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Home > Pain Management > What Are the Harmful Effects of Pain Relievers?

What Are the Harmful Effects of Pain Relievers?

December 13, 2022
5 min read
By Shiza Khan, M.Sc. – Clinical Nutrition & Dietetics | Dietitian/Nutritionist

In this article:

  • Harmful Effects of OTC Painkillers
  • Who Can Take Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?
  • Final Word

Some medicines are an indispensable part of every first-aid kit. These include painkillers such as acetaminophen (paracetamol) as well as nonsteroidal anti-inflammatory drugs (NSAIDs) (1) such as aspirin, ibuprofen, and naproxen.

harmful health effects of taking over-the-counter pain medications

Since they are easily available without a prescription, people often end up using them too much or too frequently, which may lead to negative side effects. This is why it is important to follow the dosage and instructions given on the label of over-the-counter (OTC) medicines.

The efficacy of the medication can vary depending on the type and severity of pain as well as other factors such as dosage. (2)

Harmful Effects of OTC Painkillers

Overuse of OTC pain medication can damage your health in the following ways.

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1. Kidney problem

Long-term or excessive use of certain painkillers and nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, acetaminophen, and naproxen sodium can increase the toxic load on your kidneys. (3)

The small blood vessels inside the kidneys have to work extra hard to filter out the waste from these medications. This can damage the blood vessels over time, resulting in analgesic nephropathy, a chronic kidney problem.

The risk of drug-induced kidney injury is further increased if you take these medicines while being dehydrated or having low blood pressure. (4)

2. Liver damage

taking certain NSAIDs can harm liver health and lead to liver damage

Aspirin and acetaminophen (paracetamol) are widely used nonsteroidal anti-inflammatory drugs that are easily available over the counter. Taking them in high doses can be toxic for the liver, but the resulting damage may not be clinically apparent.

In most cases, liver injury caused by NSAID overdose leads to acute hepatitis within 1–3 months of starting the medication. (5) If you continue taking too much of this med for a long time, it can severely damage your liver and can even be fatal. (6)

Acetaminophen is the leading cause of drug-induced liver injury in the United States, but taking it in its recommended dosages can save you from this risk.

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According to the United States Food and Drug Administration, a healthy adult should not take more than 4,000 mg of acetaminophen a day, while those with preexisting liver disease are recommended to keep the dose to 2,000 mg or less a day. (7)

3. Stomach issues

Common nonsteroidal anti-inflammatory drugs and painkillers such as diclofenac, naproxen, aspirin, and ibuprofen contain acetylsalicylic acid. Thus, these meds tend to increase gastric acidity, which, in turn, irritates and damages the inner lining of the stomach and duodenum.

NSAIDs also disrupt the healthy gut microbiome and bowel movements. Extensive or excessive use of these drugs may even cause ulcer formation in the stomach and small intestine. (8)

The best way to minimize these adverse effects is to take an antacid along with such medication. This proactive measure will help neutralize the acidity triggered by NSAIDs, analgesics, and antibiotics.

4. Heart failure

taking NSAIDs for prolonged period/high doses can lead to heart faliure

Taking NSAIDs for a prolonged period or in high doses can increase your cardiovascular risk, which may lead to a heart attack, stroke, heart failure, and even death. (9)(10) There is plenty of research to corroborate this claim, including a 2011 study published in BMJ and a 2013 review published in The Lancet.

In 2004, a very popular nonsteroidal anti-inflammatory drug called Vioxx (rofecoxib) was discontinued from the market due to this concern. (11)

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Who Can Take Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?

NSAIDs are easily available without a prescription because they are generally considered safe for everyone. But overusing these meds can cause toxicity and lead to adverse health outcomes.

Certain factors can make you increasingly vulnerable to NSAID side effects. These factors include:  

  • If you are below 16 years or above 65 years of age
  • If you are pregnant or trying to conceive
  • If you are breastfeeding
  • If you are on other medications
  • If you have asthma
  • If you have previously suffered an allergic reaction to NSAIDs
  • If you have a history of stomach ulcers
  • If you have any kind of preexisting heart, liver, or kidney ailment
  • If you suffer from preexisting blood pressure, blood circulation, or bowel problems

If you have any of these risk factors, you must consult your doctor before starting any medication. The doctor may not prohibit the use of NSAIDs in such cases but will consider all the relevant factors, rule out risks, and recommend the appropriate dosage for your particular case.

If the doctor deems nonsteroidal anti-inflammatory drugs to be unsuitable for you after the evaluation, he may recommend a better alternative such as paracetamol. (12)

Final Word

OTC painkillers are largely considered safe and effective for healthy adults, but only when used occasionally and as directed. (1)

If you have to take them frequently, are on other medications, or have preexisting medical conditions, it’s best to consult your doctor to reduce the risk of side effects. (13)(14)

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References
  1. Center for Drug Evaluation and Research. The best way to take your over-the-counter pain reliever? seriously. (four panel brochure). U.S. Food and Drug Administration. https://www.fda.gov/drugs/safe-use-over-counter-pain-relievers-and-fever-reducers/best-way-take-your-over-counter-pain-reliever-seriously-four-panel-brochure.
  2. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Using medication: The safe use of over-the-counter painkillers. 2016 Apr 6 [Updated 2017 Aug 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361006/.
  3. Analgesic nephropathy. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/analgesic-nephropathy. Published August 8, 2021.
  4. Keeping kidneys safe: Smart choices about medicines. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/keeping-kidneys-safe.
  5. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Nonsteroidal Antiinflammatory Drugs (NSAIDs) [Updated 2020 Mar 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548614/.
  6. Common bacterial skin infections. Common Bacterial Skin Infections | University Hospitals. https://www.uhhospitals.org/health-information/health-and-wellness-library/article/adult-diseases-and-conditions-v0/other-bacterial-skin-infections.
  7. Rotundo L, Pyrsopoulos N. Liver injury induced by paracetamol and challenges associated with intentional and unintentional use. World J Hepatol. 2020;12(4):125-136. doi:10.4254/wjh.v12.i4.125
  8. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Gastritis: How can you prevent painkiller-related peptic ulcers? 2010 Jun 30 [Updated 2018 Jun 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310269/.
  9. Gordin JS, Fonarow GC. New medications for heart failure. Trends Cardiovasc Med. 2016;26(6):485-492. doi:10.1016/j.tcm.2016.02.008.
  10. Varga Z, Sabzwari SRA, Vargova V. Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue. Cureus. 2017;9(4):e1144. Published 2017 Apr 8. doi:10.7759/cureus.1144.
  11. NSAIDs and the risk of heart problems and stroke. https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/nsaids-risk-of-heart-problems-and-stroke.
  12. NHS choices. https://www.nhs.uk/conditions/nsaids/.
  13. Staff FE. Best OTC pain relievers – understanding your option. familydoctor.org. https://familydoctor.org/pain-relievers-understanding-your-otc-options/. Published April 18, 2022.
  14. OTC pain medicines and their risks. OTC Pain Medicines and Their Risks | University Hospitals. https://www.uhhospitals.org/health-information/health-and-wellness-library/article/adult-diseases-and-conditions-v1/otc-pain-medications-and-their-risks.
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