Non-steroidal anti-inflammatory drugs (NSAIDs) are one of two types of over-the-counter (OTC) pain relievers available in the United States when you have aches, pains, and inflammation. NSAIDs are commonly used with 30 million users worldwide daily. The two most commonly used NSAIDs OTC are ibuprofen (Advil) and naproxen (Aleve). While NSAIDs are generally safe for most people, there are associated cardiovascular risks and are not generally recommended for people with heart failure.

Heart failure is a term used when someone’s heart isn’t pumping as well as it should. Our body relies on the heart’s pumping action to deliver oxygen and nutrient rich blood to the body. With heart failure, the weakened heart can’t supply your body with enough blood and oxygen which leads to fatigue and shortness of breath. In some cases when the heart stops pumping normally, it causes blood to back up in veins of legs, ankles, and feet, causing fluid to build up and cause swelling.

What happens if someone with heart failure takes an NSAID?

NSAIDs may decrease kidney function in heart failure patients. This can lead to sodium and water retention which increases swelling and worsening of heart failure symptoms. Ultimately, this fluid retention can overwhelm a weakened heart and lead to hospitalization.

Is there a safe NSAID to use if I have heart failure?

While not recommended, there is some evidence that shows that naproxen is the safest to use in heart failure. It is best to use the lowest possible dose and for a short period. Naproxen is available OTC at 220mg and can be take every 12 hours with food. They shouldn’t be take for more than 10 days but check in with your doctor or pharmacist first to be sure it’s safe for you. Look out for worsening symptoms of heart failure that include swelling, shortness of breath (especially while walking or lying flat), and feeling faint or dizzy.

A safer alternative…

Another alternative is topical diclofenac gel. This medication is an NSAID, but it is applied topically to the affected area and works by decreasing inflammation. Because this medication is applied to the skin and not taken by mouth, there is a decreased risk of side effects.  As always, check in with your doctor or pharmacist to see if this medication is right for you.

Prepared by Adam Taniguchi PharmD

Resources:

  1. https://www.health.harvard.edu/heart-health/pain-relief-thats-safe-for-your-heart-
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340840/
  3. https://www.sciencedirect.com/science/article/abs/pii/S0889857X22000758?via%3Dihub
  4. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure