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Osteoarthritis Health Center

Are Anti-Inflammatory Pain Relievers Safe for You?

Here's help weighing the benefits and risks of NSAIDs, from aspirin to Celebrex
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Anti-Inflammatory Pain Relievers: The Risks

For most people, taking an over-the-counter NSAID for the occasional headache or backache is very safe. "The bigger risks are for people who have chronic pain and take NSAIDs in the long-term," says Goldberg.

The most common side effect from all NSAIDs is damage to the gastrointestinal tract, which includes your esophagus, stomach, and small intestine. More than half of all bleeding ulcers are caused by NSAIDs, says gastroenterologist Byron Cryer, MD, a spokesperson for the American Gastroenterological Association.

"Gastrointestinal bleeding is a serious issue," says Cryer. "But we've seen in many surveys that people really underestimate this risk." Most ulcers caused by NSAIDs will heal once you stop taking the drug, according to the American College of Gastroenterology.

Researchers developed Cox-2 inhibitors -- like Celebrex, Vioxx and Bextra -- to get around this problem, says Klippel. Contrary to common belief, Cox-2 inhibitors are not more powerful painkillers than standard NSAIDs. Their advantage is they are much less likely to cause gastrointestinal problems.

However, after their introduction in 1999, further study revealed that the Cox-2 inhibitors had a real downside: an increased the risk of heart attacks and strokes. The heart risks of two Cox-2 inhibitors, Bextra and Vioxx, were considered significant enough to pull them from the market. Bextra also posed a risk of serious skin reactions. Celebrex is still for sale, but it now bears a strong FDA warning about the risks of heart attacks and strokes.

These heart risks may also be common to many over-the-counter NSAIDs when used long-term, although probably to a lesser extent, Klippel tells WebMD. Except for aspirin, all over-the-counter NSAIDs now must carry a warning about the risks of heart attack and stroke along with other side effects.

NSAIDs have other dangers, too. They can cause high blood pressure and kidney damage in some people. They can also cause potentially severe allergic reactions. Both prescription and over-the-counter NSAIDs now carry warnings about skin reactions as well.

The Benefits of Anti-Inflammatory Pain Relievers

Some experts feel that the risks of NSAIDs have unfairly overshadowed their benefits.

"We talk a lot about the risks of these drugs," says Klippel. "I think we also need to talk about the benefits. Every medicine has risks. But the focus on the side effects of NSAIDs has made people lose confidence in a very valuable category of drugs."

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