SEPT – 15: COVER STORY
The dangers of painkillers
Know the side effects and why you should avoid some painkillers
Painkillers like aspirin, paracetamol and ibuprofen are commonly used for relief from headache, toothache or any type of ache for that matter. But, do we know how these drugs differ from each other? And, what their side effects are?
Types of painkillers
The two main categories of commonly used pain relievers or analgesics are paracetamol (also known as acetaminophen) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which include aspirin, ibuprofen and naproxen, among others, and also drugs known as COX-2 inhibitors. Acetylsalicylic acid, also called aspirin, was the painkiller of choice since the early 20th century until the development of acetaminophen in 1956 and ibuprofen in 1962.
Paracetamol
Paracetamol is used to ease pain but does not affect inflammation. Although easier on the stomach than NSAIDs, it can damage the liver. It is safe for most people at recommended doses even when used long term (for adults: maximum daily dose 4000mg, or eight 500mg tablets in a day taken no more than two at a time).
NSAIDs
In addition to pain and fever, NSAIDs also reduce inflammation. Some are available by prescription only. NSAIDs revolutionised the treatment of pain, but long-term or heavy use has been linked to increased risk of heart disease. They can also be hard on the stomach, causing ulcers or gastrointestinal bleeding.
COX-2 inhibitors
A new family of NSAIDs, COX-2 inhibitors, developed in the 1990s, was supposed to be better than ‘regular’ NSAIDs as they were easy on the stomach. But it was found that they weren’t especially heart friendly. Two of these, rofecoxib and valdecoxib, were withdrawn due to concerns of increased risk of heart attack and stroke. A third COX-2 inhibitor, celecoxib, is considered as safe as NSAIDs.
All NSAIDs, including the COX-2 drugs, tend to boost blood pressure. This effect is strongest and happens more in people who have high blood pressure and take medication for it. These drugs can also be hard on the kidneys and, in extreme cases, cause kidney failure.
Opioids
Prescription narcotics or opioids, such as morphine, hydromorphone and oxycodone, can ease severe short-term pain from surgery, broken bone and chronic pain from cancer. They are the strongest pain medications and can be addictive. Taken for more than a few weeks, these may cause you to develop tolerance and require higher doses. However, their use is highly restricted in India.
Be alert
Each kind of pain medicine poses risks. Also, there is also a lot of variation in how people react to pain relievers. While opioids are addictive, NSAIDs have dangerous side effects and paracetamol, renowned for its safety, is now the most common cause of liver failure in the US. Do not take more than recommended dosages of any drug. Moreover, if you are regularly taking over-the-counter painkillers for a length of time, it is best to tell your doctor as you may need to be watched for side effects.
