UT Health cardiologists address FDA warning on painkillers

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The newest federal health regulation is warning people that anti-inflammatory pain relief pills such as Advil, Aleve and Motrin can increase the risk of heart-related problems and strokes.

But that doesn’t mean that these non-steroidal anti-inflammatory drugs (NSAIDs) need to be removed from your medicine cabinet altogether, especially if you are in otherwise good heart health, according to UT Health physicians.

Dr. Samer Khouri, professor of medicine and associate chief of cardiology at The University of Toledo Medical Center, said that ibuprofen, Naproxen and other NSAIDs should be taken in the correct dosage for the shortest amount of time.

“There is a risk and the risk is real,” Khouri said. “This new warning is a good idea because people sometimes think that over-the-counter pills don’t come with any risks because they can buy them so easily.”

The Food and Drug Administration’s new warning states that an increased risk of heart attack and stroke can occur even in the first few weeks of taking NSAID drugs. The current label only warns that high dose and/or long-term use can increase the risk of heart-related problems.

While Khouri supports the new label, he wants to make sure that the public knows that taking an aspirin like Bayer is still recommended for patients with heart disease or if you suspect you are having a heart attack or stroke. The new warning does not apply to aspirin, even though it’s technically an NSAID, he said.

“I think the public might be getting confused in this area because aspirin does not fall under this new FDA warning, although no drug is without risk,” he said. “Aspirin by itself can be an excellent medication to decrease cardiovascular disease, including heart disease and stroke, while also helping with headaches, fevers and arthritis.”

Dr. Rajesh Gupta, a cardiologist at UTMC and assistant professor of medicine, said it comes down to weighing the risks versus the benefits.

“If a 25-year-old person with tennis elbow or a sprained ankle wants to take an Aleve, then that is low risk while the treatment benefit is fairly good,” Gupta said. “However, for a 70-year-old with heart disease and a prior stent procedure, the benefits don’t outweigh the risks.”

If patients already are on a long-term Naproxen treatment, for instance, they might want to consider finding an alternative treatment, he said.

“We have known for a many years that long-term NSAID use is associated with gastric ulcers, kidney disease and high blood pressure. This new FDA warning adds heart attack and stroke risk to this list,” Gupta said. “In general, these medications are not suited for long-term use, but the bottom line is each person should get individualized advice from his or her doctor because not every case is the same.”