Choosing Wisely is an initiative by the ABIM Foundation to identify commonly-used tests or procedures whose necessity should be questioned and discussed. This information was developed by Consumer Reports in cooperation with the American Society of Nephrology.
When people have pain, they often take pain medicines called NSAIDs (non-steroidal anti-inflammatory drugs). These include:
- Advil and Motrin (generic and store-brand ibuprofen). Ibuprofen is also in other over-the-counter drugs, such as cold medicines.
- Aleve (generic and store-brand naproxen).
- Celebrex (generic celecoxib).
NSAIDs help ease pain and inflammation. But if you have high blood pressure, heart failure, or kidney disease, you should not take an NSAID. And you should not take any drugs that have ibuprofen or another NSAID in them. Here’s why:
NSAIDs are bad for your blood pressure.
NSAIDs can cause high blood pressure. And if you have high blood pressure, they can make it worse. This increases your chances of having a heart attack or a stroke.
NSAIDs can also keep some blood pressure drugs from working right. NSAIDs can interfere with:
- Diuretics, or water pills, such as Hydrodiuril (generic hydrochlorthiazide). Diuretics remove excess water from the blood vessels.
- ACE inhibitors, such as Prinivil and Zestril (generic lisinopril). ACE inhibitors are drugs that relax the blood vessels.
- ARBs such as Cozaar (generic losartan). ARBs are another group of drugs that relax the blood vessels.
NSAIDs are bad for your heart and kidneys.
Long-term use of NSAIDs can make your body hold onto fluid. This can make the symptoms of heart failure, such as shortness of breath, swollen ankles, and a rapid or irregular heartbeat, worse. NSAIDs can also keep the kidneys from working well. This makes taking NSAIDs risky for people who already have kidney disease.
Which painkillers can you use if you have heart or kidney disease?
There is no simple answer. The best painkiller to use depends on your health problems. It also depends on any other drugs you take. Be sure to tell your doctor about any prescription drugs, over-thecounter drugs, or herbal medicines you take.
Over-the-counter Tylenol (generic acetaminophen) is often the best choice for people with high blood pressure, heart failure, or kidney problems.
- However, high doses of Tylenol can damage the liver, so take the lowest dose you can to get enough pain relief.
- Never take more than 4,000 milligrams (mg) a day. That’s equal to twelve 325 mg pills.
If Tylenol or generic acetaminophen do not work, ask your doctor about using a stronger prescription painkiller, such as Ultram (generic tramadol) for a short time.
- If you have kidney problems, do not take more than 200 mg a day. And take it once every 12 hours to limit the risk of side effects.
- Do not use tramadol if you have epilepsy or if you take Paxil (generic paroxetine), Prozac (generic fluoxotine), or Zoloft (generic sertraline). Taking tramadol with these drugs can increase your risk of seizures.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk. © 2012 Consumer Reports. Developed in cooperation with the American Society of Nephrology (ASN). To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.