Where were you in 1974?

You could have seen the movie The Sting, starring Paul Newman and Robert Redford. Its soundtrack introduced ragtime music, showcasing Scott Joplin’s musical genius.

1974 the Food and Drug Administration approved ibuprofen as a prescription medicine to treat mild to moderate pain and inflammation.

Acetaminophen eases headaches and fever, but ibuprofen is more effective for muscle aches and inflammation. In 1974, doctors could prescribe ibuprofen instead of aspirin for muscle aches, arthritis pain and swelling, and menstrual cramps.

Aspirin and ibuprofen are non-steroidal anti-inflammatory medications or NSAIDs. Ibuprofen is less irritating to the stomach than aspirin, which gives better pain relief and fewer side effects.

One decade later, facing the expiration of its patent, ibuprofen's manufacturer applied to the FDA for approval to sell it without a prescription. In addition to the 400mg, 600mg, and 800mg tablets of prescription-only Motrin®, in 1984, the FDA approved ibuprofen as Motrin-IB® 200mg tablets, available over the counter (OTC).  

Years later, naproxen followed the same path: first as a prescription-only anti-inflammatory, then approved for OTC use as Aleve®. The main options for pain relief by mouth without a prescription today include aspirin, acetaminophen, ibuprofen, and naproxen.

Non-prescription doses of naproxen or ibuprofen are much safer than aspirin and more effective than acetaminophen in relieving muscle pain, menstrual cramps, and toothache.

Although taking an NSAID is usually safe for easing fever and muscle aches, it can be dangerous for people with certain medical conditions like heart failure.

82-year-old Diana takes a water pill daily for her heart failure, preventing fluid from building up in her lungs.

Last month, Diana started taking ibuprofen (Advil®) for a sinus headache. She continued her medications, but the ibuprofen in the Advil® triggered fluid retention. She ended up in the hospital with trouble breathing from fluid in her lungs and swelling in her hands and feet.

NSAIDs can also spell trouble for people with kidney problems, like diabetics. Taking ibuprofen or naproxen by prescription or OTC can trigger kidney damage,  especially if you get dehydrated. Excessive sweating or suffering from vomiting or diarrhea can cause dehydration. Taking NSAIDs when your body is low on fluids can seriously harm your kidneys.

People who have had a bleeding ulcer should also avoid taking NSAIDs like ibuprofen and naproxen. These medicines interfere with maintaining the protective gel layer that lines your stomach, protecting it from the acids you secrete to digest your food. Taking ibuprofen or naproxen erodes the gel lining of your stomach, making it thinner, which puts you at risk for stomach pain or bleeding.

When taken at the beginning of menstrual flow, just one dose of ibuprofen or naproxen can head off debilitating abdominal cramps. One dose of an NSAID right before a tooth extraction can avoid suffering from swollen  "chipmunk cheeks" afterward. 

Do you make frequent trips to the bathroom at night? One intriguing side effect of NSAIDs is reducing the frequency of urination. You only need a small dose: one 200mg ibuprofen tablet or Advil® Dual Action tablet at bedtime is enough to make a difference.

Here are 5 Tips to Help Keep Yourself Safe When Taking NSAIDs:

1.           Keep yourself hydrated.

Even young, healthy people can suffer severe kidney damage if they become dehydrated while taking an NSAID medicine. NSAIDs interfere with your body’s safety net for your kidneys when you get low on fluid.

2.           Ask your doctor first.

Most people can take low doses of ibuprofen or naproxen without harm. However, NSAIDs can aggravate and accelerate kidney problems. If you have diabetes, take Tylenol® (acetaminophen) for aches and pains instead of an NSAID, and consult your doctor before taking ibuprofen or naproxen.

3.           Protect your heart.

If you have congestive heart failure, also called CHF, avoid taking any medicine that includes an NSAID. By causing sodium and water retention, ibuprofen and naproxen counteract the beneficial effects of water pills that help to keep fluid out of your lungs and reduce swelling in your hands and feet.

4.           Watch your blood pressure.

NSAIDs often cause your blood pressure to rise. They can interfere with how medicines keep your blood pressure in a normal range.

5.           Don’t double up.

It’s surprisingly easy to take two NSAIDs at the same time. That’s because the prescription strengths have different brand names than the OTC versions of the same medicines. Not realizing that you are taking two drugs with the same ingredient puts you at risk for overdose and side effects like stomach pain, bleeding, kidney and heart problems.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

Ó2023 Louise Achey