Stroke Recovery: Advil Usage And Safety

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammation. However, their use has been associated with an increased risk of adverse cardiovascular events, including stroke. While the link between NSAIDs and stroke is not yet fully understood, it is important for patients and doctors to be aware of this potential risk. The Food and Drug Administration (FDA) in the United States has issued a warning that NSAIDs, except aspirin, may increase the risk of stroke and heart attack. As such, it is recommended that people avoid taking NSAIDs unless advised by a doctor. This is particularly important for individuals who have experienced a stroke, as certain pain medications may no longer be safe for them.

Ibuprofen can increase the risk of stroke

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can be purchased over the counter. NSAIDs are commonly used to relieve mild to moderate pain and are particularly effective in reducing inflammation. However, ibuprofen has been associated with an increased risk of adverse cardiovascular events, including stroke.

In 2005, the FDA issued a warning that NSAIDs, including ibuprofen, may increase the risk of heart attack and stroke. This warning was further strengthened in 2015 based on the advice of an expert panel. The risk of stroke associated with ibuprofen use is particularly concerning because of the drug's widespread use and availability.

Several studies have found a link between ibuprofen use and an increased risk of stroke. One study, published in the British Medical Journal, found that ibuprofen was associated with more than three times the risk of stroke when compared to a placebo. Another study, a longitudinal cohort study of nearly 75,000 patients, found that the use of ibuprofen was associated with an increased risk of ischemic stroke. Additionally, a meta-analysis of 31 studies found that ibuprofen was associated with the highest risk of stroke among the NSAIDs studied.

The mechanism by which ibuprofen may increase the risk of stroke is not fully understood, but it is thought to be related to the drug's effect on the balance of prostaglandins, thromboxane, and prostacyclin, which can impact vascular function, platelet aggregation, and smooth muscle proliferation. Additionally, ibuprofen has been found to increase blood pressure, which is a known risk factor for stroke.

Given the potential risks associated with ibuprofen use, it is important for individuals to carefully consider the benefits and risks before taking this medication. For individuals with a history of cardiovascular disease or other risk factors for stroke, alternative pain relievers may be preferable. It is always advisable to consult with a healthcare professional before taking any medication, including over-the-counter drugs like ibuprofen.

Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause strokes

Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation associated with arthritis, tendinitis, bursitis, menstrual cramps, headaches, colds, and the flu. They can be purchased over the counter or through a prescription. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib.

NSAIDs can increase the risk of heart attack and stroke, which can lead to death. This risk may occur as early as the first few weeks of use and may increase with longer use and higher doses. NSAIDs can increase this risk in patients with or without heart disease or risk factors for heart disease. In general, patients with heart disease or risk factors are more likely to experience a heart attack or stroke following NSAID use because they are already at higher risk.

The U.S. Food and Drug Administration (FDA) has strengthened its warning label on prescription NSAIDs to reflect the risk of heart attack and stroke. The FDA advises patients taking NSAIDs to seek immediate medical attention if they experience symptoms such as chest pain, shortness of breath, weakness on one side of the body, or slurred speech.

While the evidence for the risks associated with NSAIDs is still debatable, it is generally recommended that people avoid taking NSAIDs unless deemed safe by a doctor.

The FDA has strengthened its warning about the increased risk of heart attack or stroke when taking higher doses of ibuprofen

In 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increased the risk of having a heart attack or stroke. In July 2015, the FDA took the unusual step of further strengthening this warning. This was done on the advice of an expert panel that reviewed additional information about NSAIDs and their risks.

The FDA has noted the following ibuprofen warnings and similar risks of other NSAIDs:

• Heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID.
• The risk increases with higher doses of NSAIDs taken for longer periods.
• The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.

The FDA recommends that it is best for people with heart disease to avoid NSAIDs if at all possible, and for everyone who is considering taking an NSAID to proceed with caution. Here are some strategies:

• Take the lowest effective dose, and limit the length of time you take the drug.
• Never take more than one type of NSAID at a time. There appears to be a risk associated with all types of NSAIDs.
• Try alternatives to NSAIDs such as acetaminophen. It relieves pain but does not appear to increase heart attack or stroke risk.
• If nothing else works and you need to take an NSAID for arthritis or other chronic pain, try taking week-long "holidays" from them and take acetaminophen instead.

Antidepressants can be used to treat post-stroke pain

SSRIs such as fluoxetine and paroxetine have been shown to increase the availability of monoamines, as well as decrease the expression of pro-inflammatory markers in animal models of cerebral ischemia. Fluoxetine has also been shown to augment cerebral excitation and inhibition by increasing levels of GABA, a primary inhibitory neurotransmitter, via promoting neurogenesis of GABAergic interneurons.

In addition to their effects on cerebral excitation and inhibition, SSRIs also have direct vasodilatory effects on small cerebral vessels, which can lead to increased synaptic connectivity and enhanced neurogenesis through excitatory mechanisms. They also induce neural growth factor activity, which results in potentiation of natural neurogeneration.

Several clinical studies have demonstrated that antidepressants improve physical recovery and motor function independent of the presence of depression in the study population. For example, the FLAME trial showed that patients receiving fluoxetine for 3 months had significantly higher improvements in Fugl-Meyer motor scale scores compared to those receiving a placebo. Similarly, a double-blinded randomized trial found that patients recovering from stroke who were randomized to receive fluoxetine, nortriptyline, or a placebo for 3 months had less disability at 1 year following stroke or 9 months following the discontinuation of their antidepressant treatment, even after controlling for the presence of depression, age, and baseline stroke disability.

Antidepressant treatment plays an increasing role in the management of patients with acute stroke. Early initiation of antidepressant therapy in non-depressed stroke patients may reduce the odds of developing post-stroke depression and improve cognitive and functional recovery.

Anticonvulsants can help with certain types of post-stroke pain

Anticonvulsants are drugs that are typically used to treat seizures. However, they can also help with certain types of post-stroke pain, such as central pain syndrome (CPS). CPS is a chronic pain condition that stems from damage to the central nervous system. It can manifest as intense freezing or burning sensations, and it often occurs years after a stroke.

Gabapentin (Neurontin) and pregabalin (Lyrica) are two anticonvulsants that doctors may prescribe for pain after a stroke. These drugs are calcium channel modulators. However, there is a lack of clinical trials proving the effectiveness of these drugs, and studies supporting their use have produced mixed results.

Lamotrigine is another anticonvulsant that may help with post-stroke pain, but studies supporting this are small and limited.

While anticonvulsants can be beneficial for certain types of post-stroke pain, it is important to note that they may not be effective for all individuals and should be used under medical supervision.

In addition to anticonvulsants, other types of medications that may be prescribed for post-stroke pain include antidepressants, corticosteroids, and antispasmodics. Physical therapy, electrical stimulation, adaptive equipment, Botox injections, and mirror therapy are also used to manage post-stroke pain.

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