Under or Over the Counter?

The trouble with ibuprofen

by ALICIA PRIEST

It’s time to say good night. As our visiting friends prepare to descend the stairs to the guest room, we offer them an alarm clock, glasses of water, and extra blankets should the coolness of the basement turn too cold.

Suddenly, they take out a small plastic bottle and offer us something in return: “Anyone for an Advil?” Apparently, for them it’s an end-of-day ritual as regular as brushing their teeth.

Whether it’s muscle aches, joint pain, head­aches, backaches, or just plain fatigue so deep it racks our bones, welcome to the age of ibuprofen—
a drug found in Advil, Motrin, and many other over-the-counter products. After a certain age, it seems, popping a pill before bed is routine.

Ibuprofen belongs to a class of pharmaceuticals called non-steroidal anti-inflammatory drugs (NSAID). One little-known fact about these concoctions is that, according to the American Gastroenterological Association, more people die annually in North America from NSAID side-effects than from AIDS. So how do they work? In a nutshell, NSAIDs act by blocking production of an enzyme that makes prostaglandins, chemicals that cause pain and inflammation.

Athletes have been consuming ibuprofen in regular and large doses for years. Initially, they used it to treat the swelling and injuries that resulted from pushing their bodies past normal limits. But now, ibuprofen is often taken before the big push, as a way to prevent the inevitable soreness following athletic performance.

There is nothing heroic about putting up with pain. In fact, suffering exacts a high mental and physical toll—numerous studies show that chronic pain wreaks havoc on people’s relationships, their ability to work, and their quality of life. But this is not major pain we’re talking about. These products are designed for temporary relief of mild to moderate pain, not the crippling ache of rheumatoid or osteo-arthritis.

All pharmaceutical treatments—whether behind or over the pharmacy counter—contain some risk of harm. Even aspirin and acetaminophen have come under scrutiny because of serious concerns about overuse. (Too much aspirin causes stomach bleeding and too much acetaminophen results in liver and kidney damage.) Obviously, people get a false sense of safety about a drug when it’s made as accessible as toilet paper and toothpaste. In too many cases, self-medication leads to indiscriminate and chronic use.

Safe when taken in low doses for short periods of time, ibuprofen can harm a person’s health when taken (as many people, including my houseguests, do) every day for years.

According to a 2005 McMaster University study, people who take high doses of ibuprofen—even for short periods—are three times more likely to experience stomach bleeding than those who do not take painkillers. Researchers expressed surprise at the finding because ibuprofen was thought to be one of the safest drugs around. The study, however, suggested that even healthy young people are at great risk of internal bleeding if they take large amounts of ibuprofen. Participants in the study took about double the recommended maximum dosage.

While the drug is intended for short-term use, a Health Canada advisory panel concluded in 2005 that, in reality, it is “frequently being used chronically and at a high dose.” The panel’s main concern, however, was not stomach bleeding but ibuprofen’s possible cardiovascular risk. In June 2006, European scientists reported in the British Medical Journal that people on prolonged high doses of ibuprofen have similar risks of heart attack as those using prescription-only anti-inflammatory drugs such as Celebrex and Vioxx. The latter was pulled from the market two years ago because studies showed it increased the incidence of heart attacks and strokes. It was the biggest drug recall in history. Given those findings, the panel went on to recommend that Health Canada move ibuprofen behind the pharmacy counter, where it would be sold contingent upon consultation with a pharmacist.

In a 2006 scientific review, however, Health Canada rejected that advice, stating that heart safety of ibuprofen is “considered satisfactory” when the drug is used as directed. Unfortunately, it often isn’t. Government won’t do the responsible thing and restrict ibuprofen’s use. The next time you feel achy, tired, or sore, try ice or heat, a massage, and/or rest with a good book or good music. If you have to take ibuprofen, follow the directions. It could save your life.

Alicia Priest is a Victoria-based freelance writer and a former registered nurse who occasionally experiences aches and pains for which she takes the occasional ibuprofen.

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