In the December issue of Medicine & Science in Sports & Exercise, the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and exercise-induced small intestinal injury was examined. The research question was based on how NSAIDs are commonly used by athletes prior to physical exercise in order to prevent associated pain. Researchers believed that these drugs could have negative effects on patients’ gastrointestinal (GI) mucosa during exercise.

The study included nine men who were in good health and who were adept at cycling. Participants were put through four different trials: two 400mg doses of ibuprofen prior to cycling; cycling with no administration of ibuprofen; two 400mg doses of ibuprofen with no physical exercise; and no administration of ibuprofen paired with physical rest. Researchers found that taking ibuprofen before cycling lead to higher rates of exercise-induced small intestinal injury and dysfunction of the gut barrier in study participants. Investigators concluded that intake of NSAIDs by athletes may lead to negative adverse events, and that administration of these drugs to active athletes should be avoided.

Analysis:

Nonsteroidal anti-inflammatory drugs, or NSAIDs, (Acular, Acular LS, Acuvail, Advil, Advil Childrens, Advil Infants, Aggrenox, Aleve, Arthrotec, Caldolor, Cambia, Cataflam, Celebrex, Clinoril, Daypro, Feldene, Fiorinal, Flector, Indocin, Lodine, Midol, Mobic, Motrin, Nalfon, Naprelan, Neoprofen, Nevanac, Ocufen, Orudis, Pennsaid, Ponstel, Profen, Relafen, Solaraze, Sprix, Toradol, Treximet, Vimovo, Voltaren, Voltaren Xr, Bromday, Xibrom, Zipsor, Bextra, Duract, Vioxx) are used for their antipyretic (fever-reducing), anti-inflammatory, and analgesic properties. Common generic compounds of these pain killers include naproxen, ibuprofen, and aspirin. These medications are available by over the counter, though some may be prescribed due to higher dose strengths.

FAERS data (from 11/01/1997 to 06/30/2012) was aggregated and standardized by the AdverseEvent RxFilter process. We identified 2,710 serious adverse events which listed NSAIDs as the primary suspect associated with gastrointestinal or abdominal injury. We identified 1,201 hospitalizations and 203 patient deaths where NSAIDs were determined to be the primary suspect.

Note: This analysis does not take into account the number of patients taking each medication. In order to calculate the number of cases involving NSAIDs, we aggregated cases reporting the following drugs as the primary suspect at the time of the adverse event: Acular, Acular LS, Acuvail, Advil, Advil Children’s, Advil Infants, Aggrenox, Aleve, Arthrotec, Caldolor, Cambia, Cataflam Celebrex, Clinoril, Daypro, Feldene, Fiorinal, Flector, Indocin, Lodine, Midol, Mobic, Motrin, Nalfon, Naprelan, Neoprofen, Nevanac, Ocufen, Orudis, Pennsaid, Ponstel, Profen, Relafen, Solaraze, Sprix, Toradol, Treximet, Vimovo, Voltaren, Voltaren Xr, Bromday, Xibrom, Zipsor, Bextra, Duract, Vioxx. In order to calculate the number of cases involving gastrointestinal or abdominal injury, we aggregated cases reporting the following adverse events: MedDRA High-Level Terms: Abdominal injuries NEC, gastrointestinal disorders.