Advil and Ibuprofen for Back Pain – The Risks

Starting in 2015, the FDA required that manufacturers of non-steroidal anti-inflammatory medication strengthen the warnings on their prescription drug labels. This affects both prescription and over-the-counter NSAIDs. (These warnings are called drug facts labels.) The strengthened warnings now indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the chance of a heart attack or stroke, either of which can lead to death.

Note that though also an NSAID, the FDA says their revised warning does not apply to aspirin.

About Advil and Ibuprofen Risks

Ibuprofen tablets medicine
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Advil is an NSAID often recommended or prescribed to people with neck or back pain. NSAIDs are anti-inflammatory medications known to relieve pain and reduce swelling. They are sometimes given in prescription doses for arthritis and pain conditions.

The generic name for Advil is ibuprofen. Other forms of ibuprofen exist, as well, including Motrin and Aleve. That said, the FDA warns you to take only one ibuprofen product at a time. The best way to figure out if you’re ingesting more than one is by reading the labels of each drug you’re considering and comparing their active ingredients, the FDA informs.

Risks vs Benefits

Like any medication, the use of Advil comes with potential benefits as well as risks to your health. The benefits, of course, are the promise of pain relief, as well as control of swelling and therefore possible scar tissue down the road.

As far as risks go, some are minor, while others can be fatal.

Heart Attack Risk

The Food and Drug Administration (FDA) says that if you take NSAIDs, of which Advil is one, the chances of your having a cardiovascular event is higher than it is for people who do not take this drug. Cardiovascular events include both heart attack and stroke.

The NHS (in the UK) says a heart attack occurs when the heart’s blood supply is blocked.

The bad news is that even if you’re a first time NSAID user or you take it in the short term only, you are not exempt from the possibility of a heart attack.

According to the FDA, a heart attack can occur as early as the first few weeks of NSAID use, though the risk might be higher with longer-term use. 

“There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division.

It’s important to know that a fatal heart attack can happen without warning. This is one reason why staying in good communication with your doctor is paramount. Working with your doctor may include things like thoroughly describing your family’s history of cardiovascular events, being honest about your smoking habits, and making sure you have the conversation about your cholesterol, blood pressure and/or diabetes, as these measurements/conditions relate to the risks posed to you from taking ibuprofen.

The FDA also warns you not to take ibuprofen just before or after a coronary artery bypass graft, also known as CABG. CABG is a heart procedure.

What to Do:

If you experience symptoms of heart problems, such as chest pain, difficulty breathing, sudden weakness in one part or side of the body, stop taking the NSAID and seek immediate medical attention.

Stroke Risk

Like a heart attack, a stroke is a cardiovascular event and one of the possible side effects of taking Advil.

A stroke occurs when the blood supply to the brain is disturbed, says the NHS in the UK. Strokes can be very serious and can occur without warning.

Most of the facts and warnings around stroke risk—especially as these relate to taking Advil/ibuprofen or other NSAIDs—are similar to those for heart attack. This includes the FDA’s 2015 assertion that even short-term use can increase your risk.

As with the risk for heart attack, taking Advil may make you more vulnerable to a stroke than not taking it, even at the beginning of the medication course. Just the same, long-term users may have a higher risk, according to the FDA.

Speak with your doctor about your risk factors and be honest with her about your not-so-good health habits such as smoking. Also be sure to let her know if any member of your family has had a stroke. It's a good idea to learn how to spot the symptoms of a stroke.

What to Do:

The acronym FAST is a handy way to keep this information nearby. With FAST, you look for 3 symptoms and if they are there, you take 1 action as follows:

  1. Face - Uneven
  2. Arm - One arm hanging down.
  3. Slurred Speech
  4. Time to call 911 - Every second counts in terms of preserving life and the ability to function, so don't delay.

In fact, 10-year-old Sophia Tabors of St. Louis did her science fair project on "how to tell when someone's having a stroke, and what to do." Because of this project, Sophia was able to detect when her grandfather was having a stroke. CBS News reports she was able to recognize the symptoms while they were occurring and take the appropriate action of telling her mother, who then called 911. The doctor said that Sophia and her mother's quick response helped saved Sophia's grandfather a lot of functioning and possibly his life.

Stomach Ulcer and Bleeding Risk

Because Advil is an NSAID, you may be subject to side effects that affect the lining of your stomach and your digestive system. Examples include ulcers, bleeding in the lining of the stomach, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning, and can cause death.

According to Dr. Theodore Fields, attending physician at the Hospital for Special Surgery in New York, GI problems such as the development of ulcers, are the most common side effects of taking Advil.

The risk may be higher if you take NSAIDs over the long term, if you're older, have poor health, and/or drink three or more alcoholic drinks per day while taking ibuprofen.

Some good news: Fields says that stomach and digestive related side effects from taking Advil are often not serious.

But side effects can happen at any time, he comments. In severe cases, the NSAID medication may irritate your stomach lining such that it erodes a small area of it. This is an ulcer. In the worst cases, he says, the erosion can lead to internal bleeding, which may be life-threatening.

What to Do:

Minimize the risk of ulcers by taking your NSAID at the end of a full meal or with an antacid. If you notice symptoms such as severe abdominal pain, tarry stools or blood in your stool, stop taking the medication and call your doctor as soon as possible.

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