NSAIDS, renal problems and women

[WindingRoad]

I'm curious as to why women are more predisposed to experiencing renal complications due to prolonged NSAID use? I have been researching this topic and I find that in many cases is says women over 30 are much more at risk of developing this but no good and detailed description as to why??? I know several of you work in medicine so I thought I'd give it a shot on TE to see if anyone wants to share some info. I've determined a general cause that applies to men and women but I'm still not clear as to why women are MORE at risk. Basically it sounds that the NSAIDS impair the kidneys ability to concentrate urine properly. The only possible linking factor I ran across that makes sense is dehydration. Maybe due to monthly cycles women have more fluid loss? The typical patient that experiences analgesic nephropathy is considered to anemic, experience many headaches, female over 30 and had history of stomach ulcer. These are the signs the docs are supposed to look for. Any insight appreciated. ;)

[Biciclista]

what is NSAID?

[indysteel]

what is NSAID?

Non-steroid anti-inflammatory drug. It refers, most commonly, to drugs like aspirin, ibuprofen, and naproxen.

[Biciclista]

thank you. I am more than normally freaked out about taking these medications, even under doctor's orders. My sister has had issues with her liver and never takes this stuff (nor does she take tylenol, i don't know how she survives!) I didn't know that there were more problems for women then men...

[zoom-zoom]

I know this much...a doctor buddy of mine makes a point of telling anyone who will listen to NEVER EVER take NSAIDS 6 hours before or after any endurance activity. Apparently the risk of renal failure is just too great under these circumstances. I have listened. A post-workout ice bath is safe and more effective, anyhow, IME. And pain is there for a reason. Sometimes masking it is courting worse pain in the end.

During a marathon I ran there were a couple of guys right behind me for the first 20+ miles who were popping Advil every hour. Made me cringe. Also made me wonder why they were running a marathon if they weren't ready or willing to endure some pain.

[OakLeaf]

Zoom-zoom, does that prohibition include a maintenance dose of baby aspirin?

[zoom-zoom]

Zoom-zoom, does that prohibition include a maintenance dose of baby aspirin?

I don't think so. Mainly the danger has been studied with ibuprofen and at standard or higher doses from the things he's posted and said (though it's likely that all NSAIDS offer similar risk). Here's some more info.:
http://sportsmedicine.about.com/od/medicationanddrugs/a/NSAID_endurance.htm
http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/

[Cataboo]

I use ibuprofen a fair amount. I don't use it to take away pain, because frankly ibuprofen doesn't touch any pain that I have. If my wrist is hurting, I take it - my wrist will still hurt. What it does seem to help for me is reducing swelling. Take the ibuprofen when I have wrist pain and maybe my wrists will only hurt for a few days and not for a few weeks.

So my taking NSAIDs has nothing to do with whether or not I am willing to endure some pain to participate in the endurance activities I'm doing. I've already accepted the pain, I just hope to limit how long I am in pain by reducing the swelling.

I have a friend that is a critical care nurse and has seen too many cases of kidney damage from ibuprofen use. She makes sure to keep herself very hydrated when taking ibuprofen. If she takes a couple in the morning, she drinks a few liters of water with it to minimize the kidney damage. I've taken to doing the same whenever I take some ibuprofen and trying to make sure I don't become dehydrated. Unfortunately the situations where I usually "need" it, I'm usually fighting to stay hydrated.

http://blog.remotemedical.com/wilderness-medicine-blog/2009/3/26/ibuprofen-hydrate-before-you-medicate.html

[malkin]

I'm curious as to why women are more predisposed to experiencing renal complications due to prolonged NSAID use?


My guess:
Women are smaller than men and so the dose would be proportionally larger, causing more side effects.

I'm not looking for an argument, just making a guess.

