Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications used to treat arthritis. Since NSAIDs are available by prescription and over the counter, some patients end up taking two different NSAIDs. Patients may take two because of inadequate pain relief or because they don't realize both drugs are in the same therapeutic drug class. Taking two different NSAIDs is not good -- it can increase the risk of undesirable side effects and serious adverse events. It has also been found to worsen health-related quality of life (the ability to perform usual daily activities).
Popular NSAIDs Have Risks
Millions of people take NSAIDs every day for arthritis, acute injury, and menstrual cramps. It is estimated that more than 100,000 Americans are hospitalized and between 15,000 and 20,000 die each year from ulcers and gastrointestinal bleeding related to NSAID use. Speaking only of arthritis, 14 million patients take NSAIDs regularly -- up to 60% of whom will experience gastrointestinal side effects as a result.
NSAID use is also associated with an increased risk of heart attack or stroke that can lead to death -- and the risk goes up for patients who use them long-term or have heart disease. Kidney or liver problems are possible with NSAID use as well.
Recommendations for Safe Use of NSAIDs
The FDA recommends that for safe use of NSAIDs, the medication should be taken:
- only as prescribed
- at the lowest possible dose that is still effective
- for the shortest time needed
According to research presented at the 2007 Annual Scientific Meeting of the American College of Gastroenterology, patients underreport their use of over-the-counter NSAIDs. Survey results have shown that patients who don't report over-the-counter NSAID use believe the drugs are insignificant because they are available without a prescription. To ensure safe use of medications, patients must tell their doctors about all of the drugs and dietary supplements they are taking.
The responsibility falls on both the patient and the doctor. The patient should be telling and the doctor should be asking about medication use. Your doctor can't advise you not to take two different NSAIDs if he doesn't know you are doing so.
Taking Two NSAIDs is Risky
The increased risk associated with taking two NSAIDs is significant. A study published in the European Journal of Clinical Pharmacology concluded that the risk of severe drug reactions causing injury to the liver and acute renal failure was 6 to 7 times higher in reported cases of simultaneous use of two NSAIDs. Don't let that happen to you. Use NSAIDs safely and appropriately. If you already take a prescription NSAID, check with your doctor before taking over-the-counter medications too.
Association between concomitant use of several systemic NSAIDs and an excess risk of adverse drug reaction. François Clinard, et. al. European Journal of Clinical Pharmacology. April 21, 2004.
Association of health-related quality of life with dual use of prescription and over-the-counter nonsteroidal anti-inflammatory drugs. Kovac, Stacey H. et al. Arthritis Care & Research. February 15, 2008.
Medication Guide for NSAIDs. U.S. Food and Drug Administration. April 19, 2007.
Use of common, but potentially dangerous, pain medications underreported. American College of Gastoenterology. October 15, 2007.