One NSAID More Dangerous than All the Others?
I see countless patients who by middle age or older become what I call an NSAID addict. While these patients often believe they’re smartly using the stuff around them to keep active as they age, little do they know that using these drugs denotes a ticking time bomb of health risks. Now, a new study adds a bit more fuel to the idea that these are dangerous drugs.
NSAID Addicts
I see these patients in the office every day. Their addiction usually begins at the recommendations of a doctor, maybe their family physician or an orthopedic surgeon. They have middle-aged aches and pains that prevent them from doing what they want to do. Instead of going to a physician who will look at what’s wrong, diagnose, and treat these issues with precise regenerative medicine injections, they begin popping NSAID drugs, like Motrin or its prescription cousins. They get to a point that they have to pop a pill just to work out or be active. Little do they know that they are addicted to some of the most dangerous drugs we have.
What Is Diclofenac?
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). In the U.S., diclofenac is only available by prescription (brands include Cambia, Voltaren, Zipsor, etc.), but in some countries it can be purchased over the counter. It is commonly prescribed for pain and inflammation in conditions such as arthritis and even migraines.
While we know all NSAIDs are dangerous, it seems diclofenac may be more dangerous than all the others.
Diclofenac a Serious Cardiovascular and GI Risk
The purpose of the new study (a cohort combining 252 studies) was to study any cardiovascular adverse events in low-risk subjects after taking the NSAID diclofenac and then compare these to adverse events in those taking other NSAIDs (ibuprofen and naproxen), acetaminophen, or nothing. The results? Compared to those who took nothing, there was a 50% increase in adverse events in those taking diclofenac. Compared to those taking acetaminophen or ibuprofen, the adverse events increase for diclofenac was 20%, and compared to naproxen, it was 30%. So what exactly were these cardiovascular adverse events? Findings included atrial fibrillation or flutter, ischemic strokes, heart failure, heart attacks, and even death due to a cardiac event.
Another disturbing finding was that diclofenac also was found to increase the risk of a gastrointestinal (GI) bleed—a dangerous side effect that has already been well established with NSAIDS and is required, along with the cardiovascular risks, by the FDA to be on the warning label; however, the GI bleed risk is significantly higher (two and a half times higher in fact) with diclofenac when compared to the NSAID ibuprofen.
A Review of More Reasons to Stay Away from NSAIDs
As if the risk of death from a heart attack or GI bleed isn’t troubling enough, there are many, many more reasons to stay away from NSAIDs. Whether it’s a prescription NSAID, such as Voltaren (diclofenac) or Celebrex (celecoxib) or even a seemingly more innocuous over-the-counter NSAID (don’t be fooled just because you can buy Advil [ibuprofen] right off the shelf—these are very dangerous drugs), the side effects apply. Let’s take a look at some of these:
- This isn’t the first study to reveal the particular risks with diclofenac in comparison to other NSAIDs. Take a look at this one I covered way back in 2011, showing heart attack risks significantly higher with diclofenac (398% risk of death from heart attack) when compared to celecoxib (207%), ibuprofen (239%), and other NSAIDs.
- Ibuprofen has been linked to infertility in males.
- Arthritis damage may worsen following the use of NSAIDs.
- NSAIDs may damage stem cells, causing them to produce defective cartilage. This link also provides another study on diclofenac (Voltaren), which shows that instead of turning into normal tendon cells, the drug causes stem cells to turn into pieces of fatty tissue.
- Even just as little as one week of NSAID use can increase heart attack risk by as much as 50%.
Additionally, NSAIDs even in normal dosages can be risky, but many consumers exceed these minimum NSAID dosages without even knowing it. How? Either by taking too much (the label directs one pill, but the consumer takes two) or by taking two drugs for two separate conditions and not realizing both are actually NSAIDs. This unintentional overdosing significantly increases the risk of dangerous side effects and can even cause an accidental poisoning, so if you’re going to take the risk with NSAIDs, make sure you are well aware of the maximum dosages.
What Can You Do?
Read my book Proactive! It contains everything you need to know to avoid being an NSAID addict! Click on the book cover below to learn these secrets:
The upshot? Don’t become and NSAID addict! Take care of your body, and don’t pop pills that increase your chances of kicking the bucket!
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What if you are 65 heart is healthy, calcium test score was 0. workout 2hrs per day. Have herniated disc with severe arthritis, is taking one Advil every other day to help manage the pain still putting me at risk.
