side effects of long term nsaid use
Side Effects of Long-term NSAID Use
Non-steroidal anti-inflammatory medications, also known as NSAIDs, are used to reduce pain and inflammation. These medications are easily available over-the-counter, and are some of the most widely-used medications in the world. Unfortunately, most people take these medications without knowing the side effects and risks associated with them. This Buzzle article lists some of the long-term side effects of NSAIDs.
A startling article published in the New England Journal of Medicine in 1999 brought to light the fact, that in United States alone, 103,000 patients are hospitalized and 16,500 NSAID-related deaths occur every year. The Food and Drug Administration suggests the figures may be higher, somewhere around 20,000 a year.
When you have a headache, a backache, or some muscle pain, what is the first thing you do? Like many other people, you probably pop a pill. And lo behold, the pain miraculously vanishes. Although you may know these pills by their generic names such as Aspirin or Ibuprofen, what you may not know is that these medications are classified as NSAIDs or non-steroidal anti-inflammatory medications. Used to reduce inflammation and relieve pain, NSAIDs are often used to treat a variety of conditions including muscle aches, sprains, backaches, osteoarthritis, migraines, dental pain, bursitis, and menstrual cramps. They can relieve the symptoms caused by irritation or injury such as redness, swelling, and pain.
Everyday millions of people take non-steroidal anti-inflammatory medications for reducing pain and swelling. Since most of the NSAIDs are available over-the-counter without prescriptions, people tend to take them whenever they feel the slightest ache. What most people fail to understand is that like any other medication, NSAIDs also have a number of side effects, some of which may be severe. Despite the severity of its toxicity, especially with chronic use, there is hardly any information about the side effects of NSAIDs. Before we can look at the side effects of using NSAIDs long-term, let us first try to understand how these medications work.
How Do NSAIDs Work
NSAIDs work by inhibiting the cyclooxygenase (COX) enzymes in various parts of the body. The COX enzymes are responsible for the production of prostaglandins, hormone-like substances that are responsible for pain and inflammation. NSAIDs prevent the COX enzymes from releasing prostaglandin. This, in turn, keeps the pain and inflammation in check.
The COX enzyme is present in two different forms, COX-1 and COX-2. While COX-2 reduces only pain, inflammation, and fever, COX-1 is responsible for protecting the gastric lining of the stomach. NSAIDs can be broadly classified as non-selective and selective, based on the types of cyclooxygenase (COX) enzymes it inhibits. While non-selective NSAIDs inhibit both COX-1 and COX-2 enzymes, selective NSAIDs inhibit only the COX-2 enzyme, thus allowing the production of prostaglandins that protect the stomach while relieving pain and inflammation as well. Some of the common non-selective NSAIDs are Aspirin, Ibuprofen, Naproxen, Ketoprofen, and Diclofenac. Selective NSAIDs include Celebrex (celecoxib) and Mobic (meloxicam).Common Long-term Risks Associated with NSAIDs
» Leads to Gastrointestinal Problems
Gastrointestinal problems and upper GI tract injuries are some serious side effect of NSAIDs. The COX-1 enzyme inhibited by NSAIDs reduces the production of prostaglandins that protect the lining of the stomach. Without its protective mucus layer, the stomach acids can cause small erosions in the stomach and duodenum, which can burst and lead to bleeding as well.
Short-term effects of NSAIDs include an upset stomach (dyspepsia), nausea, indigestion, pain, and diarrhea. In the long term, people using NSAIDs can develop peptic ulcers and gastrointestinal perforations (holes in the wall of the stomach or intestines). The risk is higher for elderly people or for those who have a history of ulcers. People who suffer from chronic pain and are on NSAIDs for a long term, suffer more from ulceration and other related problems than people who take an occasional pill.
An alternative for non-selective NSAIDs that cause gastrointestinal disorders is a selective COX-2 inhibitor. Selective NSAIDs can reduce pain and inflammation while lowering the risk of gastric ulceration.
» Increases Cardiovascular Risks
While COX-2 inhibitors may pose lesser gastrointestinal problems, they have a serious downside. Researchers have found that these drugs increase the risk of heart attacks and other cardiovascular problems. Due to this risk, two COX-2 inhibitors, Vioxx and Bextra, were removed from the market.
Except aspirin, all other NSAIDs need to have a black box warning that states that NSAIDs may increase the risk of serious cardiovascular thrombotic events, myocardial infarction, and strokes. The risk is greater for people who have cardiovascular disease, high blood pressure, or those who take the medications for an increased duration.
Other common side effects include:
• Headaches
• Dizziness
• Skin rashes
• Drowsiness
• Edema (Retention of fluid)Less Common Side Effects of NSAIDs
» Drug-induced Hepatitis
High doses of NSAIDs in the long term is known to cause toxic hepatitis, which is characterized by the inflammation of the liver as a result of exposure to certain toxins. The liver is responsible for breaking down chemicals and drugs in the bloodstream. While it does have an increased capacity for regeneration, when exposed to the drugs for a long time, serious harm can be caused to the liver.
In most cases, stopping the intake of the medication helps in recovery. However, if left untreated, toxic hepatitis can cause irreparable damage to your liver, cause scarring of liver tissue (cirrhosis), and in certain cases, even lead to liver failure. Symptoms of drug-induced hepatitis include abdominal pain, fatigue, appetite loss, headache, and yellowing of skin.
» Renal Toxicity
When the body is exposed to a drug for a long time, then the drug toxicity may increase the chances of damage to the kidneys. Shortness of breath, loss of energy, and irregular heartbeat are some of the signs of kidney damage caused by drugs. A simple blood test can help in discerning the condition. People who abuse drugs for a long term are likely to suffer from permanent damage to the kidney. NSAIDs also interfere with antihypertensive medications, thus causing high blood pressure and kidney damage.
» Interactions with Medications
NSAID interactions with other medications such as Ciclosporin (immunosuppressant medication), Phenytoin (anticonvulsant), Lithium (mood stabilizer), Clozapine (antipsychotic), and Warfarin (blood thinner) can cause side effects. NSAIDs taken with alcohol are also known to cause side effects. In case such medications are taken with NSAIDs, then it has to be closely monitored by the doctor.When Should NSAIDs Be Avoided
There are certain medical conditions and situations where NSAIDs are generally avoided as the medications increase the severity of the condition. These include:
• Rhinitis (Leads to the inflammation of mucous membrane of the nose)
• Aspirin-induced Asthma (Leads to excessive production of leukotrienes, which causes wheezing and shortness of breath)
• Chronic Urticaria (Worsens the hives)
• Pregnancy (NSAIDs stop prostaglandin synthesis. It can thus lead to the closure of the fetal ductus arteriosus. This a small connecting vessel that allows fetal blood to bypass the lungs and usually closes after birth. Other dangers include fetal renal impairment, and a delay in labor and birth.)
In case you have gastrointestinal bleeding, renal or hepatic impairment, Crohn's disease (inflammatory bowel disease), or heart problems, it is advisable to take NSAIDs only after consulting a doctor.