Most people take their kidneys for granted…until something bad happens. When your kidneys fail, though, your life hangs in the balance. Short of dialysis or a kidney transplant, kidney failure rapidly becomes a life-threatening condition. That’s why we need to treat our kidneys with respect. NSAID pain relievers can damage kidneys and lead to kidney failure.
Taking NSAID Pain Relievers for Granted:
If you come down with a headache or your back starts to hurt, the go-to drugs of choice are nonsteroidal anti-inflammatory drugs (NSAIDs). Millions of people rely on pain relievers like celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Advil, Motrin IB), meloxicam (Mobic) and naproxen (Aleve, Naprosyn) to get through the day.
We have heard from many people in pain that they can’t manage without an NSAID. Here are just a couple of comments from readers:
Angela in Portland, Oregon relies on ibuprofen:
“Advil is my go-to pain reliever. I only use it when it’s all that will work for me. I have tried through the years to find another pain reliever. If my pain is manageable I don’t take anything. I only take it when I don’t have a choice. I don’t know what I would do without Advil.”
Michelle in Marietta, Georgia, also depends on ibuprofen:
“I’ve been using 800 Motrin for as long as it’s been available. I remember seeing a Mayo Clinic TV Special and they used it as a first try against pain. It was their go to pain reliever. It ALWAYS helps my pain. After two shoulder surgeries I took two hydrocodone pills, then only 800 Motrin. The doctor couldn’t believe I wasn’t taking the hydrocodone. Same with my knee replacement.”
Vaudi in Fayetteville, North Carolina, loves Celebrex:
“I’ve taken Celebrex for years. When I had back surgery a year ago, I had to stop Celebrex for 3 months. I could barely move. I couldn’t wait till the day when my spinal neurosurgeon said I could take Celebrex again. At last I had a spring in my step and felt great.”
The Other Side of the NSAID Coin:
Q. I am aware that OTC pain relievers have side effects. However, two different orthopedic surgeons and a sports medicine doctor have all downplayed the risk of ibuprofen and/or naproxen. They recommend that I take one or the other daily for pain and swelling in my knee or hip.
The sports medicine doctor was openly hostile when I said I wouldn’t take ibuprofen as often as he recommended because I am concerned about the health of my kidneys. My two older siblings, who have both had knee replacements, have been advised by their primary care physicians that they can no longer take ANY ibuprofen because of reduced kidney function. Another sibling who worked at a kidney center saw first-hand the horrible things that happen when your kidneys give out for any reason.
I imagine it is hard for doctors that they don’t really have any safe and effective options to offer their patients in pain.
A. You have identified the Achilles heel of anti-inflammatory pain relievers. In addition to damaging the digestive tract, chronic use of drugs like ibuprofen and naproxen can be hard on the kidneys. There is also a risk of elevated blood pressure and cardiovascular complications.
Sometimes natural remedies can be easier on the body. We describe a number of herbal approaches in our eGuide to Alternatives for Arthritis. This online resource can be found under the Health eGuides tab.
NSAID Pain Relievers and Kidney Function:
Researchers have discovered that NSAIDs are not as benign as many people think. Taking a pain reliever of this sort can put your kidneys and your heart at risk.
A large study in BMJ (May 9, 2017) confirmed earlier reports that people who take NSAIDs are at higher risk for heart attacks. This does not come as a great surprise, since other analyses have shown a link between NSAID use and heart attacks, strokes and cardiac arrest (European Heart Journal-Cardiovascular Pharmacotherapy, April 2017).
People who suffer from arthritis often rely on an NSAID to ease their joint pain. Within a week of starting to use this type of medicine, however, biomarkers of subtle kidney damage may start to climb (Nephron, Feb. 8, 2017).
A reader’s scary story:
“A scary scenario was presented by my nephrologist after my blood levels of creatinine (an indicator of kidney function) became mildly elevated. Further tests indicated I was in the early stages of kidney disease.
“He said there is a lifetime limit to the total amount of all NSAIDs taken, after which kidney damage occurs. It is not a set number, but varies by individual.
“I had been in health care 30 years and had never heard this before. Fortunately, the injury was caught early. After stopping all NSAIDs and discontinuing Nexium (another drug that might contribute kidney disease), my creatinine and other biometrics returned to normal over several months.
“I also eliminated caffeine and was put on a different blood pressure medicine. High blood pressure eventually can cause kidney damage also. My blood pressure is doing better, in part because ibuprofen can cause fluid retention and raise blood pressure.
“The last thing I want is to be on dialysis or needing a kidney transplant. Because NSAIDs are sold over the counter and so widely used, everyone thinks they are safe. Little is mentioned about long-term adverse effects.
“Because I exceeded the total number of NSAIDs that can be taken safely, I must avoid exposure to them. That includes aspirin. I now use acetaminophen (Tylenol), and it works surprisingly well. Anyone who has been taking NSAIDs long term should ask the doctor about this, as the consequences could be life altering and expensive. (By the way, eliminating ibuprofen also improved my heartburn symptoms.)”
Other Stories About NSAID Pain Relievers:
Bob in Chapel Hill, NC, on NSAIDs and Kidney Damage
“I had to stop regular use of naproxen because of kidney damage. I was an orthopedic surgeon for 40 years. I had to stop prescribing the NSAID butazolidin because it caused leukemia and a number of other side effects. Then I became more cautious about prescribing other NSAIDs because of the risk of heart attacks,”
HW on ibuprofen:
“I have had several experiences with side effects of a severe nature. A friend took Motrin for arthritis. It led to kidney failure. That led to a kidney transplant. My friend subsequently died from complications.
“My husband took aspirin, then Motrin and other NSAIDS for arthritis. He developed a severe allergy that caused serum sickness. Just because these drugs are available over the counter does not mean they are harmless.”
