Ask a clinician before taking an NSAID painkiller if you are 60 or older, have had stomach bleeding, or take an anticoagulant or steroid
Painkillers such as ibuprofen, naproxen, and aspirin can injure the stomach. In trials using high doses, ibuprofen was associated with about four times the risk of serious upper gastrointestinal complications, including bleeding and perforation, compared with placebo. Older age, previous stomach bleeding, anticoagulant or steroid use, and daily alcohol use increase concern.
What it takes
Nothing for the action itself. Ask a doctor or pharmacist.
What you may gain
These drugs are called nonsteroidal anti-inflammatory drugs, or NSAIDs; common examples include ibuprofen, naproxen, and diclofenac. A meta-analysis included 280 randomized trials comparing NSAIDs with placebo, involving 124,513 participants. Relative risks of upper gastrointestinal perforation, obstruction, or bleeding were 3.97 for ibuprofen (95% CI 2.22–7.10, approximately fourfold), 4.22 for naproxen (2.71–6.56), and 1.89 for diclofenac (1.16–3.09). All of the NSAID regimens roughly doubled the risk of heart failure. US regulations require a stomach-bleeding warning on over-the-counter NSAIDs. It identifies six higher-risk situations: age 60 or older; a history of stomach ulcers or bleeding; taking an anticoagulant or steroid; taking another NSAID; having three or more alcoholic drinks daily while using the drug; and taking more than directed or for longer than directed.
Context & considerations
The paper's conclusions concern high-dose regimens. It does not give a separate risk estimate for occasional use for a day or two at the labeled dose. Many combination cold remedies also contain NSAIDs, so check ingredients before adding a painkiller. If a doctor has prescribed long-term low-dose aspirin to prevent blood clots, do not stop it or add another painkiller on your own.
Research & references
Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9894):769–779. https://doi.org/10.1016/S0140-6736(13)60900-9; 21 CFR 201.326(a)(2)(iii)(A), Stomach bleeding warning. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.326