Health Tips

In Part 1, we discussed what NSAIDs are, how they work and the reasons they can be harmful to gastrointestinal systems, especially if taking it for long-term. 

In Part 2, we look at the effects of NSAIDs on other parts of the body.

Worse kidney and high blood pressure 

Remember we mention that prostaglandins have protective effects for the kidney as well as benefits in regulating blood pressure? Taking NSAIDs for a long time reduces these beneficial prostaglandins, which can worsen kidney function and raise blood pressure. Those who have high blood pressure and kidney disease, watch out!

It was reported that 1 in every 5 NSAIDs users experience kidney-related side effects, such as fluid and electrolyte disorder, reduced kidney function and nephrotic syndrome (protein leaked into your urine and it may appear foamy). In addition, regardless of whether you have high blood pressure or not, taking NSAIDs is known to raise your blood pressure considerably.

Mind you, these two side effects were not unique to nonselective NSAIDs only– taking coxibs can damage your kidney and worsen your blood pressure control too!

Increased risk of cardiovascular diseases

The most important cardiovascular diseases associated with NSAIDs usage include cardiovascular death, myocardial infarction (MI, i.e. heart attack), and stroke. Other diseases to watch out for include heart failure, atrial fibrillation (irregular heartbeat and rhythm) and venous thromboembolism (blood clot forms in the deep vein of legs). 

Scientists found that with the use of NSAIDs, it reduces a particular type of prostaglandin called I2 (PGI2 or prostacyclin) in your blood vessels, while doing nothing on the potentially prothrombotic platelet thromboxane A2 production. (Prothrombic means the higher tendency to form blood clots in the blood vessels.) This imbalance dynamic could lead to injury of the blood vessels and increase risk of cardiovascular diseases. NSAIDs effects on the blood pressure, kidney, fluids and electrolytes also partly contributed to the risks.

The chemical structure of prostacyclin. Panoramix303, CC BY-SA 3.0 , via Wikimedia Commons

But not all NSAIDs have the same effect on your cardiovascular risk. In a 2013 meta-analysis, it was found that diclofenac and ibuprofen increase the risk, but not naproxen. The study also found that coxibs can increase cardiovascular risk, perhaps as much as diclofenac and naproxen did.

Have asthma? Be careful.

NSAIDs can sometimes cause a rare but severe problem called bronchospasm, i.e. when the airways go into spasm and contract. This makes it hard to breathe and causes wheezing (a high-pitched whistling sound). The use of nonselective NSAIDs may precipitate acute exacerbations of airway inflammation in patients with the condition "aspirin-exacerbated respiratory disease" (AERD), particularly those with underlying asthma. In contrast, coxibs are much less likely to trigger AERD in patients with this syndrome.

Other problems

Many NSAIDs users are also taking medicines for other medical conditions. NSAIDs sometimes can interact with these medicines and result in unpleasant side effects. For example, taking NSAIDs with medicines that affect bleeding, such as warfarin or clopidogrel, can increase the risk of bleeding in the person. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRI) (e.g. Prozac®), also appear to increase the risk of gastrointestinal bleeding. What this might mean is that if the person accidentally cut open his or her skin, the bleeding can be excessive and serious; worse still, if the person already has an ulcer in the stomach, this might even lead to internal bleeding!

Get to the root cause of your pain with a professional help

If you are taking NSAIDs on a long-term basis, chances are you have some long-term pain issues in your body. It’s easy to get NSAIDs nowadays – go to any pharmacy and with just a few bucks you can have a strip of NSAIDs tablets. But is that the best for your body in the long run? Don’t you want to know what is really going on with that pain and what’s the best way to manage it?

Currently, there are many treatment options for pain besides NSAIDs. For instance, instead of taking NSAIDs tablets, do you know you can apply NSAIDs creams and gels on your painful site? Gels and creams tend to have lesser side effects compared to its tablet form.

We are not saying that NSAIDs are absolutely bad and you should not take them at all; all we are saying is that there may be better pain treatment options other than NSAIDs. Consult a doctor or healthcare professional for a more holistic pain management. Your doctor may refer you for a chiropractor or physiotherapy for pain treatment. If your doctor thinks that you need NSAIDs long-term, ask him or her how you can prevent the side effects we mention above. 

References

1. UpToDate - Nonselective NSAIDs: Overview of adverse effects

2. UpToDate - Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)

3. UpToDate - Overview of COX-2 selective NSAIDs

Written by

Ms Joyce Toh