Key takeaways:
If you’ve experienced a heart attack in the past, some pain medications, including over-the-counter (OTC) and prescription products, can be unsafe.
Tylenol (acetaminophen) is usually a safe pain medication to use. Your provider may also recommend a topical NSAID medication.
Oral NSAIDs can raise your risk of heart attack, stroke, high blood pressure, and heart failure — especially if you’ve previously had a heart attack.
Talk to your provider about which pain medication might be the safest and most effective for you.
Save on related medications
If you’ve had a heart attack, you know that it can be a life-changing event. In addition to dealing with the heart attack itself, you are usually prescribed multiple medications to help prevent future heart problems. This can be overwhelming, especially if you haven’t taken a lot of medication before.
One of the important things to know is which medications you can safely take after having a heart attack. This is because some pain medications, even over-the-counter (OTC) products, can be unsafe or cause problems when combined with other treatments you are taking.
This article will describe which pain medications can be safe to use and which ones to avoid after having a heart attack.
Are over-the-counter medications safe to use after a heart attack?
OTC medications are often safe to take, which is why these medications are available without a prescription. However, if you have certain medical conditions, including a previous heart attack, high blood pressure, heart failure, or kidney disease, some OTC medications should be used with caution. The rule of thumb is that you should always consult with a healthcare professional before taking a new OTC medication.
Are NSAIDs safe to use?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications, available OTC and by prescription, that can lower inflammation and relieve pain. NSAID pain medications that are OTC include naproxen (Aleve) and ibuprofen (Motrin, Advil) for oral options, and diclofenac (Voltaren) gel as a topical medication.
Oral NSAIDs
When taken orally, NSAIDs can cause high blood pressure, kidney damage, and can raise your risk of heart attack and stroke. If you’ve had a heart attack, your cardiologist — a provider specializing in treating heart conditions — may tell you to avoid taking NSAIDs because of this risk.
Aspirin is an OTC medication that is also considered an NSAID, but it’s usually not used for pain relief. Also, aspirin does not have all of the same risks as other NSAIDs. In fact, it is often used to prevent heart attacks and strokes.
If you take aspirin, taking another NSAID medication can interfere with its benefits, so you should be especially cautious about taking oral NSAIDs if your provider also has you taking aspirin for stroke or heart attack prevention.
Topical NSAIDs
Topical NSAIDs like diclofenac gel usually don’t have the same risks as oral NSAIDs because not enough of the medication is absorbed into the body to cause the same effects. In fact, one study found a 36% lower risk of heart problems with topical NSAIDs compared to oral NSAIDs.
While topical NSAIDs and other topical pain relievers are thought to be safer than oral NSAIDs, they may not be as effective at treating certain types of pain. This is because the medication is applied to the skin and can’t reach some deeper locations of pain. However, applying large quantities can still be risky — it’s possible to absorb too much of the medication.
Even though studies have suggested that they’re lower risk, topical NSAID labeling advises against using the products if you’ve had a heart attack — unless the benefits outweigh the risks. Because of this, you’ll want to talk to your provider first before giving them a try.
Is Tylenol safe to use?
Tylenol (acetaminophen) is one of the safest pain medications to use if you’ve had a heart attack. While it may be less effective than NSAIDs, many people still find that it helps with pain relief.
Tylenol doesn’t have the same risks as NSAIDs when it comes to your heart. However, liver damage can occur if you take very large doses or if you take doses above the recommended daily limit over long periods of time.
If you have liver problems or if you consume alcohol (three or more drinks every day), you should talk to your healthcare provider because you may need a lower dose to avoid liver damage.
What about other topical products?
Other topical OTC pain relievers containing capsaicin, menthol, or methyl salicylate — like Bengay, Capzasin, Flexall, and Icy Hot — can also be used. However, they have caused skin burns or blistering in rare cases, so products containing these ingredients should be used with caution.
What about prescription pain relievers — are they safe?
There are several different types of prescription pain medications available, including NSAIDs, opioids, gabapentinoids, and others. The best medication often depends on the type of pain you’re treating and your underlying risks.
If you need prescription medication to treat your pain, you and your healthcare provider can decide which medication is right for you.
What pain medications should I avoid after a heart attack?
Many prescription pain medications can be used safely after a heart attack, but several can potentially cause problems. Here’s a few that you should know about.
NSAIDs
As mentioned above, NSAIDs can have several harmful side effects, especially if taken at high doses for long periods of time. These medications raise the risk of heart attack, stroke, high blood pressure, and heart failure — which is even more common in people who have heart disease, including those who’ve had a previous heart attack.
Examples of prescription NSAIDs include higher strengths of ibuprofen and naproxen, as well as prescription-only products like celecoxib (Celebrex) and meloxicam (Mobic).
Opioids
While you may not need to completely avoid opioids, these medications should be used with caution because of their potential for dependency, overdose, and death. Since they are controlled substances, laws regulate how they are prescribed. Your healthcare provider can help determine whether opioids are a safe option for pain relief for you.
Triptans
Although they are not traditionally known as pain relievers, triptans are a class of medications that help treat migraine headaches. But they can cause serious heart problems, including death, if you have heart disease.
Some examples of commonly used triptans are sumatriptan (Imitrex), rizatriptan (Maxalt), and eletriptan (Relpax). These medications are contraindicated, meaning that they shouldn’t be used in people who have previously had a heart attack.
The bottom line
If you’ve had a heart attack and you need to take an OTC medication to help with pain, Tylenol is the safest choice.
You should avoid taking oral NSAIDs because of harmful side effects, including a higher risk of having a heart attack or stroke. However, your provider may decide that topical NSAIDs are an option for you.
Many prescription pain medications can be safe after a heart attack, and the best medication often depends on the type of pain you are treating. Your provider will work with you to find safe and effective options. OTC medications on the shelf or at home can be risky, so it’s best to talk to your provider first.
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References
Bennett, J. S., et al. (2005). The use of nonsteroidal anti-inflammatory drugs (NSAIDs): A science advisory from the American Heart Association. Circulation.
Diener, H. (2020). The risks or lack thereof of migraine treatments in vascular disease. Headache: The Journal of Head and Face Pain.
Endo Pharmaceuticals Inc. (2018). VOLTAREN- diclofenac sodium gel [package insert].
Lin, T., et al. (2017). Comparative risk of cardiovascular outcomes between topical and oral nonselective NSAIDs in Taiwanese patients with rheumatoid arthritis. Journal of the American Heart Association.
Marcum, Z. A., et al. (2010). Recognizing the risks of chronic nonsteroidal anti-inflammatory drug use in older adults. Annals of Long-Term Care.
MedlinePlus. (n.d.). Opioids and opioid use disorder (OUD).
Taubert, K. A. (2008). Can patients with cardiovascular disease take nonsteroidal antiinflammatory drugs? Circulation.
U.S. Food and Drug Administration. (2016). FDA drug safety communication: Rare cases of serious burns with the use of over-the-counter topical muscle and joint pain relievers.
