NSAIDs: the everyday painkillers with a serious safety problem

Duet Health is gathering data and campaigning to raise awareness of the side effects — adverse drug reactions, or ADRs — associated with non-steroidal anti-inflammatory drugs. This toxicity results in significant numbers of hospitalisations and even deaths, and most of them are largely preventable.

NSAIDs such as ibuprofen, naproxen and aspirin have been estimated to be responsible for 30% of UK hospital admissions for adverse drug reactions, mainly due to gastrointestinal bleeding, heart attack, stroke and kidney damage.

Three of the four Trustees of Duet Health Foundation have been affected by NSAID reactions. Julie's father died abruptly one night from a sudden acute gastrointestinal haemorrhage associated with long-term NSAID use. Mike, who is medically qualified, was hospitalised for the same reason despite being well aware of the risks: he haemorrhaged and collapsed in the middle of the night, and would probably have died had Julie not been at home to call an ambulance. Another of our Trustees had her father hospitalised with a gastrointestinal haemorrhage associated with NSAID use.

This is not a new discovery. More than twenty years ago a number of academic groups gathered to address the issue. In 2004 a scientific publication reported that preventable adverse drug reactions were responsible for 10% of hospital admissions in older people, at a cost to the NHS of around £800 million every year. Another publication twelve years later, in 2016, found that deaths from NSAID-related reactions remained very high — more deaths than from road traffic accidents, and twice as many as from asthma or cervical cancer.

Despite the compelling data, little has changed in awareness of the potential dangers. The patient leaflets supplied with these medicines do note the risks, and recommend taking them alongside drugs that protect the gut, such as proton-pump inhibitors like omeprazole. But the leaflet is often the only warning anyone reads.

Certain NSAIDs, ibuprofen in particular, are freely available without prescription in pharmacies and supermarkets. Patient education therefore has to be an essential part of any strategy to reduce the risk. Access to this class of drugs needs tighter safety provisions, and patients, pharmacists and doctors all need to be more aware of the recommended precautions — and to act on them.

References: Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ. 2004;329(7456):15–19. Davis A, Robson J. The dangers of NSAIDs: look both ways. Br J Gen Pract. 2016 Apr;66(645):172–173.