. For example, diclofenac is available topically as a gel (Voltaren), patch (Flector), or solution. Using these topical forms carries less risk of side effects compared to the pill version.
How do NSAIDs work?
There are actually two main categories of NSAIDs, selective and nonselective, which refer to their specific inhibition COX enzymes (cyclooxygenases) in the body.
Nonselective means they inhibit COX-1 and COX-2 enzymes, and examples include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and ketorolac (Toradol).
Selective NSAIDs (aka COX-2 inhibitors) such as celecoxib (Celebrex), are just as good at alleviating pain and inflammation as nonselective NSAIDs and are slightly less likely to give gastrointestinal side effects. Celecoxib is sometimes advised for patients with a history of a stomach (or intestinal) ulcer, and/or gastrointestinal bleeding when taking nonselective NSAIDs. The downside to selective NSAIDs such as celecoxib is they carry a slightly higher risk of having a stroke and heart attack.
What are NSAIDs great for treating?
Generally speaking, they work great for……
Muscular and/or joint pain
Inflammation (arthritis, pericarditis)
Painful menstrual periods
Is there a downside to taking NSAIDs?
Most people have no problems when taking NSAIDs, especially if they are only taken when needed. The longer someone takes NSAIDs, the higher likelihood of developing side effects and/or medical problems.
NSAIDs are well known to raise blood pressure and cause upset stomach upset, medically termed dyspepsia.
There is also the potential to cause allergic reactions, such as angioedema, wheezing, anaphylaxis, and interstitial nephritis, meaning inflammation inside a specific part of the kidneys.
And it also has the potential cause other kidney problems,
Glomerulonephritis (inflammation of different parts of the kidney), nephrogenic diabetic insipidus (which is a different type of diabetes that makes you pee a lot of clear urine which can leave you dehydrated), last but not least, kidney damage, which can eventually lead to kidney failure. That is why NSAIDs should not be given those with chronic kidney disease.
When taken over the long-term, NSAIDs carry a higher risk of peptic ulcer disease, meaning an ulcer form in the stomach or small intestine. The older the patient, the higher risk of an ulcer forming. Ulcers are bad because not only can they cause pain, but they can cause bleeding as well. Sometimes the bleeding is so severe that patients require critical care, meaning a stay in the intensive care unit.
Also, sometimes the ulcer can erode right through the wall of the stomach and/or intestine, creating a hole there. When this happens, it’s a surgical emergency.
Antacid histamine blockers, like famotidine (Pepcid), and medications that inhibit acid production, like omeprazole (Prilosec) or lansoprazole (Prevacid), does reduce the risk of developing an ulcer related to NSAID use.
Anyone who has had a heart attack, or a cardiac catheterization to open blocked arteries, a stroke, or blocked arteries in the brain, would have at higher risk of worsening cardiovascular disease (heart attack, stroke) when taking NSAIDs (except for aspirin).
NSAIDs, especially at high doses over a long time period, can harm the liver, although this is relatively rare.
Most doctors advise discontinuing NSAID use roughly one week before elective surgery to lower the risk of excessive bleeding. With that said every patient and their doctor need to discuss the risks and benefits of doing so.
Can someone who has had an allergic reaction to aspirin take other NSAIDs, such as ibuprofen?
Those who have had hives (urticaria) or other allergic symptoms in response to aspirin should avoid NSAIDs, generally speaking, at least until this has been addressed by an allergist. It is possible for someone who has had a reaction to one NSAID take an alternative NSAID safely. It might be necessary to see an allergy specialist to address this issue.
Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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