Mercy's Dr. Susan Besser Provides Insight on Taking Too Many Over-The-Counter Pain Meds

Dr. Susan Besser, responding to a query from Healio.com, answered questions concerning how physician can know if patients are taking too many NSAIDs (Nonsteroidal Anti-inflammatory Drugs) what the risks are, and what may be safer alternatives to dealing with pain. Dr. Besser is a primary care provider specializing in Family Medicine and sees patients at Mercy Personal Physicians at Overlea.

What are the current dosing recommendations for NSAIDS for adults? For children?

Unfortunately I can’t give you a numerical answer to this one (such as milligrams per dose) because the different NSAIDs are all dosed differently. The recommendations are, of course, to start with the lowest dose and titrate up as needed. For example, an adult taking Ibuprofen should start with 200mg every 6 to 8 hours.  For children, the dosing is weight based and most medications have a dosing chart in the packaging.

Are there common complaints that a patient may make, that can be a sign that they are taking too many NSAIDS?

The most common complaint associated with overuse of NSAIDs is GI distress/heartburn. Another common complaint is easy bruising.

Why is it so dangerous to take so many NSAIDS?

Over use of NSAIDS can cause many adverse side effects from heartburn to GI bleeds to impaired kidney function to worsening high blood pressure to swelling to heart failure. Some of these effects are obvious, but others are subtle and occur over time (not with just one dose)

How can a PCP convey this danger to patients?

Have a conversation! You as the patient need to discuss ALL the medications you are taking, including the over-the-counter ones. Sometimes primary care physicians (PCPs) may forget to ask about OTC medications, and patients don’t always bring it up. 

Do you have any concerns that NSAIDs could become the next opioid epidemic? Why or why not?

Yes, there is definite overuse of NSAIDs but it probably won’t achieve the same status as opioid epidemic. People don’t use NSAIDs for the other (“getting high”) effects in the same way they do for opioids. Yes, they are overused for pain management but opioids are over and misused for reasons other than pain.

A concern with NSAID overuse is their prevalence. Patients may be taking multiple NSAIDs or other medications containing NSAIDs without being aware of the duplication. For example, patient’s may be taking both Ibuprofen (OTC) and Naprosyn (OTC) together (or at least in the same day) without realizing they are both NSAIDs.

Additionally, other common medications such as cold medications also contain NSAIDs so a patient may take a cold reliever for the cold symptoms, not realize it also has an NSAID and then take additional NSAID for aching or fever.

What can primary care physicians do now, to avoid NSAIDs becoming the next opioids?

Have a conversation! Education is the best way to avoid a crisis such as has happened with opioids. Stop the problem before it starts!

Susan Besser, M.D., is a primary care provider at Mercy Personal Physicians at Overlea, Mercy Medical Center.