The Liver Can Also Be Affected by NSAID Pain Relievers:
George on liver function:
“I have been taking NSAIDs in high doses since 1997. I was diagnosed with arthritis. Now I am told that my liver is border line. Are there any medications that I can take for pain that won’t hurt my liver that are not NSAIDs?”
The Quandary: NSAID Pain Relievers or?
Occasional use of NSAIDs for a headache, back spasm or other temporary aches and pains is probably not a problem for most people. When it comes to arthritis or other chronic inflammatory conditions, however, people may need to search for safer options. Older people may be especially vulnerable as kidney function often declines with age.
Louise has few options:
“I began to show decreased kidney function after years of taking Aleve twice a day to alleviate hip and back pain. I also have arthritic pain in both hands.
“Now I use a little Aspercreme on my hands until they get ‘warmed up.’ It helps a little.
“Tart cherry juice at bedtime helps me to sleep more soundly and seems to help my hands a bit. For hip-back my Dr. prescribed Tramadol as much as 3 times a day but I will take only once with a Tylenol which she said will boost effectiveness.
“IF ONLY someone would come up with an NSAID that includes something to protect kidney function! Not many options left for those of us wanting to avoid the heavy-hitter pain meds.”
Topical NSAIDs may not prevent problems as Errol notes:
“I quit NSAIDs several years as my doctor advised because of early stage kidney disease. After a bad knee injury a specialist put me on Voltaren Gel for 9 months. Now I am in stage 4 kidney disease. I had been stable for several years before the daily use of Voltaren Gel.”
NSAIDs and PPIs: A Double Whammy for Kidneys?
Here is a dilemma. NSAIDs are known to be irritating to the digestive tract. That may be an understatement. Some people develop bleeding ulcers after using NSAIDs.
Rochelle in Coopersburg, PA shared this story:
“I’ve been taking NSAIDS for years. Last June, I had bleeding ulcers. It was so bad I was admitted to intensive care for 5 days. I thought I was having a heart attack. I lost sooo much blood and had to have numerous blood transfusions.
“In conclusion: I would like to state: my doctor never informed me of the dangers of NSAIDS. That is no excuse. So now I am very skeptical of taking any drug.”
We can understand Rochelle’s caution. A bleeding ulcer like hers can be a life-threatening situation. Not infrequently, physicians prescribe proton pump inhibitors (PPIs) to try to counteract the nasty NSAID effect on the stomach. These are drugs like esomeprazole, lansoprazole and omeprazole. A systematic review of the medical literature concluded that PPIs can help protect against stomach ulcers when patients require NSAIDs (Current Medical Research and Opinion, Jan. 25, 2017).
A Challenging Question:
The trouble is that PPIs, like NSAIDs, have been linked to kidney damage (Kidney International, Feb. 22, 2017). Put another way, is a PPI plus an NSAID equivalent to 1+1=2 (double the risk to kidneys)? Or could this combo be equivalent to 1+1=3? Could there be synergistic damage to the kidneys from this dual action? Or is there no problem from such a combination?
A study in BMJ Open (Feb. 15, 2021) attempted to begin answering that question. The authors concluded:
“Concomitant use of NSAIDs with PPIs significantly increased the risk for AKI [acute kidney injury].”
That is a very scary observation. We were disappointed not to find any further research into this critical question. We suspect that a lot of physicians continue to prescribe PPIs together with NSAIDs to protect the digestive tract. Is this combination leading to greater risk of kidney problems in the future? Why isn’t the FDA requiring further research to resolve what we think is an crucial question?
Learn more about PPIs and kidney damage at this link:
People in Pain Are Caught in the Middle:
Natural approaches such as sensible exercise, acupuncture, bromelain from pineapple, turmeric, tart cherry juice, grape juice with pectin or gelatin may offer some people relief without endangering their kidneys or their hearts.
Norma in North Carolina compares turmeric to NSAIDS:
“After a rotator cuff injury, I was in lots of pain. The NSAIDs did not help much. I started taking turmeric after a couple of friends recommended it. The improvement was amazing. I ran out and did not take it or a couple of weeks. The pain was back as badly as before. I started taking turmeric again yesterday and the improvement is again amazing!”
Karen also found the active ingredient in turmeric helpful:
“I have very painful arthritis in my thumbs and my knees. My knees need to be replaced but I just don’t want surgery.
“I saw a Curcumin post on the Peoples Pharmacy site and thought I would look into trying it… since I was in such agony.
“Well, I can say that after 3 weeks, I am amazed at how my pain is minimized. I can use my thumbs again and it has helped my knees immensely. I was very skeptical because I have no cartilage in my knees anymore. Only bone on bone.
“I swear by curcumin and will continue with it because of the astonishing results I have had with it. It has anti-inflammatory properties and I am amazed at how well it works. I take the capsules with food to avoid stomach upset. I would advise anyone who has unbearable arthritic pain to give this a try. I am even thinking of trying to get off of Celebrex, and just use the curcumin instead. I don’t like to take prescription painkillers as they make me too groggy and sleepy.
“Thank you Peoples Pharmacy for providing such a wonderful site where people can find and try natural remedies, on their own, eliminating prescription drugs, with all their side effects and contraindications. ♥”
A word of caution from The People’s Pharmacy. Some people are allergic to turmeric and its active ingredient curcumin. This can show up as a bad itchy rash. Others get digestive tract upset. Anyone on a blood thinner should not take this supplement. We have heard from readers that warfarin and turmeric may lead to an increased risk of bleeding (high INR levels).
We have provided much more information about the pros and cons of non-drug approaches for arthritis and joint pain in our book, Quick & Handy Home Remedies.
Share your own experience with NSAIDs and/or PPIs in the comment section below and please vote on this article at the top of the page.
