If you are over 60, have had stomach bleeding, or take blood thinners or steroids, ask a doctor before taking painkillers like ibuprofen

Cost

Free. Ask a doctor or pharmacist once.

What you get

This class of drugs is called nonsteroidal anti-inflammatory drugs (NSAIDs), and common ones are ibuprofen, naproxen and diclofenac. A meta-analysis pooled 280 randomized trials of these drugs against placebo, with 124513 people. Compared with placebo, the risk of upper gastrointestinal perforation, obstruction or bleeding was: ibuprofen RR 3.97 (95% CI 2.22–7.10, about 4 times), naproxen 4.22 (2.71–6.56), and diclofenac 1.89 (1.16–3.09). All of these drugs roughly doubled the risk of heart failure. U.S. rules require a stomach-bleeding warning on these over-the-counter drugs. The warning lists six kinds of people at higher risk: those over 60, those who have had a stomach ulcer or bleeding, those taking blood thinners or steroids, those taking another drug of this kind at the same time, those who have 3 or more alcoholic drinks a day while using it, and those who take more or for longer than the label says.

Notes

The paper's conclusion is about high-dose use. For taking it for a day or two now and then at the label dose, this paper gives no separate figure. Many combination cold medicines also contain ingredients of this type, so taking them with a painkiller doubles up; read the ingredient list first. If a doctor has you taking low-dose aspirin long term to prevent clots, don't stop it yourself, and don't add another painkiller yourself. For how to use this class of drugs for menstrual pain and when to see a gynecologist, see §3.25 (taking painkillers like ibuprofen for menstrual pain).

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9894):769-779. https://doi.org/10.1016/S0140-6736(13)60900-9
2. 21 CFR 201.326(a)(2)(iii)(A) Stomach bleeding warning. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.326

Translated from the Chinese original. Original book, section 34, tip 3. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer