Clipping Board » Drug Poisoning ─ It is necessary to be aware of the toxic side effects before taking medication.
Source: [Common Health Magazine / Issue 31]
Author: Text by Lin Zhencen, Photography by Xiao Shiying
Reviewed by: Clinical Pharmacy Expert, Pharmacist Jiang Shaoqing from Heping Hospital
Do you often take painkillers for headaches or other pains? These easily accessible over-the-counter pain relievers have gradually become a part of our daily lives. But are they really safe? A popular TV host, setting aside their on-screen playful demeanor, earnestly and firmly looks at you in an advertisement and says, "Panadol won’t let you suffer a second longer." In that very second, over 1,200 non-narcotic pain relievers (including aspirin, Panadol, and related medications) are swallowed by people in Taiwan and the U.S.
It is estimated that Taiwan consumes 100 million non-narcotic pain relievers annually (with annual sales of about 800 million NT dollars, including aspirin and Panadol-related drugs), while Americans use over 8 billion Tylenol (known as Panadol in Taiwan) and 30 billion aspirin tablets each year on average.
"Painkiller advertisements are deeply ingrained in people's minds," admits Mr. Huang, a pharmacist who runs a pharmacy in Zhubei. He notes that when people come to buy medicine, they don’t ask which drug is most suitable for them but instead purchase based on the "ad slogans they remember best," without knowing the contents of the painkillers or whether they might cause allergies.
With such massive sales figures, intensive drug advertisements, and widely circulated online information about painkillers, what exactly is their appeal? And what problems might arise from long-term use?
**Pain: A Difficult Problem to Solve**
Common over-the-counter painkillers can generally be divided into two types. The first is simple analgesics, containing acetaminophen (brand names include Panadol, Tylenol, etc., hereafter referred to collectively as acetaminophen), which provides pain relief and fever reduction. The second type includes nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, brand names like Bufferin, aspirin, and pediatric Wincofen), which not only relieve pain and reduce fever but also have anti-inflammatory effects, alleviating pain caused by joint inflammation.
In 1897, German chemist Hoffmann, seeking to relieve his father’s arthritis, discovered acetylsalicylic acid, which led to the creation of aspirin—the ancestor of NSAIDs. Fifty years later, in 1946, "the father of drug metabolism" Brodie and Nobel Prize-winning physiologist Axelrod, during a casual conversation, found that the toxic headache powder acetanilid could be modified into acetaminophen, which does not accumulate in the body and has fewer side effects. This led to the synthesis of acetaminophen, now one of the most commonly used pain relievers alongside aspirin.
NSAIDs and acetaminophen are similarly effective in pain relief, working by inhibiting prostaglandin production (an inflammatory substance found throughout the body). They have broad systemic effects—for example, aspirin can also be used to prevent cardiovascular blockages or even cancer. However, their downside is the potential for widespread side effects and numerous contraindications. People with poor liver, kidney, or stomach function, those taking anticoagulants, children under 20, asthma sufferers, or individuals prone to bleeding should avoid NSAIDs. For instance, "pediatric Wincofen (Tapal)" was once used as a children’s fever reducer but was discontinued in pediatrics due to the risk of severe brain-damaging side effects like Reye’s syndrome. However, the low-dose aspirin in "pediatric Wincofen" makes it a common preventive medication for vascular blockages in heart disease patients.For those who cannot use non-steroidal anti-inflammatory drugs, acetaminophen provides an alternative. Acetaminophen acts directly on the central nervous system in the brain, blocking pain transmission. It is a simple analgesic and antipyretic (fever reducer) with no other known effects. Its advantage is fewer systemic side effects, making it safer for children and pregnant women.
Easily accessible over-the-counter pain relievers have gradually become a part of our daily lives. But are they really safe?
Does Panadol harm the liver?
Most doctors believe that the safety assurances in painkiller advertisements lead people to lower their guard, making accidental overdoses more likely.
"People always think these drugs are as safe as eating M&M's chocolates," said Dr. William Lee, a professor at the University of Texas Southwestern Medical School.
In fact, the dangers of painkillers exceed what you might imagine.
One major risk is that excessive acetaminophen intake can cause liver and kidney damage. Dr. Lee analyzed 300 cases of acute liver failure and found that 38% were related to acetaminophen poisoning. Another 307 patients with severe liver damage showed that 35% were linked to acetaminophen toxicity.
In the U.S., over 100,000 people are hospitalized each year due to acetaminophen overdose. In Taiwan, the numbers are also rising. For example, at Linkou Chang Gung Memorial Hospital, there have been at least 20 cases of acetaminophen poisoning annually over the past two to three years, with a rapid increase. "These drugs are too easily accessible," said Dr. Lin Jie-liang, head of the Toxicology Department at Linkou Chang Gung Memorial Hospital, with deep concern.
In reality, many factors can lead to acetaminophen poisoning, and negligence easily crosses the line. These include repeated use of acetaminophen-containing products, pre-existing liver or kidney issues, and alcoholism—all of which can increase the toxicity of acetaminophen accumulation in the liver.
For example, adults consuming more than 4 grams of acetaminophen per day may experience poisoning and liver damage. In Taiwan, each Panadol tablet contains 500 mg of acetaminophen, meaning taking more than eight tablets a day is dangerous. Moreover, acetaminophen is not only found in painkillers but is also common in other everyday medications.
According to U.S. statistics, over 200 drugs on the market contain acetaminophen, including cough syrups like Taiwan's "Feng Re You" and "You Lu An."
A lack of awareness about acetaminophen-containing products cost 23-year-old American Patrick his life.
After injuring his back, Patrick was prescribed acetaminophen combined with the opioid painkiller codeine during his hospitalization. After discharge, he continued taking over-the-counter acetaminophen for a week. One day, he suddenly developed a high fever and vomiting. Shockingly, the hospital administered a large dose of acetaminophen before diagnosing his liver failure, leading to acute acetaminophen poisoning. Patrick passed away within a week.
Additionally, alcohol increases the risk of acetaminophen poisoning.
Long-term alcohol use makes liver oxidative enzymes abnormally active, causing toxic metabolites of acetaminophen to accumulate in the liver and damage liver cells.
Furthermore, chronic alcoholics or heavy drinkers metabolize acetaminophen faster, requiring higher doses for pain relief, often leading to unintentional overdoses.
In recent years, drug manufacturers have added warnings to their products, advising that those who regularly consume more than three alcoholic drinks per day should take acetaminophen only under a doctor's supervision.
This caution stems from a case in Virginia, where a man took a standard dose of acetaminophen and had a pre-dinner drink, leading to liver failure and necessitating a liver transplant.
Moreover, early hepatitis symptoms are often mild and resemble the common cold, making it easy to misuse acetaminophen products.If the doctor does not immediately detect the soaring SGOT and SGPT levels in the liver and continues to administer acetaminophen, the consequences would be unthinkable.
In the UK, due to the high number of acetaminophen poisoning cases, the government has even strictly limited its sale, allowing only a regulated quantity to be purchased at a time.
Doctors advise that if you have abnormal liver or kidney function, it is best not to take acetaminophen painkillers without professional guidance.
Before using painkillers, always check the ingredient list on the packaging to see how much acetaminophen it contains, to avoid repeated use and increased toxicity.
Do nonsteroidal painkillers harm the kidneys?
Painkillers not only damage the liver but also take a toll on the kidneys. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in particular poses significant risks to kidney health.
NSAIDs work by inhibiting prostaglandins, which are directly involved in the dilation of renal arteries. When renal arteries are suppressed by painkillers, kidney tissues suffer from insufficient blood flow, leading to necrosis due to lack of nutrients.
Moreover, using painkillers daily for more than six months "may already constitute what we call abuse," says Dr. Lin Jie-liang. In contrast, pure acetaminophen causes less kidney damage, but excessive intake can still harm the kidneys.
Foreign studies show that 5–9% of dialysis patients are victims of NSAID abuse. Annually, about 1.7 out of every 1,000 people who abuse painkillers will require dialysis , "a rate comparable to the annual incidence of lung cancer among smokers," warns Dr. Lin Jie-liang, a nephrologist and director of the Toxicology Department at Linkou Chang Gung Memorial Hospital, urging people not to overlook the dangers of painkillers.
Additionally, excessive painkiller use can accumulate in the kidneys, leading to interstitial nephritis, urinary tract tumors, and increased risks of cardiovascular stroke and gastric ulcers. "This is not alarmist talk," Dr. Lin emphasizes. "These cases are not uncommon in nephrology clinics, and the damage is often irreversible."
Worst of all, kidney damage caused by drugs often goes undetected in routine kidney function tests. Dr. Lin considers urine concentration tests one of the viable methods for early detection.
When kidneys are damaged, their ability to concentrate and acidify urine weakens. Therefore, Dr. Lin recommends patients provide their first morning urine for testing. By assessing urine concentration, kidney damage can be inferred, allowing for intervention before it progresses to uremia.
For arthritis patients who must use painkillers long-term, such as those with lupus or rheumatoid arthritis, in addition to strict dosage control, Dr. Li Xiu-shen, head of the Rheumatology and Immunology Department at Taipei Mackay Memorial Hospital, requires regular urine tests, blood pressure monitoring, and blood biochemistry checks to track kidney function changes.
If symptoms like anemia or bone pain appear after long-term high-dose NSAID use, it may indicate kidney problems. Dr. Lin advises getting a kidney function test promptly.
However, for patients who must take daily aspirin to prevent heart disease, Dr. Lin reassures that the preventive dose is too small to cause kidney issues.
It is estimated that over 16,000 Americans die annually from gastric complications caused by NSAIDs. Combining these drugs with alcohol further increases the risk of stomach bleeding.
How to mitigate the stomach-related side effects of painkillers?
Another major issue with NSAIDs is their harm to the gastrointestinal tract, especially for those with weak stomachs or a history of ulcers.
This is because prostaglandins protect the stomach lining, and NSAIDs inhibit their production, relieving pain at the expense of stomach health.It is estimated that more than 16,000 Americans die each year from stomach-related injuries caused by non-steroidal pain relievers. Taking these medications along with alcohol further increases the risk of stomach bleeding.
As for whether combining such drugs with antacids can truly protect the stomach?
"Hardly," says Jiang Shaoqing, a clinical pharmacy expert specializing in cancer medications and well-versed in pain relievers, currently a pharmacist at Taipei Veterans General Hospital. He dismissively refutes this notion, describing it as a "false sense of security." He believes this approach may instead reduce the absorption of painkillers. Clinically, it has been observed that unless antacids are taken every two hours, they do not effectively prevent ulcers. The typical dosage is insufficient to lower stomach acid.
However, for patients with arthritis who must rely on anti-inflammatory painkillers for relief, stronger stomach medications—such as proton pump inhibitors (brand names like Losac and Takepron)—can be used to reduce the occurrence of stomach ulcers, Jiang points out.
Because early-stage stomach ulcers often cause no noticeable symptoms, Li Xiushen, director of the Rheumatology and Immunology Department at Taipei Mackay Memorial Hospital, also reminds patients taking non-steroidal anti-inflammatory drugs (NSAIDs) to inform their doctor immediately if they experience pale complexion or black stools.
As for whether people with Helicobacter pylori (which clinically increases the risk of stomach ulcers and gastric cancer) can take NSAIDs, the issue remains controversial. Some scholars argue that H. pylori is an infection that stimulates the stomach to produce prostaglandins, and taking aspirin can inhibit prostaglandins, thereby speeding up healing.
On the other hand, some doctors believe H. pylori should be eradicated before taking such medications. However, if NSAIDs are only taken 2–3 times a month, they rarely cause severe stomach damage. Generally, it is recommended to eat something before taking NSAIDs or to take them with food, such as crackers or milk, to reduce stomach irritation.
Some doctors opt for newer COX-2 inhibitors (such as Celebrex or Vioxx), which have fewer stomach-related side effects. Additionally, pharmacist Jiang Shaoqing warns that people with asthma or nasal polyps should avoid NSAIDs, as they can worsen allergic reactions.
Studies show that 4–20% of people experience bronchial constriction or even death after taking these drugs. Therefore, if you fall into this category, do not purchase painkillers on your own. Moreover, new research suggests that patients with irritable bowel syndrome (IBS) should avoid any aspirin-containing painkillers, as these drugs can cause gastrointestinal side effects and even worsen the condition.
### Safe Use of Painkillers
If painkillers are necessary, how can they be used to minimize harm to the body?
■ **Use painkillers only when necessary, and for short durations.**
"Painkillers should only be used as a last resort," says Lin Jieliang. Most nephrologists do not prescribe painkillers for more than three days, and once the pain subsides, the medication should stop immediately. (Post-surgical patients are an exception.) Even arthritis patients who live with chronic pain are advised: "If you're not in pain, try not to take painkillers." Responsible orthopedic and rheumatology doctors will repeatedly remind patients of this. Dr. Li Xiushen believes arthritis treatment should be phased: anti-inflammatory painkillers can help during acute flare-ups, but afterward, patients should rely on exercise, rehabilitation, and rest to manage pain.
■ **Drink plenty of water and urinate frequently.**
When taking painkillers, it is essential to drink ample water—at least 2,000–3,000 cc per day—to help flush the drug's toxins from the body. Dr. Lin Jieliang considers this insufficient: "You should urinate at least 7–10 times a day."He pointed out that some people are prone to sweating or dehydration, especially children who may experience vomiting and diarrhea when they have a fever, leading to reduced urine output. This makes it difficult for the body to metabolize medications, so increased water intake is necessary.
Research abroad has shown that the harmful effects of painkillers are more severe in subtropical regions, possibly due to the hot climate, excessive sweating, and reduced urination, which hinder the adequate elimination of drug toxins.
■ Avoid Mixing Painkillers
Unless directed by a doctor, it is best not to mix two or more types of painkillers. Combining painkillers can amplify their side effects and increase toxicity to the liver and kidneys. For example, compound cold medicines or painkillers containing both aspirin and paracetamol should be "avoided as much as possible," according to Lin Jieliang. It is safer to use single-ingredient medications. Especially avoid taking two single-ingredient drugs simultaneously (such as swallowing one paracetamol pill followed by an aspirin pill), as this increases liver and kidney toxicity. If two medications must be taken, they should be spaced at least 4 to 6 hours apart to avoid interactions.
■ Understand the Limits of Painkillers
Painkillers cannot treat all types of pain. They are generally only effective for pain caused by superficial skin or organ tissue damage and transmitted via nerves, such as headaches, toothaches, or menstrual cramps. Conditions like stomach pain, dull aches, or trigeminal neuralgia cannot be relieved by ordinary painkillers.
Jiang Shaoqing believes that doctors should carefully assess a patient's pain to determine the most suitable medication. For instance, if a patient describes numbness or stabbing pain, it may be caused by neuropathy, which standard painkillers cannot effectively address.
Listen to the Voice of Pain
However, pain is the body's warning signal of maladaptation and requires attention and proper management. Therefore, when pain strikes, take a moment to reflect on what might be wrong with your body or lifestyle, rather than relying solely on medication to escape the problem or ignoring the need to investigate the root cause. Sometimes, simple changes in habits, rest, exercise, or even weight loss can improve pain.
Physician and writer Zhuang Yu'an shared that he found an emotional and stress outlet through watching movies, helping him forget his pain—"loving movies, not loving paracetamol." Only by identifying the true cause of pain can you discover your own "paracetamol."
The War on Painkillers: Panadol Vs. Aspirin
Author: Text by Lin Zhencen, Photography by Xiao Shiying
Reviewed by: Clinical Pharmacy Expert, Pharmacist Jiang Shaoqing from Heping Hospital
Do you often take painkillers for headaches or other pains? These easily accessible over-the-counter pain relievers have gradually become a part of our daily lives. But are they really safe? A popular TV host, setting aside their on-screen playful demeanor, earnestly and firmly looks at you in an advertisement and says, "Panadol won’t let you suffer a second longer." In that very second, over 1,200 non-narcotic pain relievers (including aspirin, Panadol, and related medications) are swallowed by people in Taiwan and the U.S.
It is estimated that Taiwan consumes 100 million non-narcotic pain relievers annually (with annual sales of about 800 million NT dollars, including aspirin and Panadol-related drugs), while Americans use over 8 billion Tylenol (known as Panadol in Taiwan) and 30 billion aspirin tablets each year on average.
