Posts Tagged ‘NSAIDs’


By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy


The moustache is gone.  It went from barely noticeable to itchy over the first two weeks.  Over the next two weeks it started catching food and now it is gone.  My upper lip does feel a little cold and naked, but I wasn’t really happy with how grey my whiskers were coming in anyway.  I was feeling kinda old.  In case you missed Barret’s talk last week and all the hairy lips around town the last month, Movember has just come to an end.  Now we are onto the season of Santa, kid’s Christmas concerts, and eating and drinking too much.   I have to remember to be nice to my wife and be helpful with the kids so the holiday season doesn’t make Doris’s blood pressure go up too much.


If you are on high blood pressure pills and the holidays or the holiday parties give you a headache, what medication should you reach for?  Without a prescription, the most common choices in the pharmacy are ibuprofen, naproxen sodium, ASA and acetaminophen.  Let’s look at how they affect blood pressure and blood pressure pills.


The safest choice is acetaminophen.  The brand name for acetaminophen is Tylenol.  Acetaminophen won’t make your blood pressure go up.  Acetaminophen is very unlikely to interact with your blood pressure medications.  The only time we really worry about acetaminophen is if a person has liver problems.  Acetaminophen is broken down by the liver so if a person has liver problems it might need to be avoided.


If acetaminophen is so safe, why would someone with high blood pressure take anything else?  Acetaminophen treats pain, but doesn’t treat inflammation.  Some headaches have an inflammatory component.  So some people find acetaminophen doesn’t work that well for their headaches.  What about ASA?


ASA or aspirin or acetylsalicylic acid treats both pain and inflammation.  Some people find ASA works very well one their headaches.  The downside to ASA is the blood thinning.  Many people on high blood pressure medications are also on blood thinners.  So if they take ASA with their blood thinners, their blood make get too thin and cause bleeding problems.  What else could someone use?


Ibuprofen which goes by the brand name Advil or Motrin, and naproxen sodium which goes by the brand name Aleve are called NSAIDs.  NSAIDs or non-steroidal anti-inflammatories are very good at treating pain and inflammation.  They can be very effective for treating headaches.  The problem with NSAIDs is that they can increase your blood pressure.  NSAIDs are more likely to increase your blood pressure if you are older, male, overweight, have diabetes or certain heart, liver or kidney conditions.


Now stop panicking.  I know some of you are on blood pressure pills and have taken an NSAID once in a while for a headache already.  That’s okay.  If you take an NSAID for 2-3 days for a headache, a sore tooth or a sore knee, that won’t be a problem.  But if you have to start using an NSAID everyday for a week or more, let your pharmacist or doctor know.  They may want you to monitor your blood pressure to see what is going on.  How much NSAIDs will affect your blood pressure can depend on which blood pressure pill you are on too.  Calcium channel blockers like nifedipine and amlodipine should be the least affected by NSAIDs.  However, if you are on an ACE inhibitor like ramipril or an ARB like telmisartan plus a diuretic like hydrochlorothiazide, you should probably avoid NSAIDs without checking with your doctor first.


Just like itchy lips in Movember, headaches during the holiday season are common.  If you have high blood pressure, acetaminophen is the safest way to treat a headache just like shaving December 1st is the best cure for an itchy mustached lip.  During a board meeting of the MS Society we were discussing, with a little envy, how Movember is close to the perfect fund raiser.  Other than a website, there is no overheard like making meals or supplying safety vehicles like we need to do for the MS Bike Tour.  You don’t have to gather all the participants in one place.  For Movember the participants are all over the world.  And all the monetary pledges are done online.  You don’t have to mail out pledge forms, or collect and count money.  The whole Movember idea is just fabulous from a fund-raising point of view.  And it is fun to look like a 70’s adult film star for a month knowing your wife can’t complain.



As always if you have any questions or concerns about these or other products, ask your pharmacist.  