[WindingRoad]

Thanks Cataboo for this link! :)

http://blog.remotemedical.com/wilderness-medicine-blog/2009/3/26/ibuprofen-hydrate-before-you-medicate.html[/QUOTE]

[shootingstar]

I have a friend that is a critical care nurse and has seen too many cases of kidney damage from ibuprofen use. She makes sure to keep herself very hydrated when taking ibuprofen. If she takes a couple in the morning, she drinks a few liters of water with it to minimize the kidney damage. I've taken to doing the same whenever I take some ibuprofen and trying to make sure I don't become dehydrated. Unfortunately the situations where I usually "need" it, I'm usually fighting to stay hydrated.


I'm a little shocked and amazed...by this whole thread. Do some people take painkillers that often when engaged in sport that requires several hrs. of etc.?

I never have but maybe it's because I do long, but slower rides. I mean even 100 kms-120 kms. touring rides, where it would several days each of this type of cycling per week, I never took any drug...of anything. I've been riding for past 19 yrs. But then I'm wierd.

My dearie occasionally takes a Tylenol for long rides where he is bike touring over mountain passes with his pannier weight ...and these are rides averaging 100 kms. for several consecutive days each. He's more attuned to taking his puffer to breathe easier. I am aware that for a 4-wk. touring ride ..he would be taking tylenol..hmmmm maybe no more 8-10 times or less for that whole time period.

I will ask 2 sisters about all this --they both jog. 1 is a physician and the other is a hospital pharmacist (Latter does see all sorts of situations which land patients in the hospital. She actually knows more about drug therapy for clinical research purposes and informs my physician sister.).

[WindingRoad]

Quick n' dirty version of research that I thought you all might appreciate: :)

Apparently there are people who do endurance events who live on Advil and other NSAIDs to get them through. The problem with it is a big long scientific explanation but I won't bore you with all of the details. Basically it boils down to if you NEED to take NSAIDS make sure you stay hydrated because they affect biological pathways to shut off pain but they also affect pathways that control the normal blood volume via your kidneys. Without these chemical messengers our bodies don't understand we need to hold on to our fluids and the body eliminates them when actually we need the water. This is why its so scary when people pop Advil while doing endurance events because you are likely already dehydrated. The damage to the kidneys starts because of fluid electrolyte imbalances in a critical point of the urine formation system. We absolutely must have a certain amount of sodium in very specific locations on the route of that urine formation system. Without the sodium, the body just doesn't hold on to the water when it should. This is the same concept as when you eat a bunch of salty food and get water gain. Destroying that electrolyte balance in the kidney can ultimately cause kidney failure if it goes on long enough.

Why women?

Apparently we use a LOT more painkillers than men. We are MUCH more likely to suffer from headaches, backaches and various forms of chronic pain. The female chronic pain sufferers who use high doses of NSAIDs regularly are the most at risk group. There is another complicating issue in that women, as we age tend to get dehydrated easier anyways. We also all know what we lose in the monthly cycle, this reduces the blood volume we have to work with too.

Moral of story:

Don't overdo it on your Ibuprofen, Acetaminophen and Aspirin. If you do have to take them stick to the recommended dosage and drink lots of water while taking them.

[Chile Pepper]

We are MUCH more likely to suffer from headaches, backaches and various forms of chronic pain. The female chronic pain sufferers who use high doses of NSAIDs regularly are the most at risk group. There is another complicating issue in that women, as we age tend to get dehydrated easier anyways.

This describes me, unfortunately. I get a lot of headaches and also have fairly consistent back and knee pain, so I wind up taking a lot of ibuprofen and Tylenol. I have taken ibuprofen on the bike--never for training, but rather for headaches. Bright sunlight is one of my triggers, but now I'm thinking dehydration might be playing a role. I'll switch to carrying Tylenol on the bike in case it's necessary, and in general I'm going to try to cut back on how often I use these meds.

Thanks, Winding Road! This has been an interesting thread.

[Cataboo]

I think woman in general just take more ibuprofen than men. Most females start taking it for menstrual cramps when teenagers and then just continue to use it. I don't know any guys that are in the habit of taking as much ibuprofen as myself or my female friends.

