Back pain? Toothache? Fever? Headache? If you’re like millions of Americans you’ll reach for a trusted medication that’s been available since 1984. Yet just a couple of years ago a leading newspaper said that taking it for just one day upped the risk of heart attack by half!
The drug is called 2-(4-isobutylphenyl) propionic acid, or to use its more familiar name, ibuprofen. It’s marketed under the brand names Advil, Motrin, and others.
Most consumers figure, “Look, it’s been used for 35 years and can be bought from convenience stores and gas stations — no prescription required – so surely it must be safe, right?”
Turns out that is not an easy question to answer. . .
Good for Pain – Bad for the Body
Ibuprofen was discovered after ten long years of seeking an alternative to high dose aspirin, which came with unpleasant and risky side effects — indigestion, allergic reactions, gastrointestinal bleeding, and potentially, death.
Using himself as a guinea pig at times, British pharmacologist Stewart Adams knew he’d made a breakthrough when he took 600 mg of the experimental compound to cure his headache and it did the trick.
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID), one of many that are now on the market. They work by blocking a class of proteins called cyclooxygenase (COX), which produce prostaglandins — hormone-like fats — that play key roles in promoting pain and inflammation.
Blocking COX successfully reduces these effects. The trouble is, prostaglandins also play some useful roles; they help protect the gastrointestinal tract. NSAIDs can irritate the mucous membrane layer of the stomach, cause bleeding, and induce ulcers.
For this reason, NSAIDs of all description, not just ibuprofen, are implicated in tens of thousands of hospital admissions every year, and many of those people die.
As if this wasn’t bad enough, some types of prostaglandin also act on the endothelium, the cells that line blood vessels. By interfering with this function, NSAIDs can constrict arteries, elevate blood pressure, raise the risk of blood clots, and increase fluid retention.
I want to stress these effects occur in people who take them week after week, month after month. Rarely in people who take them for short-term pain.
Appears Safe in Low Doses
In 2006 a research group from Oxford University, England, analyzed data from 138 randomized trials. They found that ibuprofen was linked to an increased risk of cardiovascular disease, but only if this involved taking 800 mg three times a day; doses that require a doctor’s prescription.2
A more typical dose for a headache or other pain is 400 mg, with doses at least six hours apart.
Because over-the-counter (OTC) ibuprofen is limited to 200 mg per tablet, with a maximum recommended dose of 6 tablets over 24 hours, the findings of the Oxford group cannot be applied to OTC ibuprofen.
In 2011 a Swiss group investigated the safety of NSAIDs. Ibuprofen was one of many types they looked at. They concluded that “little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.”3
However, out of the 31 trials they looked at, only two used ibuprofen, and these were for osteoarthritis at doses of 2,400 mg per day for more than a year. This has no relevance to people taking the drug for an occasional headache.
In 2013 researchers from the UK and Canada teamed up to carry out a new analysis which included the Swiss findings. They wrote that ibuprofen was associated with a higher risk “when used in clinical trials in high doses but not in the lower doses typically used in the community.”4
Now It’s Safe, Now it Isn’t
So ibuprofen appears to be out of the woods for OTC use. In 2012 this was confirmed by a group of American researchers who found that ibuprofen was the safest choice of NSAID based on its gastrointestinal profile and being less toxic to the kidneys.5
But in 2017 the picture changed, or appeared to, with two new studies. One newspaper headline linked the drug to a heightened risk of cardiac arrest. And earlier I mentioned the other newspaper, which screamed that taking it for just a single day increased the risk of a heart attack by nearly half. Yikes!
Sounds scary. We’ll have a look at these studies in the next issue.