The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at

NSAIDs & Heart Attacks – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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NSAIDs & Heart Attacks

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 “Eric, stop chewing your shirt!”  Some kids chew their nails.  Others suck their thumbs.  I was a thumb sucker.  My son Eric chews the collar of his shirt.   Yes, it annoys me.  Apparently it annoys me enough that I repeat the phrase, “Eric, stop chewing your shirt!”  a lot.  We were at Eric’s soccer practice and I was saying things like, “Good kick Eric!”  and “Go get the ball!” when apparently I let a “Eric, stop chewing your shirt!”  slip out.  My daughter, Emily commented, “Dad you are addicted to saying that aren’t your?”  Maybe I am.  Some repetitive phrases are repetitive because they are true.  Like when it comes to prescription medications, you have to weigh the risk versus the benefit.

A customer came into the pharmacy and was very worried by what she had seen on the news.  Her husband was on heart medications and he also needed to take NSAIDs for his arthritis.  She thought the news segment had said that NSAIDs would be dangerous for his heart.  It was time for me to do some reading.

There was a CTV news story on May 9, 2011 that talked about NSAIDs and heart attacks.  The news story referenced a study that had been published in the May 2011edition of the journal  Circulation.  Olsen et. al looked at people in Denmark who had their first heart attack between 1997 and 2006.  Then the Danish scientists looked at how many of these people took NSAIDs.  NSAIDs are non-steroidal anti-inflammatory drugs and are used to treat pain and inflammation.  They have names like ibuprofen, naproxen, diclofenac, rofecoxib and celecoxib.  What the Danish scientists found was that people who took NSAIDs after their first heart attacks were more likely to have another heart attack or die than those people who didn’t.

It was an interesting study.  It had over 83,000 people in it, which is impressive.  And it showed evidence that even short courses of NSAIDs in these patients who had previous heart attacks may be harmful.  We had assumed that short courses of treatment with NSAIDs should be safe in heart patients.  This study says maybe short courses of NSAIDs aren’t safe.  But the study wasn’t perfect either.

The biggest problem with this study was that it was a retrospective observational study.  So the Danish researchers looked back on data that had already happened.  They didn’t start an experiment and see how it turned out in the future.  That means that although the researchers seemed to have taken great care to track the patients carefully using Danish hospital and pharmacy records, some biases may have crept into the data.  The best type of study is called a prospective double blind placebo controlled study.  In that type of study half the people get the active pill and half the people get the sugar pill.  Neither the doctors in the study or the patients know which is which. 

Despite its weaknesses, the study found some interesting things.  It found that the NSAID diclofenac was the most likely to cause a recurrent heart attack or death and the NSAID naproxen didn’t seem to increase the risk of a recurrent heart attack or death at all.  The OTC NSAID we all use, ibuprofen, seemed to be okay for 7 days or less, but increased the risk of recurrent heart attack and death after that.  If that all sounds a little confusing, well it is.

I was confused because the study said diclofenac was more likely to cause a recurrent heart attack or death than rofecoxib or Vioxx.  Vioxx was pulled off the market in September 2004 because it caused too many heart problems.  So is diclofenac a dangerous drug?  Was Vioxx really not that bad?  These questions still need to be answered.

So what does this study really tell us?   Well not a whole lot by itself.  Although there have been other studies that seem to indicate that NSAIDs can cause or worsen heart problems, we still need more studies to say for sure one way or the other.  So don’t throw out your NSAIDs. 

We don’t know for sure how bad NSAIDs are for the heart.  But let’s assume we knew for certain that all NSAIDs caused an increased risk of heart attacks, would we throw out all the NSAIDs then?  Still, no.  There are very few black and white answers when it comes to medications.  All medications have side effects.  In every case we have to weigh the risks versus the benefits in that particular patient.  Let’s say we had a patient who had a previous heart attack who also has arthritis.  We have been treating his arthritis successfully with diclofenac.  Every time we change to another drug his pain becomes unbearable.  If we assume diclofenac increases his chance of another heart attack or death, what should we do?  After discussing the options with his doctor, I think it might be very reasonable to keep him on diclofenac if he is aware of the risks.

So if you have a heart condition should you throw out your NSAID’s?  No.  We just don’t know enough yet on how NSAIDs effect the heart.  If you want to discuss with your doctor whether you want to try a non-NSAID pain killer instead, that could be reasonable.  Just remember the new pain-killers will have their own side effects and potential risks.  So again you and your doctor will have to weigh the risks and benefits.  And Eric should really stop chewing his shirt.

CTV news article:

Circulation article:

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at

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