Did you know that Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like Advil and Aleve can cause dangerous bleeding events? This is the reason doctors ask patients to take these medications with food. Eating provides some protection to the lining of the stomach and small intestine, which are the most common sites of bleeding ulcers. These bleeding events can be fatal. The mechanism that causes this side-effect is 2-fold.
- There is direct injury to the intestinal lining due to prostaglandin effects caused by NSAIDs.
- NSAIDs also inhibit our platelets to some extent, which increase the time required for the body to form a clot. Clotting is necessary to stop the bleeding process. This effect is mild and even negligible for many people, but for some individuals whose platelets are always low this relatively small drop in platelet function can be significant.
The two most common over-the-counter (OTC) NSAIDs:
- Advil (also known as Motrin). The official (generic) drug name is Ibuprofen.
- Aleve (also knows as Naprosyn). The generic drug name is Naproxen.
Both of these medications are also available in higher dosages by prescription only, but it is not clear that a higher dose is riskier. It seems to be more of an idiosyncratic reaction. Some people can tolerate large quantities and high doses of NSAIDs, while there have been reports of this adverse effect after just one dose. The reaction most typically occurs in individuals who use NSAIDs frequently.
Aspirin is also related to the NSAID class of medications because it also inhibits COX (cyclo-oxygenase) enzymes, which has a suppressive effect on inflammation. Aspirin is the only NSAID that can be absorbed directed through the stomach lining and therefore has greater potential for stomach ulceration and bleeding. Aspirin also inhibits our platelets far more effectively than all the other NSAIDs. In fact, Aspirin has such a strong effect on platelets that it takes 7 days for the body to restore normal platelet function after just one dose. But this is not necessarily a bad thing for everyone.
Many doctors prescribe Aspirin exactly for this purpose, because it can be quite helpful at reducing the risk for forming blood clots, thereby lowering risk of heart attack and stroke in some individuals. For this reason, many people take baby Aspirin (low dose Aspirin) every day. There are also some studies indicating that taking Aspirin every day provides some protection from certain cancers, in particular colorectal (Colon) cancer.
Please note that NSAIDs can interact with a variety of other medications, including other NSAIDs to increase the risk of life threatening bleeding events. Carrying a Medication Card can prevent doctors from prescribing medications that interact in this dangerous way.
*Check out PAA’s ultra-thin, water-resistant, and extremely durable Wallet-Medication-Cards.
We at PAA are eternally concerned about the gigantic problem with medication safety. Questions about NSAIDs and the topic of Medication Safety are important and welcome here. Please submit questions or personal stories in the ‘comments’ section below and I will respond promptly.
Justin Groode MD | Patient Advocate Alliance, LLC
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