The anatomy of over-medication with common painkillers

The patient’s blood pressure was low. His stomach was acutely tender. Blood tests showed his haemoglobin had dropped to 9.8 grams per decilitre (g/dL), when it should have been at least 14 g/dL. This pointed to internal bleeding. His kidney function had sharply deteriorated: creatinine, previously normal at 1 mg/dL, had shot up to 2.3 mg/dL, while his blood urea and potassium levels were significantly elevated, indicating kidney injury.

An endoscopy confirmed the diagnosis: multiple gastric erosions and a small actively bleeding ulcer. Doctors diagnosed him with NSAID-induced acute gastritis, upper gastrointestinal bleeding and acute kidney injury — all triggered by repeated use of ibuprofen.

He required aggressive intravenous fluids, acid-suppressing infusions and immediate withdrawal of the painkiller. His diabetes and blood pressure medications had to be temporarily stopped and then modified to protect his kidneys. His case is a reminder of how casually we consume some of the most potent drugs in our medicine cabinets.

What self-medicating with painkillers does to your body

The class of medicines known as NSAIDs — non-steroidal anti-inflammatory drugs — includes some of the most commonly used painkillers in India: ibuprofen, diclofenac, naproxen, indomethacin, etoricoxib, mefenamic acid and aspirin. They are routinely taken for headaches, body aches, arthritis, fever and menstrual pain, often without medical supervision.

These drugs work by blocking enzymes responsible for producing prostaglandins, chemicals involved in pain and inflammation. But prostaglandins do far more than generate pain signals. They also protect the stomach lining, maintain blood flow to the kidneys and help regulate blood vessel function. Suppress them, and the body loses some of its natural safeguards.

This is why NSAIDs can erode the stomach’s protective barrier, allowing acid to injure its lining. The result can be gastritis, ulcers and, in severe cases, gastrointestinal bleeding. Black stools, burning abdominal pain and unexplained weakness are often the first clues. Sometimes, the damage can begin within just five or six days of regular use.

The kidneys are equally vulnerable. They depend on prostaglandins to maintain healthy circulation, particularly during dehydration. In hot weather, when many people are already mildly fluid-depleted, NSAIDs can sharply reduce blood flow to the kidneys and precipitate acute injury.

For elderly patients or those with diabetes, hypertension or existing kidney compromise, the risk is significantly amplified.

Why painkillers are a risk with other medications

NSAIDS do not work well with other drugs because they alter individual functioning and change the way the body processes drugs. The combination with blood pressure medicines or diuretics is especially hazardous because NSAIDS reduce blood flow to the kidneys and can sharply impair kidney functions. Ibuprofen can block aspirin’s ability to protect the heart, limiting its effectiveness. In susceptible individuals, aspirin and related drugs can trigger asthma attacks.

As for blood pressure medication, NSAIDs increase water retention and constriction, opposing the effects of the former and diuretics, which can worsen hypertension.

That misconception is especially risky for older adults. Ageing kidneys have less reserve. Comorbidities such as hypertension and diabetes create an internal environment where even short-term NSAID use can trigger disproportionate harm.

How to manage pain then?

The safer option for routine pain relief is often paracetamol, used judiciously, along with topical pain-relief gels. For chronic osteoarthritis, physiotherapy, weight management and structured strengthening exercises remain far better long-term strategies than repeated reliance on tablets.

Painkillers have an important role in medicine. But they have to be taken under medical guidance and prescribed dosage. The strip of tablets in your drawer doesn’t mean you can pop pills repeatedly because they worked before.

(Dr Tickoo is senior director, Internal Medicine, Max Healthcare)