Strong stuff, but take it safely

NSAIDs are a solution for pain against which an ordinary paracetamol is no longer helpful. Pain at rheumatic conditions for example, or in gout, a bursa or tendonitis.

What are NSAIDs?

NSAIDs stand for non-steroidal anti-inflammatory drugs, or non-hormonal anti-inflammatory drugs. Examples of the active substances are ibuprofen, diclofenac and naproxen. Until the early 1990s, they were only available on prescription, but since then you can simply buy them at the drugstore or pharmacy.

Doses of over-the-counter NSAIDs have increased over the years. Since 2010, naproxen has even been available in doses of 550 milligrams. Not all doctors and pharmacists are happy about this. The Amsterdam GP Joachim Knap: “That is a high dose, with potentially strong side effects. But many people do not read the package leaflet and the information that the pharmacist provides does not always get through. People often even think that NSAIDs are harmless, because they may be touted by commercials, and those commercials are basically saying, “Buy it, they’re good painkillers!” They are, but they are also dangerous.”

Extra careful

And that ‘dangerous’ is not an exaggeration. According to data from 2008, 1100 people are hospitalized every year due to incorrect NSAID use. The majority of these involve complications in the upper gastrointestinal tract (such as stomach bleeding). Bleeding in other places also occurs. Other NSAIDs should be included because their kidney function suddenly deteriorates rapidly or because they suddenly (or worsen) suffer from heart failure.

General practitioner Knap has many elderly people in his practice and it is precisely with them that problems often occur. “I am sometimes amazed at how easily people tell what medication they have tried. The elderly should be extra careful with NSAIDs, because the side effects are more severe with them due to their older age. Also in combination with certain conditions or other medicines, the risk of side effects increases. Those who use an NSAID and are older than 70 years (or older than 60 years and take a blood thinner) have an increased risk of serious stomach problems, such as an ulcer or stomach bleeding.”

Stomach upset

NSAIDs have the side effect that they can damage the lining of the stomach (and intestines). This can lead to ulceration and eventually to bleeding, requiring hospitalization. Annoyingly, the NSAID use makes the bleeding more intense, because these painkillers inhibit the action of the platelets. And if someone also uses blood thinners, for example after a thrombosis, the fence is completely off the dam.

Dozens of people die every year from stomach bleeding as a result of NSAID use. Knap: “It has been known for a long time that older people have to take an antacid in addition to an NSAID. But not everyone does that. I am afraid that the number of fatal stomach bleeding will increase because antacids will soon no longer be reimbursed for many people.”

Own responsibility

“We try to keep a closer eye on drug use in collaboration with pharmacists,” says Knap, “but the system is never watertight. When the drugs went on sale, they were only allowed in boxes of a maximum of ten or twenty pills. but of course you can easily build up a larger stock by going to more drugstores and pharmacies.That information does not always reach your regular pharmacy, or the general practitioner or specialist.In fact, it can happen that the doctor also prescribes NSAIDs , which only increases the dangers.”

It is therefore up to the patient to inform the pharmacist, general practitioner or specialist about the medicines that have not been prescribed by the doctor. “And that doesn’t always happen,” Knap knows. “I think the NSAIDs should simply be taken off the market altogether.”

Many worried doctors, such as Knap and also the pharmacists’ organization KNMP, raised the alarm with the Ministry of Health, Welfare and Sport. Knap is not satisfied with the result. “NSAIDs can still be bought without a prescription. Although high-dose naproxen can only be bought at the pharmacy, the responsibility remains with the patient. And as far as I’m concerned, she doesn’t belong there.”

Guidance

The moral of the story: if you are in pain, choose paracetamol first. That often helps just as well and has far fewer side effects. Take up to six 550 mg a day or 1000 mg three times a day. Only if that does not help, an NSAID is a good choice. Always read the package leaflet to make sure it is suitable for you. Do not swallow more than is allowed, even if the pain remains severe. In that case, it is better to combine an NSAID and paracetamol, for example. The leaflet states how much you can take per day.

If you are currently using an NSAID for a long time, discuss this with your doctor or pharmacist. They can check whether the type of painkiller you are taking and the dose is still suitable for you. In any case, tell the pharmacist which medicines you have bought yourself (without a prescription) and ask him to include these in your medication overview. Ask for a printout and take it with you to your practitioner(s).