Beware of the risks and side effects of certain medications

An acid blocker for heartburn, ibuprofen for headaches, and diclofenac for muscle and joint pain: many of these over-the-counter painkillers are well-established to relieve pain and inflammation. However, they can become dangerous if they are taken permanently or in high doses. Not only can they upset the stomach, but they can also damage the heart, liver and kidneys, or in the worst case even lead to heart attack, stroke, and kidney or liver failure. The risk is particularly high if organ function is already impaired or if other pre-existing conditions, such as diabetes, vascular diseases, high blood pressure or elevated cholesterol levels already exist. People who smoke or regularly consume alcohol should also be careful when taking painkillers. “Patients at risk should generally coordinate the use of any medication with their doctor”, advises Professor Christoph Wanner, President of the European Renal Association (ERA) and Head of Nephrology at the German University Hospital in Würzburg. He and his team from Würzburg have launched the ‘Strong Kidneys’ campaign to raise public awareness of kidney disease, with a special focus on prevention and early detection of kidney disease.

 

Painkillers

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, acetylsalicylic acid, diclofenac or naproxen do not contain cortisol or typical cortisone compounds. They work by inhibiting the enzyme ‘cyclooxygenase’ (COX), and their side effects depend on the subgroup that is blocked. Ibuprofen and diclofenac, for example, inhibit both COX-1 and COX-2. According to the European Medicines Agency (EMA), caution is advised especially for diclofenac. The risk of a heart attack or other vascular complication is significantly higher than with ibuprofen or naproxen. In addition, diclofenac can interact with other medications, such as acetylsalicylic acid (ASA). In principle, when taking combined painkillers, the active ingredients should be well-tested. Interactions with natural remedies can also not be underestimated. Furthermore, NSAIDs can impair the effect of other medications, such as antihypertensives. Christoph Wanner sums up: “There is no doubt that these medications are very effective substances against certain complaints and for some people they have a great alleviating value for the pain of the musculoskeletal system. A single dose certainly does no harm, but longer-term use must be weighed up.”

 

Acid blockers

Proton pump inhibitors (PPI), such as pantoprazole or omeprazole, and H2 receptor antagonists, so-called antihistamines, should not be used permanently. Although they are extremely effective against too much stomach acid and relieve heartburn and gastritis, long-term use can lead to serious side effects, such as mineral deficiencies, a decrease in bone density, and liver or kidney damage. The Health Professionals Follow-up Study (HPFS) and Nurses’ Health Study (NHS) by Dr Pietro Manuel Ferraro of the Roman Catholic University of the Sacred Heart found that PPIs and histamine receptor blockers lead to a 12 and 13 per cent, respectively, higher risk of kidney stones. Those who already have kidney problems should thus use stomach medications with caution. Dr Yan Xie of the VA Saint Louis Health Care System found that the risk of kidney inflammation and chronic kidney disease, including kidney failure, is 30 per cent higher than that of kidney patients who have not taken stomach medications.

 

Poison for the kidneys

“Medication is the most common cause of acute kidney failure, accounting for 30 per cent. The technical term is interstitial nephritis. Every second drug on the market is excreted through the kidneys”, explains Christoph Wanner. “Our kidneys are already permanently under pressure. Every day, 1800 litres of blood flow through the paired organs. They tirelessly filter the degradation products and toxins like a sewage treatment plant. The substances from the medication thus represent an additional burden.” This can lead to toxic nephropathy, and acute or chronic damage to various functional units of the kidney, such as the renal tubules or their vessels, the glomeruli, caused by the pathogenic substances. NSAIDs also reduce the production of prostaglandins, which play an important role in renal blood flow.”

If the kidneys react hypersensitively to the drugs, symptoms typical of allergies often appear, such as joint and limb pain as well as skin rash and fever. Since proteins and red blood cells can no longer be adequately filtered, there is often blood in the urine, which is sometimes not immediately visible but becomes increasingly concentrated as it progresses. Blood pressure rises, water is deposited in the legs and arms, the skin becomes pale, insomnia, cardiac arrhythmia, nervousness, concentration problems and bad breath occur.

“The negative effects can be temporary. But they can also cause inflammation of the kidney tissue. At best, they disappear after stopping the medication, at worst the kidneys fail,” Christoph Wanner summarises.

 

Natural and healthy alternatives

Basically, you should always check first whether there is a drug-free treatment option: physiotherapy, heat, cold, massages or exercise training. A healthy plant-based diet sometimes works better than an acid blocker. For example, Craig H. Zalvan, a doctor from New York, recommended his patients to eat a predominantly plant-based diet rich in fresh fruit and vegetables, cereal products and nuts. Animal products, fatty foods and chocolate had to be avoided. Instead of coffee and soft drinks, the patients had to drink water. Within six weeks, not only did the reflux symptoms improve, but the study participants also lost excess weight and were able to lower their high blood pressure and cholesterol levels. If you have been taking PPIs for a long time, you should not stop taking them abruptly but you could switch to interval therapy. Gradually phase them out and adjust your diet. In addition, it is highly recommended to get to the bottom of the cause of the symptoms, but this should be done in consultation with your doctor.

If there are no alternatives to over-the-counter medications, they should be taken for a limited period of time and in the appropriate dosage. To avoid or reduce side effects, it is advisable to drink plenty of fluids when taking the medication. Read the package insert or consult the doctor or pharmacist, if necessary. If you already suffer from kidney or heart disease, it is essential to coordinate your fluid and medication intake with your doctor.

 

Do not withhold information from your doctor

In the interest of their health, particularly high-risk patients should not withhold any information from their doctor.  Any use of over-the-counter medication, herbal remedies or food supplements should be reported. “Supposed herbal or plant-based health products can lead to kidney inflammation, especially in Asian countries,” Christoph Wanner states.

Only if patients are honest, the doctor can keep track of and assess their personal risk. A medication plan can help. According to the German Society of Nephrology, especially the unreflective use of NSAIDs in patients with chronic kidney disease is a major problem with a high number of unreported cases, which is responsible for a high rate of acute kidney failure and worsening of blood pressure control.

 

Regular check-ups

Christoph Wanner particularly advises GPs to identify patients with kidney disease by means of a simple blood and urine test and to examine high-risk patients such as diabetics, hypertensive patients and patients who are dependent on long-term medication every one to two years. The blood count as well as kidney and liver values, and blood pressure should then be checked.  When the patient is taking psychotropic drugs or antidepressants, other instrumental examinations are also necessary.

The dosage of high blood pressure medication and diuretics should also be monitored regularly. Improper use can lead to acute kidney failure. Patients in whom the filtering capacity of the kidneys is reduced and the albumin value in the urine is more than 300 mg/g creatinine in at least two measurements, or if it is more than 500 mg proteinuria per gram of creatinine despite therapy, should be referred to a specialist. The earlier the disease is detected, the better the prognosis.