The popular OTC painkillers are designed for short-term use, and for good reason.
I go through a bottle of ibuprofen every few months – it’s my go-to for all my aches and pains. Do I have to worry about taking it too much?
Dear Reader:
Yes, you do! Ibuprofen has been around since the 1960s and is one of the most popular OTC anti-inflammatories available, especially since it works so well for joint pain, which many of us have. But like any drug, it should be used sparingly and only in the short-term. This goes for all other types of drugs in the NSAID (non-steroidal anti-inflammatory drug) category, including other OTC medicines such as naproxen as well as prescription NSAIDs such as diclofenac sodium. When you become too reliant on these medications over an extended period time, it raises the risk of kidney damage.
Why the Kidney?
As a nephrologist, or kidney doctor, I have a unique vantage point. I have seen the damaging, irreparable effects that excessive OTC painkiller use can leave on the kidney, a life-sustaining organ that balances the electrolytes in our body and removes excess fluid.
The damage from NSAIDs happens indirectly. The medicines work by blocking the production of chemicals called prostaglandins, which cause pain and inflammation. But prostaglandin also plays a role in blood flow to the kidney, so when production drops, kidney cells don’t get enough oxygen from blood and they begin to die off.
Kidney cells have a limited capacity to repair themselves, so in many cases the damage is irreversible. Unfortunately, there is no treatment or cure for kidney damage – the condition can only be managed from getting worse. In severe cases, a dialysis machine is needed to do the work of the kidney.
Simple Testing Can Tell
All of this is easily avoided! Before you get ready to take that pill, ask yourself, do I really need this? Am I taking too much? A typical pattern is patients starting with one to two ibuprofen a week, and when that does not solve the problem, they increase their dosage and frequency. This is when problems may occur.
To further complicate matters, everyone tolerates ibuprofen differently. Some long-term users might have no kidney damage whatsoever, however, I had one patient who took NSAIDs for two to three months and ended up on dialysis. That is extremely rare, but it emphasizes the importance of being aware and getting a kidney screen at your next checkup. Some doctors may not order this simple urine or blood test routinely, so if you are a frequent NSAID user you should specifically request it.
If this screen comes back with elevated levels of creatinine, your physician will likely refer you to someone like me who can evaluate further. Unfortunately, there are no symptoms to indicate the onset of kidney damage, but one of the more common side effects of NSAIDs, stomach irritation, may be an indication that you are taking too many and you should see your primary care physician to get checked out.
Use Common Sense
As with any medication, moderation and common sense is best. Stick with a low dose and low frequency. Also, consider these alternatives that lessen the risk of kidney damage:
- Acetaminophen – For most people, it doesn’t work as well as ibuprofen for joint and arthritic pain, but the risk of kidney damage is much lower.
- Excedrin – A combo pill that includes aspirin, acetaminophen and caffeine. Aspirin is also an NSAID, but in low doses will not damage the kidney.
- Turmeric – This Middle Eastern spice contains curcumin, known for its anti-swelling properties. It’s also available in pill and topical form.
Remember, it’s always a good idea to review your recent medication history with your primary care physician during your annual checkups. Just because it’s OTC, doesn’t mean it is not without risks.
Dr. Ronald R. Reichel of White Plains Hospital Physician Associates is board-certified in nephrology and internal medicine; he sees and treats patients for chronic kidney disease (CKD), acute kidney injury (AKI), electrolyte disorders, acid-base disorders, secondary hypertension, hyperparathyroidism, proteinuria, kidney transplants as well as kidney stones. To make an appointment, call 914-849-7060.