Non-Steroidal Anti-inflammatories (NSAIDS) are a commonly used class of drug for pain management, as well as their anti-inflammatory component, and many patients seem to falsely believe that they are harmless. This leads to patients taking them when they may not necessarily need to, without concern for drug interactions or long-term effects. After a recent safety review, the FDA is requesting updated warning labels for over-the-counter NSAIDS. The FDA warns that NSAIDS can increase the risk of heart attack, heart failure, and stroke, not only for patients with heart disease, but also for those without heart disease or risk factors.
NSAIDS are especially useful in treating patients with arthritis, but the American College of Rheumatology advises patients with heart disease to take acetaminophen instead, due to an extensive list of side effects and potential risks. Before recommending OTC pain medications, a healthcare provider should be aware of disease states or conditions, such as kidney or liver disease, hypertension, asthma, patient age, and other medications such as steroids, diuretics, and anticoagulants. Although Tylenol can cause serious liver damage, and lacks anti-inflammatory properties, it is just as effective as ibuprofen for pain and fever reduction, without the extensive side effect profile.
Topical NSAIDS are another potentially safer method of treatment for osteoarthritis inflammation. Because they remain more localized, systemic effects are not as prevalent, and adverse effects were found to be minimal. This information came from a review of randomized, double-blind trials, published in Cochrane Database Systemic Reviews by researchers at Oxford. Ultimately, patients need to be made more aware of the risks associated with NSAIDS, especially such it is such a commonly used prescription and OTC pain medication.
As pharmacists, I think this raises important points about what information to gather from a patient, such as their disease states and medications, before recommending OTC pain medications. With topical pain medications gaining more momentum, and more information available on their side effect profile, do you think this will change the nature of OTC pain medication counseling?