Does taking nonsteroidal anti-inflammatory drugs (NSAIDs) increase my risk of heart attack or stroke?
Answer From Rekha Mankad, M.D.
Yes. Nonsteroidal anti-inflammatory drugs (NSAIDs) — medications commonly used to treat pain and inflammation — can increase the risk of a heart attack, stroke and high blood pressure, whether you already have heart disease or not, although the risk is greater in those who have heart disease.
NSAIDs, available over-the-counter or with a prescription, include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox DS, others), diclofenac sodium (Voltaren, Solaraze, others) and celecoxib (Celebrex). One study found celecoxib used at moderate doses to cause less risk of cardiovascular diseases than ibuprofen or naproxen did, but more research is needed.
If you need to take an NSAID, take the smallest dose for as short a time as possible to limit the risk of heart attack or stroke. NSAIDs are also probably safe to take once in a while. But be aware that serious side effects can occur as early as the first weeks of continuously using an NSAID and the risk can increase the longer you take it.
To help ease muscle or joint pain, consider other therapies — such as hot or cold packs or physical therapy — before taking NSAIDs. Your doctor might suggest other medications, such as acetaminophen (Tylenol, others) for general pain relief. If you have the coronavirus, there's no evidence that ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) need to be avoided.
Aspirin doesn't appear to be associated with a higher risk of heart attack or stroke. If you take aspirin to help prevent a heart attack, talk with your doctor before taking NSAIDs. Some NSAIDs interact with aspirin and affect its ability to prevent a heart attack.
If you develop signs or symptoms of a heart attack or stroke — such as chest pain, shortness of breath, weakness in one part of the body or side of the body, or sudden slurred speech — get medical attention right away.
Dec. 10, 2020
- FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. U.S Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm. Accessed Nov. 9, 2020.
- Rane MA, et al. Risks of cardiovascular disease and beyond in prescription of nonsteroidal anti-inflammatory drugs. Journal of Cardiovascular Pharmacology and Therapeutics. 2020; doi: 10.1177/1074248419871902.
- Atiquzzaman M, et al. Role of nonsteroidal antiinflamatory drugs in the association between osteoarthritis and cardiovascular diseases: A longitudinal study. Arthritis & Rheumatology. 2019; doi:10.1002/art.41027.
- Solomon DH. NSAIDs: Adverse cardiovascular effects. https://www.uptodate.com/contents/search. Accessed Nov. 9, 2020.
- Bindu S, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical Pharmacology. 2020; doi:10.1016/j.bcp.2020.114147.
- NSAIDs and the risk of heart problems and stroke. Arthritis Foundation. https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/nsaids-risk-of-heart-problems-and-stroke. Accessed Nov. 9, 2020.
- Information about taking ibuprofen and aspirin together. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-taking-ibuprofen-and-aspirin-together. Accessed Nov. 13, 2020.
- Pepine CJ, et al. Cardiovascular safety of NSAIDs: Additional insights after PRECISION and point of view. Clinical Cardiology. 2017; doi:10.1002/clc.22814.
- Nissen SE, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. The New England Journal of Medicine. 2016; doi:10.1056/NEJMoa1611593.