If you're like most Americans, you probably take nonsteroidal anti-inflammatory drugs (NSAID), like Advil or Motrin (ibuprofen), or Aleve (naproxen sodium) to treat pain or fever. The U.S. Food and Drug Administration (FDA) recently strengthened its warning that both prescription and nonprescription NSAIDs increase the risk of heart attack and stroke as early as the first weeks of use. One notable exception to this is aspirin, an NSAID  used in low doses to reduce the risk of stroke and heart attack.

“As with any drug, over-the-counter or prescription, it’s best to be conservative,” says Dr. David Shute, GreenField Health Medical Director. “I advise my patients to take non-aspirin NSAIDs only when the benefits exceed the risks and to take the lowest effective dose.”  

Research shows that generally the risk increases with higher doses and the longer use of an NSAID. Also, risks are higher in persons with vascular disease or risk factors for vascular disease.  

Should you stop taking NSAIDs altogether? Not necessarily, says Dr. Shute. “These drugs can be very helpful in certain instances including viral infections and some types of arthritis. The take-home point here is that these medications have more risks than we previously understood and those risks should be carefully weighed against the benefits.”

The FDA also advises:

  • Seek medical attention immediately if you experience symptoms such as:
    • Chest pain
    • Shortness of breath or trouble breathing
    • Sudden weakness or numbness in one part or side of the body
    • Sudden slurred speech
    • Many medicines contain NSAIDs, including those used for colds, flu, and sleep, so it is important to read the labels and avoid taking multiple medicines that contain NSAIDs.
    • Patients who take low-dose aspirin for protection against heart attack and stroke should know that some NSAIDs, including those in over-the-counter (OTC) products such as ibuprofen and naproxen, can interfere with that protective effect.
    • Read the patient Medication Guide you receive with your NSAID prescription. It explains the risks associated with the use of the medicine.
    • Read the Drug Facts label before taking an OTC NSAID. Talk to your health care professional or pharmacist if you have questions or concerns about NSAIDs or medicines that contain them.

Finally, acetaminophen (Tylenol) is not an NSAID. It is categorized as an analgesic (pain reliever) and antipyretic (fever reducer).  Acetaminophen is not known to increase the risk of stroke and heart attack and is a safer alternative to NSAIDS.  “Unfortunately, many patients find it less effective,” says Dr. Shute.