What are ibuprofen alternatives without the side effects

Question

Came across an article saying that Ibuprofen blocking COX-1 and COX-2 has side effects:

They work by inhibiting enzymes called cyclooxygenase 1 (COX-1) and 2 (COX-2). These are involved in a number of internal pathways that result in production of hormone-like substances called prostaglandins, which promote inflammation and increase pain perception.

Animal studies have shown blocking COX-2 and the subsequent pathway of prostaglandin production may have the unwanted effects of increasing the tendency of blood to clot inside arteries, and a reduced ability of the heart to heal after a heart attack. In the early 2000s, a number of large studies found a significant association of negative heart events, such as heart attack and stroke, with the use of selective COX-2 inhibitors. This resulted in two of these drugs, Valdecoxib and Rofecoxib or Vioxx, being withdrawn from the market.

They talk about a lot of products doing the same and taken off the shelves.

However they don't propose any alternatives with same benefits and no side effects.

I'm no expert and no doctor, so I'm coming here to ask about what soft pain killer should I use instead to avoid those side effects and have the same pain killing effect, even if it's less strong? Tylenol ?

Answer 1

Are ibuprofen side effects something to worry about?

Short answer: maybe.

Longer answer: As with a lot of health questions, it depends on how they are being taken. If, for example, you hurt yourself playing a sport and want to take a painkiller for some short-term relief, ibuprofen probably won't do you much harm in the short term.

On the other hand, if you are in chronic pain (or inflammation, as another answer notes) the situation is a little different. If you are taking an NSAID - ibuprofen is one of several in this class of drug - on a regular basis it's worthwhile watching out for some side effects. One mentioned in the article you linked are stomach ulcers as NSAIDs can have an effect on the protective lining of the stomach. Usually some form of 'gastroprotection' is offered to offset this, such as a PPI (proton pump inhibitor, such as omeprazole).

As another example, if you are taking ibuprofen for recurrect headaches (eg migraines), you can counter-intuitively end up getting another kind of headache, called a [medication overuse headache(https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/medication-overuse-headache/) (MOH).

The bottom line is that any long-term use should be discussed with a medical professional; who can assess relative risks and check for interactions with any other regular medications.

But ibuprofen/NSAIDs can't be safe! Vioxx was taken off the market...

Quite true. From the article you quoted:

In the early 2000s, a number of large studies found a significant association of negative heart events, such as heart attack and stroke, with the use of selective COX-2 inhibitors. This resulted in two of these drugs, Valdecoxib and Rofecoxib or Vioxx, being withdrawn from the market.

The Vioxx controversy was a pretty big deal, and resulted in compensatory payouts and fines. The VIGOR study demonstrated a 4-fold increase in heart attack risk on rofecoxib (Vioxx) versus naproxen. This was attributed to the 'cardioprotective' effect of naproxen. This was incorrect, and another trial (APPROVe was stopped early because selective COX-2 inhibitors demonstrated adverse cardiovascular events. There was a raft of litigation relating to the sale of Vioxx, with payouts and fines in the billions of dollars.

If you are interested, the Vioxx controversy created lots of discussion ongoing to this day- from editorials, to book sections, entire books themselves and arguments relating to tort reform. It is clearly beyond the scope of this question!

That said, not all NSAIDs are Vioxx; and as noted above, it is possible to take them (even ibuprofen) relatively safely.

What are the alternatives to ibuprofen?

As another answer comments, it depends on what you are taking ibuprofen for. As mentioned above, you may be fine continuing to take ibuprofen, depending on circumstances.

Alternatives include:

• naproxen (another NSAID, but with lesser risk / may be protective)
• paracetamol / acetaminophen (ie Tylenol, as you say)
• NSAID cream / gel, eg for joint pain
• tramadol may help for some kinds of pain, but there are issues with addiction and constipation
• alternatives, such as exercise, acupuncture, meditation etc can all potentially reduce pain

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Further Reading

• NHS page on NSAIDs
• VIGOR, for reference
• APPROVe, also for reference
• Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis
• Heart-safer NSAID alternatives

Answer 2

I understand that you are bothered and anxious over the fact the ibuprofen might have side effects.

Every drug has side effects without exception. But that does not mean everybody will have those side effects. The probability of anybody getting one or more side effects is usually very low.

You should talk to your physician who can help you choose the safest drug for you and help you with information that will allow you to make choices.

If you are considering to take Ibuprofen as an anti-inflammatory drug, you can consider Acetaminophen (Paracetamol) as an Alternative. The safety profile of Acetaminophen is slightly better than Ibuprofen at normal dosages.