What Pain Relievers Can I Take if I Have Heart Failure?
Key takeaways:
People with heart failure often experience chronic pain. Some pain medications are safer to take than others.
Acetaminophen (Tylenol) and topical pain relievers are the preferred pain relievers to take if you have heart failure.
Pain medications like gabapentinoids, opioids, and long-term NSAIDs should be avoided if you have heart failure.
It’s estimated that about 20% of adults in the United States experience chronic pain — ongoing pain that continues despite medications or other treatment. It can last from months to years, and has the ability to impact your quality of life. And if you have heart failure, chronic pain can cause your condition to become worse, so it’s important to keep it under control.
But before you reach for the bottle of Advil on the shelf, know that many medications used to treat pain can interfere with heart failure therapies and can have problematic side effects.
While it’s always important to check with your provider about which medications are best for you, here we’ll cover pain medications options that are safe, as well as some that you should avoid if you have heart failure.
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Are over-the-counter pain medications safe to use if you have heart failure?
Over-the-counter (OTC) medications are usually considered safe for most people — that’s why they don’t require a prescription from a healthcare provider. However, many OTC products have safety precautions that you should be aware of, especially if you have a chronic condition like heart failure or if you take other medications.
There are three main categories of OTC pain medications: NSAIDs (nonsteroidal anti-inflammatory drugs), acetaminophen (Tylenol), and topical medications (creams, ointments, etc.).
Experts consider Tylenol and topical pain relievers to be the preferred pain relievers in people with heart failure.
Are NSAIDs safe?
NSAIDs are effective pain medications that work primarily by lowering pain and inflammation. Ibuprofen (Advil, Motrin) and naproxen (Aleve) are two NSAIDs available OTC. Aspirin is also an NSAID, but providers usually don’t advise taking it for pain.
When taken in large quantities or at higher doses over long periods of time, NSAIDs can raise the risk of stomach bleeding and ulcers, kidney damage, and worsening heart failure symptoms.
If you have certain medical conditions such as heart failure or kidney disease or take medications that are unsafe to take with NSAIDs, it’s safest to avoid NSAIDs altogether.
Is Tylenol safe?
Tylenol is considered a safe OTC medication in most cases. Some people think it may be less effective than NSAIDs for some types of pain, but it can still be an effective pain reliever for most.
Tylenol does not have the same risks as NSAIDs when it comes to your heart. But if you take extremely large doses or take daily doses over the recommended limits for long periods of time, it can cause liver damage and potentially be fatal. However, Tylenol can be used safely when taken within the recommended amounts, so it’s best to follow the dosing instructions on the product’s packaging.
If you have current liver problems or drink three or more alcoholic beverages every day, talk to your provider before using Tylenol because you may need to use a lower dose.
Are topical pain relievers safe?
Topical pain relievers like creams and gels are applied externally to the skin to relieve pain.
Some common examples of OTC topical pain relievers are capsaicin, menthol, and lidocaine.
Since these products are applied to the skin, they may be more effective for some types of pain than others. For example, topical pain medications tend to be more helpful for joint pain in the hands and feet than for deeper pain like that in the back and hips. This is because, with the latter, the medication can’t absorb deep enough to get to the needed site of action.
Topical pain relievers are among the safest pain medications because you don’t absorb very much of the medicine through your skin, so you don’t have as many risks as with oral medications. But it’s possible to apply too much, causing you to absorb excessive amounts of the medication. When using these products, follow the directions on the packaging.
And if you’re using a product that contains capsaicin, menthol, or methyl salicylate (like Bengay or Icy Hot), there have been reports of severe burns that cause pain, swelling, and blistering of the skin. Although this is rare, you’ll want to use these products with caution.
For people with heart failure, topical pain relievers are generally very safe to use. But you’ll still want to talk to your provider about which topical products are best.
What about prescription pain relievers?
When pain is severe enough to require prescription pain relievers, many medications can be useful. Your provider will determine which ones will work best for you and are safe to use with heart failure.
However, you should avoid taking prescription pain medications that worsen heart failure or interact with other medications you may be taking for the condition. Examples of medications that can be risky are NSAIDs, gabapentinoids (gabapentin and pregabalin), and opioids.
Are prescription-only NSAIDs safe?
Some NSAIDs are available by prescription only, while others — like ibuprofen and naproxen — require a prescription only for higher-strength versions. Examples of prescription-only NSAIDs include celecoxib (Celebrex), meloxicam (Mobic), and diclofenac (Voltaren, Cataflam, Cambia).
Like OTC NSAIDs, you’ll want to avoid prescription NSAIDs as well. It’s important to remember that taking higher doses of these medications raises the risk of your symptoms getting worse, possibly resulting in a trip to the hospital.
Are gabapentinoids safe?
Gabapentin (Neurontin) and pregabalin (Lyrica) are collectively known as “gabapentinoids,” and they are primarily used to treat nerve pain. These medications have been shown to cause weight gain as a side effect, which may be due to changes in appetite or fluid (water) retention. Too much fluid in your body can put more stress on your heart, making your condition worse. Additionally, people with heart failure who are taking these medications may be more likely to be admitted to the hospital.
Are opioids safe?
Opioids are strong pain medications that work for many different types of pain. Morphine, oxycodone, and hydrocodone are examples of opioid medications. All opioids are controlled substances, which means that they have the potential for dependency, and laws regulate how they are prescribed.
In patients with heart failure, opioids are discouraged since they carry a lot of risks — like dependency, overdose, and death — without much long-term benefit. Plus, there are concerns about how these medications affect the heart in general. However, some experts suggest continuing opioids in people with heart failure if the benefits outweigh the risks.
The bottom line
If you have heart failure and need to treat your chronic pain, your healthcare provider may talk with you about the risks and benefits of each potential option to determine which medication is best for you.
Generally, Tylenol and topical pain relievers are preferred in heart failure because they have the fewest side effects and health risks. Gabapentinoids, opioids, and long-term NSAIDs should be avoided if possible.
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References
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