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Common pain reliever can have side effects
DEAR DR. ROACH: I am a 44-year-old man with chronic headaches and migraines. Should I worry about the long-term effects of taking an NSAID (such as diclofenac) at least once a week? – G.W.
ANSWER: Nonsteroidal anti-inflammatory drugs (NSAID) such as aspirin, ibuprofen and naproxen are among the most commonly taken classes of drugs in the world, with 17 million Americans alone taking them daily. Although these drugs are generally safe, any medication has the potential for side effects. Typically, the higher the dose and the more frequently it is taken, the increased risk of side effects. So, a once-a-week dose would be expected to have a low side-effect risk.
Adverse effects from this class are among the most frequently seen in clinical medicine. Although they can affect multiple systems, let me briefly go over the side effects of NSAIDs on the GI tract, kidneys and heart.
NSAIDs might affect the stomach, and although we think of ulcers, stomach pain without ulcers is more common. Ulcers happen most often in people who take higher doses for long periods of time. A history of ulcers, older age and use of other medications (steroids, warfarin, antiplatelet drugs like clopidogrel, or Plavix) increase the risk of ulcers and bleeding. NSAIDs also might affect the small bowel and colon, causing bleeding and diarrhea, among other symptoms. Again, these are most common in high doses for extended periods.
NSAIDs can affect the kidneys, causing both acute and chronic kidney failure, but only in a few percent of people. Periodic blood and urine examination is appropriate for people who are on long-term NSAIDs.
The risk of heart disease among people who use NSAIDs regularly is increased, but in people without known heart disease, the risk is small – about one bad event, such as heart attack, stroke or episode of heart failure, per thousand people taking the medication for a year.
I would advise you that the risk of any of these side effects is unlikely in someone taking the drug only once a week, but people who take these drugs every day should know about the potential harms.
DEAR DR. ROACH: When I was 64, a cyst was found in my bladder. When the cyst was removed, it was found to be cancerous. My urologist wants me to continue to have an annual cystoscopy, which I do.
I’m now 76 and in good health. Do you feel the annual cystoscopy is still necessary? – C.K.
ANSWER: Now that more people have had successful treatment of cancer, we are starting to learn about the risks they face in subsequent years. The risk of another cancer is generally higher, but it’s the exact form of cancer that determines how much risk there is, and consequently, how aggressive follow-up must be.
In the case of bladder cancer, I have read some studies that the risk is quite small after five years. However, the American Urologic Association has clear guidelines: Because of the increased risk for recurrence, it recommends annual cystoscopy indefinitely. Cystoscopy is a pretty safe procedure, so I think your urologist’s recommendation is reasonable.
Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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