Shooting star, I take ibuprofen for various aches and pains. I either get tendonitis or trigger thumb or carpal tunnel or some combination of all of those in my wrists. Most of the time I can control it, but if I'm on a multi-day long cycling or kayaking trip - my wrists swell. Probably everything else on me does, but 12 hours a day of paddling daily or cycling takes a toll, no matter what pace I'm at. Carrying a kayak loaded with gear is heavy. Once I irritate my wrists on a multi day trip, it just spirals worse unless I take ibuprofen. I take wrist braces, sleep with those on, and take ibuprofen to try to keep the inflammation down.

I guess the alternative is to give up stuff I love doing at the level I like doing it. I already have a special paddle, handlebar tape, blah blah blah blah.

One thing that i do use is topical ibuprofen cream that has arnica in it. I pretend it works and that applying it directly to my wrists will possibly lead to a lower dose.

[emily_in_nc]

This thread has been very eye-opening and scary for me. I regularly take an Aleve before my weekend ride as I have chronic pain from my pelvic fracture in a 2005 cycling accident. I assume it's my SI joint and/or nerves around that area as my right lower back and buttock usually start aching at some point during a ride, and my right leg even feels a bit weird as if there is some nerve involvement. Getting off the bike and stretching helps for awhile, but then the pain recurs.

I have no idea if the Aleve helps at all, but I figured it might help a bit. Actually, I don't think it does make that much difference since when I forget to take it, I am just as likely to have a less painful ride than when I take it!

After reading all this, I'm just going to cut it out. Just not worth it.

[shootingstar]

After enough years of cycling and some long multi-wk. or simply multi-day long, self-loaded touring rides, I feel like such a strange baby reading all this about the painkillers.

When dearie took the occasional Tyelnol, I thought he was unusual..simply because he has some other problems, ..sleep disorder, a knee that flares up at times, a shoulder muscle from a farming machinery accident years ago.

I just was not aware it was a common practice..among people doing certain sports regularily.

and I ride hybrids or my folding bike which is more effort since it's a less swifter type of bike. No, I actually I've never had a bike with dropped handlebars...yet.

Yea, well whimpy me. But I feel fine on bike.

[Cataboo]

SS, you're lucky, and I hope you remain so. My wrists have been a chronic problem from years of overuse from lab work and typing. I've been trying to keep them under control for 14 years now, and I don't expect anything to "cure" or fix them.

There's also the bad ankle, the bad knee, and the bad elbow - my bad ankle's been a problem for 20 years now.

[Kiwi Stoker]

Would we be better off using topical pain killer creams or patches like Panaflex Max patches? Bypassing the digestive tract and hopefully only targeting the direct area involved (not so good for headaches but OK for muscle or joint pain).

I have found these type of patches really helpful for my shoulder that was broken and healing tendons etc- actuallly better than taking an oral painkiller.

[emily_in_nc]

Would we be better off using topical pain killer creams or patches like Panaflex Max patches? Bypassing the digestive tract and hopefully only targeting the direct area involved (not so good for headaches but OK for muscle or joint pain).

I have found these type of patches really helpful for my shoulder that was broken and healing tendons etc- actuallly better than taking an oral painkiller.

Don't think these are available in the US, though possibly something equivalent is.

[OakLeaf]

Diclofenac sodium is available as a gel and diclofenac epolamine is available as a patch, in the USA. I don't have access to a print PDR right now, and the online version is only available to licensed prescribers, but the layperson's version (http://www.pdrhealth.com/drugs/rx/rx-mono.aspx?contentFileName=fle1865.html&contentName=Flector&contentId=334) says that it's prescribed "as a last resort [emphasis mine] to relieve acute pain due to minor strains, sprains, and bruises." That doesn't make it sound like it's much safer than the oral version...

Then there are salicylate pain patches (related to aspirin) that are available over the counter in the USA.