OTC Pain Relievers and Fever Reducers (cont.)

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Medical Editor:

Because alcohol intensifies the effect of NSAIDs on bleeding, alcohol should not be taken with NSAIDs. NSAIDs also can cause kidney damage, particularly in the elderly or patients with high blood pressure, diabetes, atherosclerosis, or who take diuretic medications ("water pills").

Patients who are allergic to aspirin should not take NSAIDs since they are likely to be allergic to NSAIDs as well. NSAIDs may cause fluid retention in persons with congestive heart failure.

The most serious side effects are kidney failure, liver failure, ulcers, and prolonged bleeding after an injury or surgery.

Pregnancy/breastfeeding and NSAIDs

NSAIDs are safe for use during the first or second trimesters of pregnancy, but should not be taken during the third trimester because they can:

  • prolong labor and delay birth,
  • increase bleeding in the mother following birth, and
  • can cause cardiac (heart) and vascular (blood vessels) complications in the newborn.

Nevertheless, use of NSAIDs during any portion of pregnancy should be approved by the treating doctor. Ibuprofen and naproxen sodium also are safe for use by nursing mothers. Due to insufficient data, ketoprofen is not recommended for use by nursing mothers.

Drug interactions and NSAIDs

NSAIDs reduce the blood pressure-lowering effects of certain high blood pressure (antihypertensive) medications, including:

NSAIDs reduce blood flow to the kidneys and reduce the action of diuretics and decrease the elimination of lithium (Eskalith) and methotrexate (Rheumatrex).

NSAIDs also decrease the ability of the blood to clot and can increase the risk of bleeding. When used with other drugs that also increase bleeding risk (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid the prolonged use of NSAIDs.

What about overdoses of pain relievers and fever reducers?

The American Association of Poison Control Centers reported that of all overdoses of OTC products, 66% involved acetaminophen, 19% involved ibuprofen, and 15% involved aspirin.

Aspirin overdose can occur with as little as 150 mg/kg (10,000 mg or 10 grams in the average sized male) as a single dose, or 90 mg/kg per day for at least two consecutive days. Symptoms of toxicity due to aspirin include:

  • tiredness,
  • ringing in the ears,
  • rapid breathing,
  • seizures, vomiting,
  • bleeding, and
  • coma.

Large doses of acetaminophen rarely cause serious problems in children. In adults, as little as 10 grams can damage the liver and the kidneys.

Overdoses of ibuprofen rarely produce important problems. Nausea, vomiting, stomach pain, tiredness, and dizziness are the most common symptoms of large doses of ibuprofen. Rarely, coma may occur.

REFERENCES:

American Association of Poison Control Centers. "2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report."
<http://www.aapcc.org/dnn/Portals/0/2008annualreport.pdf>

FDA Prescribing Information

Migraine Research Foundation. "About Migraine."
<http://www.migraineresearchfoundation.org/about-migraine.html>


Last Editorial Review: 2/11/2010



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