If you have a headache, back pain, or issues with arthritis, chances are you don’t think twice before popping an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen, aspirin, or naproxen. NSAIDs have been used for decades and are still some of the most commonly used medications worldwide, with an estimated 15% of Americans taking them on a regular basis (including OTC and prescription). Roughly 30 billion doses are taken every year to treat a wide variety of conditions, including pain, colds, coughs, and flu.
But if you’re popping or prescribing NSAIDs on a regular basis, be careful. Recent studies suggest it’s incredibly easy to take far higher than the recommended daily dose of NSAIDs, and exceeding the maximum dose is very common.
Exceeding the dose
Ibuprofen is the most widely used NSAID. It may surprise you to learn that, according to the literature, it’s also become one of the most commonly overdosed drugs in many countries.
One study attempted to discern the prevalence of NSAID-dosing that exceeds the recommended daily limit, with a specific focus on ibuprofen. Researchers looked at the habits of more than 1,300 ibuprofen users, recording details of hourly NSAID use as well as information on medical history and physical health status.
The investigators found that, not only were most users unaware that some of the products they were using were NSAIDs, but up to 15% of participants were regularly exceeding the daily recommended dose. The results showed that more than one-third of participants were taking a second NSAID on top of ibuprofen—and fewer than half of this group realized that more than one of their medications was an NSAID.
A number of factors make it easy to misuse NSAIDs, including their widespread availability and the relative safety of their use. There are more than 20 different NSAIDs on the market, which can make it easy to double up without realizing. Also, NSAIDs are present in some products that combine a number of medications, which can make it more difficult to identify how much you’re dosing.
Researchers found that overdosing on NSAIDs was especially common in men, in those who suffer chronic pain, and those who believed in “choosing my own dose.” The researchers advised that educating consumers about “how many painkillers is too many” could reduce overdosing.
What too many NSAIDs can do to you
The effects of taking too many NSAIDs are varied. Regularly exceeding the daily recommended dose can result in kidney damage or digestive problems, like stomach upset, heartburn, and ulcers. Less common adverse side effects include allergic reactions, bruising or bleeding, and liver damage. Some NSAIDs can even raise the risk of developing heart problems in some users.
Studies have found that adverse reactions to NSAIDs most commonly occur when they’re combined with other drugs or substances. Some research, for example, found that people who frequently take ibuprofen and regularly drink alcohol have a higher risk of experiencing gastrointestinal bleeding.
Researchers have found that frequency is the key. One study, for example, found no association between infrequent analgesic use and serious gastrointestinal toxicity, but concluded that a significant association appeared in those who used NSAIDs 4-7 days a week.
Studies have also shown that NSAIDs can be dangerous for unborn babies, which led the FDA to recently update its recommendations. Evidence suggests that NSAIDs can result in low levels of amniotic fluid—as such, the FDA is now advising that pregnant women avoid all use of the drugs starting 20 weeks into pregnancy.
While there is still much to learn about the adverse effects of NSAIDs, research has indicated a number of other potential negative health impacts of taking analgesics too often. One study found that all non-aspirin NSAIDs may be associated with increased cardiovascular risks. Another study concluded that risks of stroke are slightly increased among users of prescription ibuprofen. Research also suggests that prescription-strength NSAIDs are associated with increased blood pressure, which can exacerbate hypertension.
In fact, NSAIDs are legally required to state that the risk of heart attack or stroke may increase if they’re used more than directed or for longer than directed.
Pay attention to dosage
Although about one in seven Americans exceed the recommended daily dosage of NSAIDs, the majority of people taking them follow the directions and don’t experience complications.
That said, there’s enough evidence of the damage that could occur from overdosing that it’s best to pay attention to dosage, as well as any combinations of drugs taken while using NSAIDs.
A review of studies concluded that healthcare providers can play an instrumental role here, by making sure that patients use the lowest effective dose of NSAIDs for the shortest duration of time in order to treat their ailment.
For patients, the advice is simple: Follow the instructions on the label and the advice of your doctor.