Taking an over the counter Anti-inflammatory

Where were you in 1974? Ask... Were you watching the Miami Dolphins beat the Purple People Eaters in the Super Bowl? Did you see Paul Newman and Robert Redford in the movie The Sting? I fell head over heels in love with ragtime watching that movie, and I still am in awe of Scott Joplin’s musical genius. Were you watching as Richard Nixon resigned his presidency? The year 1974 was when the Food and Drug Administration approved ibuprofen for mild to moderate pain and inflammation, available only with a doctor’s prescription.

Although acetaminophen eases headache and fever, a non-steroidal antiinflammatory medication (NSAID) like ibuprofen is more effective for relieving muscle aches and inflammation. Ibuprofen is also less irritating to your stomach than aspirin, allowing higher doses with fewer side effects. Facing the expiration of its patent protection, ibuprofen’s manufacturer applied to the FDA for approval to sell it at a lower dose without a prescription.

In contrast to the 400mg, 600mg, and 800mg tablets of prescription-only Motrin® in 1984, the FDA approved ibuprofen as nonprescription Motrin-IB®200mg tablets. Years later, naproxen followed the same path: first as a prescription-only antiinflammatory, then approved for OTC use as Aleve®.

There are four options for pain relief by mouth without a prescription: aspirin, acetaminophen, ibuprofen, and naproxen. For muscle pain, menstrual cramps, and toothache, nonprescription doses of naproxen or ibuprofen are much safer than aspirin and more effective than acetaminophen. NSAIDs are sold by themselves and as an ingredient in many over-thecounter (OTC) cold, flu, and allergy remedies. 78-year-old Rose has heart failure. She takes a water pill to keep fluid from building up in her lungs.

Six months ago, Rose came down with a flulike illness, becoming so short of breath that her doctors first suspected COVID or pneumonia and hospitalized her. It turned out that despite taking her water pill, her lungs were filling with fluid from an exacerbation of her heart failure. Over the next 3 days, she recovered and went home. Last month, Rose returned to the Emergency Department, short of breath. The only thing she did differently was take Advil® Cold and Flu, which contains ibuprofen. She continued taking her water pills, but it wasn’t enough. The ibuprofen triggered fluid retention, causing her breathing problems from the fluid building up in her lungs.

Ever since, she has avoided all NSAID medicines, and she feels great. Although NSAIDs are usually safe when taken to relieve fever and muscles aches, they can be dangerous for people with certain medical conditions like Rose’s heart failure. NSAIDs can also spell trouble for people with kidney problems, like diabetics. Taking prescription or OTC ibuprofen or naproxen can trigger kidney damage in certain situations, especially if you get dehydrated. Sweating a lot when outside in hot weather or experiencing nausea, vomiting, or diarrhea can cause dehydration.

Taking any NSAID when your body is too dry can seriously harm your kidneys. People who have had a bleeding ulcer should also avoid taking NSAIDs like ibuprofen and naproxen. That’s because these medicines interfere with maintaining the protective gel layer that lines your stomach. This vital gel layer ensures that your stomach acids digest your food instead of your stomach. Taking ibuprofen or naproxen encourages thin spots and erosion of the lining of your stomach, setting you up for an episode of stomach pain or bleeding.

Even considering these possible side effects, NSAIDs like ibuprofen and naproxen are powerful against muscle sprains or strains, tension headache, dental pain, and menstrual cramps. When taken at the beginning of menstrual flow, just one dose of ibuprofen or naproxen can head off debilitating abdominal cramps. One dose of an NSAID right before a tooth extraction can avoid suffering from swollen “chipmunk cheeks” afterward.

Here are 5 Tips to Help Keep Yourself Safe When Taking NSAIDs:

1. Keep yourself well hydrated. Even young, healthy people can suffer severe kidney damage if they become dehydrated while taking an NSAID medicine. NSAIDs interfere with your body’s safety net for your kidneys when you get low on fluid. Several professional athletes have discovered this the hard way, and ended up needing a kidney transplant.

2. Ask your doctor first. Most people can take low doses of ibuprofen or naproxen without harm. For those who have kidney problems, it’s much safer to take Tylenol® or acetaminophen for your aches and pains. NSAIDs can aggravate and accelerate kidney problems. Please consult your doctor first before taking ibuprofen, naproxen, or any other NSAID for more than a couple of days.

3. Protect your heart. Have you been diagnosed with congestive heart failure, also called CHF? If so, avoid taking any medicine that includes an NSAID, which causes sodium and water retention. NSAIDs counteract the beneficial effects of drugs that work to keep fluid out of your lungs and reduce swelling in your hands and feet.

4. Watch your blood pressure. NSAIDs cause sodium retention, triggering water retention. This can cause your blood pressure to rise, interfering with how most blood pressure medicines do their job.

5. Don’t double up. Avoid taking more than one NSAID at a time. It’s surprisingly easy to take two NSAIDs at the same time. That’s because the prescription strengths have different brand names than the OTC versions of the same medicines. Not realizing that you are taking two medicines with the same ingredient puts you at risk for overdose and side effects like stomach pain, bleeding, or kidney problems.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. ©2022 Louise Achey