Greg,
Working out 2 hours a day is impressive and good for cardiovascular health, overall health, joint health, mental acuity, etc. There are, however, documented reasons why relying on Advil is not a good idea, which is why patients need to be off it for treatment. If you choose to try to replace it with things that encourage healing, please see: https://regenexx.com/blog/nsaid-addict-can/ and https://regenexx.com/blog/new-research-fish-oil-can-turn-bad-inflammation-into-healing/ and https://regenexx.com/blog/curcumin-for-bone-health/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/
What about Tylenol? You cannot fix all problems with your treatment, even after my stem cell and PRP treatments ( yes Regenexx) there is still some pain. Tylenol allows me to resume my activities. I’m 70 and very active, weight lifter, hunter, fisherman, hiker.
Frank,
Tylenol is not an NSAID, so okay. Very glad to hear you’re that active – keep it up!
20 months NSAID-free since I discontinued to prep for my procedure in the Grand Cayman.
Brian,
Congrats! That is great news!
Am 22 years suffering from back pain that causes burning sensation which radiate down my both thighs.
So I went to a to consult he wrote me these drugs : (progabalin, omicap and melonax)
Please I need and advice if its proper am a cameroonian.
Thanks
Fukah,
We’d love to help, but we’d need to examine you to answer your question. This is how we treat back pain: https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/
Obviously, not taking any form of NSAIDs is the most preferable course, but how about moderate, occassional use of Diclofenac (voltaren) in gel form on specific smaller areas? Correct me if I’m wrong, but I assume this would be safer than dropping pills of this.
Dave,
Besides the other health risks involved with NSAIDS, the issue is that they interfere with the healing process. There are alternatives that address pain and inflammation that aid in the healing process. Tylenol is a better choice for occasional pain. Please see: https://regenexx.com/blog/new-research-fish-oil-can-turn-bad-inflammation-into-healing/ and https://regenexx.com/blog/nsaid-addict-can/
Thanks! BTW, I’m a faithful user of Regenexx Omega 3 Fish Oil and Turmeric Curcumin supplements.
I am glad to report that my knee pain from osteoarthritis is gone 2 months after Stem Cell
therapy from Regenexx. I am able to walk for 30 minutes with out any pain, For 6 months I
mostly stayed home because I could walk only a few minutes, that too with pain. I am taking Omega 3 Fish Oil and doing recommended exercises for muscles of the knee.
I am delighted with the result and the joy of being able to walk. Will I have long term relief for
a few years ?
krishna,
Great to hear you’re doing so well! Likely. Some patients take advantage of being able to get a PRP booster shot over the years, some never need them.
I am bone on bone in my right knee and nearly bone on bone in my left. My ligaments are in very good shape but meniscus cartridge and articular cartilage is lacking on the inner part of my knee and I have some bone spurs throughout my knee . I have a lot of wear on the back of my knee cap as well. Otherwise. I am a healthy active 63 year old male. I am trying to avoid a knee replacement because I do like the risk of needing a revision, uncertain improvement, and the one way path that it represents.
I use diclofenac gel on average one to two times a day. I thought by avoiding diclofenac in an oral form, risk of its use would be lower. What are your thoughts on one form of diclofenac versus the other.?
I do joint stretching and strengthening but I am quite bowlegged from the osteoarthritis. My flexion is excellent but I am about eight degrees short of full extension despite my efforts. I also use various supplements: fish oil, tumeric, ginger, boswelia, astaxanthin, boron, MSM, and glucosamine sulfate but stretching, and strengthening along with diclofenac are the difference makers that have allowed me thus far to avoid a knee replacement. The diclofenac brings significantly greater relief than any of my current supplements,
I am six foot two and 260 pounds but still have a large muscular frame. I admit to having a bit of extra fat but not a whole lot. I lift weights a in addition to getting aerobic exercise. My chest measures 48 inches and my waist size is 40 inches thus most of my weight is in the form of muscle, bone, other good tissue and not fat. I am fortunate in that my family history is long life for most members. I try to eat a healthy diet. Any thoughts or advice would be much appreciated.
Paul in Maryland
Paul,
This paper studied the effectiveness and safety of topical versus oral NSAIDS: https://www.ncbi.nlm.nih.gov/pubmed/23703519 Sounds like you’re doing really well, except for your knees, but to advise in a particular case we’d need to examine you. When possible, treatment is advised over knee replacement for the reasons stated. To see if you would be a Candidate, please submit the candidate form, or call 855 622 7838.
I appreciate your work and public service. I hope what you are doing becomes even more successful and filters down and becomes more accepted mainstream medical treatment. Your newsletter is very informative.