The Painkiller Headache: Are Advil, Aleve and Motrin Safe?

You have a headache.

You go to your medicine cabinet and find a bottle of Advil, Aleve or Motrin, those popular over-the-counter painkillers that some studies have shown may cause heart problems in some patients.

Should you take it? Is it safe?

Now you have an even bigger headache.

It’s a confusing time out there, as the federal Food and Drug Administration recently has issued sweeping warnings about popular painkillers, both prescription and nonprescription.

"Almost daily, I field a question from a patient," says Dr. Peter Hurtubise of Heartland Family Health. "It’s a hot topic."

Hurtubise and several other local physicians and pharmacists offer this advice:

Over-the-counter pain medications are generally safe for healthy people who take them for short-term problems, such as a headache or a sore knee.

However, people with active heart disease or other underlying health problems should exercise some caution, and talk to their physician before taking the OTC medications.

"You have to look at them in the context of the patient and their risk factors," Hurtubise says.

Says Dr. John King of General Internal Medicine, "The question is: Are they safe? The answer that I give is they are probably safe for short-term use."

"If they are a healthy, 30-year-old man who injured his knee playing basketball, it’s fine 90 percent of the time for him to take it for a month straight," King says. "I took it for a knee injury myself for two months."

But if it’s a 65-year-old patient with heart disease, King would have a different approach, he says.

He might prescribe a different sort of painkiller, such as Vicodin. He might try to mix and match medications, or rotate them.

"It is confusing for people," he acknowledges. "I think people are scared. Trying to find the right balance is important."

The questions about painkillers began to arise after studies done on prescription painkillers such as Vioxx and Bextra strongly suggested they increase the risk of heart attacks and strokes. Both drugs, once hailed because they were safer on the stomach than older pain pills, were removed from the market.

FDA officials then said they cannot rule out the notion that all drugs in the same class, known as nonsteroidal anti-inflammatories, can cause similar problems. These include the over-the-counter drugs Advil, Aleve and Motrin.

Tougher warnings about heart risks soon will appear on the labels of those drugs.

"These are very commonly used medications," says Dr. Marlin Wenger of Lancaster Rheumatology Associates. "Now that the concern has been raised we have to be judicious in our use of them and be aware of the cardiovascular risk."

Now that Vioxx and Bextra are off the market, Wenger is prescribing other medications, as well as recommending Tylenol in various strengths.

"We are looking very carefully at these patients to decide if there is an appropriate alternative," he says.

King says patients are frustrated by the withdrawal of the popular medications from the market, particularly those who have heart problems or stomach bleeding and now have fewer options available to them.

"They can’t golf, they can’t do what they used to do," he says. "There are some people who are boxed in."

Diane Boomsma, the compounding pharmacist at Williams Apothecary on East Chestnut Street, says she consults with patients struggling with pain, with permission from their doctors. Boomsma may recommend patients try natural remedies, such as fish oil, a spice or a supplement that helps support joint function.

"We look to see if they’ve ever used it, if it’s appropriate and if there are any drug interactions and go from there," she says.

"What we’re really trying to focus on," she says, "is giving people alternatives."