People over 60, with a history of stomach bleeding, taking anticoagulants or steroids should consult a doctor before using painkillers like ibuprofen

Painkillers such as ibuprofen, naproxen, and aspirin can harm the stomach. In the high-dose trials, people taking ibuprofen had about 4 times the risk of stomach bleeding or a hole in the stomach wall, compared with people not taking it. The risk is higher for older people, people who have had stomach bleeding, people who are also taking a blood thinner or a steroid drug, and people who drink more than 3 cups of alcohol a day.

Cost

No cost involved. Simply ask a doctor or pharmacist.

Benefit

These medications are classified as nonsteroidal anti-inflammatory drugs (NSAIDs); common examples include ibuprofen, naproxen, and diclofenac. A meta-analysis encompassing 280 randomized trials involving 124,513 participants demonstrated that compared to placebo, ibuprofen raised the risk of upper gastrointestinal perforation, obstruction, or bleeding by an RR of 3.97 (95% CI 2.22–7.10; roughly about 4 times). Naproxen showed an RR of 4.22 (2.71–6.56), while diclofenac resulted in an RR of 1.89 (1.16–3.09). All NSAIDs also approximately double the risk of heart failure. U.S. regulations mandate that over-the-counter NSAIDs carry warnings about stomach bleeding; these warnings specifically identify six high-risk groups: individuals over 60, those with prior stomach ulcers or bleeding, people on anticoagulants or steroids, individuals concurrently taking multiple NSAIDs, drinkers consuming more than three alcoholic beverages daily, and users exceeding recommended dosages or duration.

Notes

The study conclusions pertain to high-dose usage. No separate figures are provided for occasional short-term use at standard doses. Many multi-ingredient cold remedies also contain NSAIDs; combining them with separate painkillers results in redundant intake. Patients prescribed low-dose aspirin long-term by physicians for thrombosis prevention must not discontinue it or self-administer additional NSAIDs without medical guidance. For how to use painkillers like these for period pain and when to see a gynecologist, see Section 3, item 25 (taking ibuprofen-type painkillers for period pain).

Sources · 2

1. 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. doi.org/10.1016/S0140-6736(13)60900-9
2. 21 CFR 201.326(a)(2)(iii)(A) Stomach bleeding warning. ecfr.gov/current/title-21/chapter-I/subchapte…