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Ibuprofen

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New data suggests that two common painkillers, ibuprofen and diclofenac, can slightly increase the risk of heart problems if taken in high doses for a long time.

People with severe arthritis often take the drugs, which also calm inflammation, to go about daily life.

The researchers said some patients would deem the risk acceptable, but they should be given the choice.

A study, published in the Lancet, showed the drugs posed even greater risks for smokers and the overweight.

The risks have been reported before, but a team of researchers at the University of Oxford analyzed the issue in unprecedented detail in order to help patients make an informed choice.

The group investigated more than 353,000 patient records from 639 separate clinical trials to assess the impact of non-steroidal anti-inflammatory drugs.

They looked at high-dose prescriptions levels, rather than over-the-counter pain relief, of 150 mg diclofenac or 2,400 mg ibuprofen each day.

They showed that for every 1,000 people taking the drugs there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding – every year as a result of taking the drugs.

Common painkillers ibuprofen and diclofenac can slightly increase the risk of heart problems if taken in high doses for a long time

Common painkillers ibuprofen and diclofenac can slightly increase the risk of heart problems if taken in high doses for a long time

So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drugs.

“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients,” said lead researcher Prof. Colin Baigent.

He added: “So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life.”

He said this should not concern people taking a short course of these drugs, for example for headaches.

However, he did warn that those already at risk of heart problems would be at even greater risk as a result of the high-dose drugs.

High blood pressure, cholesterol and smoking all increase the risk of heart problems.

Prof. Colin Baigent said: “The higher your risk of heart disease, the higher your risk of a complication. Roughly speaking, if you’ve got double the risk of heart disease, then the risk of having a heart attack is roughly doubled.”

He said patients should consider ways to reduce their risk, which could include statins for some patients.

A similar drug called rofecoxib (known as Vioxx), was voluntarily taken off the market by its manufacturer in 2004 after similar concerns were raised.

A third drug, naproxen, had lower risks of heart complications in the study and some doctors are prescribing this to higher-risk patients.

The drug does a similar job to aspirin by stopping the blood from clotting although this also increases the odds of a stomach bleed.

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Women who use painkillers such as ibuprofen during pregnancy are twice as likely to suffer a miscarriage, according to a University of Montreal study.

Specialists warn that tens of thousands of expectant mothers are taking the pills unaware of the dangers.

Ibuprofen

Ibuprofen

The major study, which was run by the researchers at University of Montreal, Canada, has found that women who took ibuprofen or similar painkillers just before they conceived until the 20th week of pregnancy were 2.4 times more at risk.

Although there are visible warnings on the drugs’ insert package saying they should not be used in pregnancy, as many as one in six expectant mothers still take them.

The Canadian study involved a group of painkillers known as Non-Steroidal Anti Inflammatory Drugs or NSAIDS, which include OTC’s (over-the-counter) ibuprofen and naproxen.

Aspirin (acetylsalicylic acid) is also in this category although it wasn’t included in the study, while paracetamol is deemed safe.

The Canadian researchers believe taking any number of the drugs can lead to the embryo not being properly implanted in the womb meaning a woman is far more likely to suffer miscarriage, which known as a spontaneous abortion.

Approximately one in eight pregnancies end in miscarriage and the majority happen in the first 12 weeks.

Often there is no obvious cause but older women and those who smoke, drink heavily or are obese are at far higher risk.

The study involved 47,050 women aged 15 to 45 and its results have been published in the Canadian Medical Association Journal.

The participants into the study were asked whether they had taken the painkillers at any time in the first 20 weeks of their pregnancy or two weeks before they became pregnant.

Despite the drug insert package warnings, about 17% of women had taken the drugs – nearly one in six.

Dr. Anick Bérard, researcher at the University of Montreal said:

“We consistently saw that the risk of having a spontaneous abortion was associated with gestational use of diclofenac, naproxen, celecoxib, ibuprofen and rofecoxib alone or in combination.

“Women who were exposed to any type and dosage of non-aspirin NSAID during early pregnancy were more likely to have a spontaneous abortion.”

But doctors pointed out the risks of a woman suffering a miscarriage due to painkillers were very small.

They also said the study did not take into account other possible causes such as smoking and obesity.

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