"Painkiller advertisements are deeply ingrained in people's minds," admits Mr. Huang, a pharmacist who runs a pharmacy in Zhubei. He notes that when people come to buy medicine, they don’t ask which drug is most suitable for them but instead purchase based on the "ad slogans they remember best," without knowing the contents of the painkillers or whether they might cause allergies.
With such massive sales figures, intensive drug advertisements, and widely circulated online information about painkillers, what exactly is their appeal? And what problems might arise from long-term use?
**Pain: A Difficult Problem to Solve**
Common over-the-counter painkillers can generally be divided into two types. The first is simple analgesics, containing acetaminophen (brand names include Panadol, Tylenol, etc., hereafter referred to collectively as acetaminophen), which provides pain relief and fever reduction. The second type includes nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, brand names like Bufferin, aspirin, and pediatric Wincofen), which not only relieve pain and reduce fever but also have anti-inflammatory effects, alleviating pain caused by joint inflammation.
In 1897, German chemist Hoffmann, seeking to relieve his father’s arthritis, discovered acetylsalicylic acid, which led to the creation of aspirin—the ancestor of NSAIDs. Fifty years later, in 1946, "the father of drug metabolism" Brodie and Nobel Prize-winning physiologist Axelrod, during a casual conversation, found that the toxic headache powder acetanilid could be modified into acetaminophen, which does not accumulate in the body and has fewer side effects. This led to the synthesis of acetaminophen, now one of the most commonly used pain relievers alongside aspirin.
NSAIDs and acetaminophen are similarly effective in pain relief, working by inhibiting prostaglandin production (an inflammatory substance found throughout the body). They have broad systemic effects—for example, aspirin can also be used to prevent cardiovascular blockages or even cancer. However, their downside is the potential for widespread side effects and numerous contraindications. People with poor liver, kidney, or stomach function, those taking anticoagulants, children under 20, asthma sufferers, or individuals prone to bleeding should avoid NSAIDs. For instance, "pediatric Wincofen (Tapal)" was once used as a children’s fever reducer but was discontinued in pediatrics due to the risk of severe brain-damaging side effects like Reye’s syndrome. However, the low-dose aspirin in "pediatric Wincofen" makes it a common preventive medication for vascular blockages in heart disease patients.For those who cannot use non-steroidal anti-inflammatory drugs, acetaminophen provides an alternative. Acetaminophen acts directly on the central nervous system in the brain, blocking pain transmission. It is a simple analgesic and antipyretic (fever reducer) with no other known effects. Its advantage is fewer systemic side effects, making it safer for children and pregnant women.
Easily accessible over-the-counter pain relievers have gradually become a part of our daily lives. But are they really safe?
Does Panadol harm the liver?
Most doctors believe that the safety assurances in painkiller advertisements lead people to lower their guard, making accidental overdoses more likely.
"People always think these drugs are as safe as eating M&M's chocolates," said Dr. William Lee, a professor at the University of Texas Southwestern Medical School.
In fact, the dangers of painkillers exceed what you might imagine.
One major risk is that excessive acetaminophen intake can cause liver and kidney damage. Dr. Lee analyzed 300 cases of acute liver failure and found that 38% were related to acetaminophen poisoning. Another 307 patients with severe liver damage showed that 35% were linked to acetaminophen toxicity.
In the U.S., over 100,000 people are hospitalized each year due to acetaminophen overdose. In Taiwan, the numbers are also rising. For example, at Linkou Chang Gung Memorial Hospital, there have been at least 20 cases of acetaminophen poisoning annually over the past two to three years, with a rapid increase. "These drugs are too easily accessible," said Dr. Lin Jie-liang, head of the Toxicology Department at Linkou Chang Gung Memorial Hospital, with deep concern.
In reality, many factors can lead to acetaminophen poisoning, and negligence easily crosses the line. These include repeated use of acetaminophen-containing products, pre-existing liver or kidney issues, and alcoholism—all of which can increase the toxicity of acetaminophen accumulation in the liver.
For example, adults consuming more than 4 grams of acetaminophen per day may experience poisoning and liver damage. In Taiwan, each Panadol tablet contains 500 mg of acetaminophen, meaning taking more than eight tablets a day is dangerous. Moreover, acetaminophen is not only found in painkillers but is also common in other everyday medications.
According to U.S. statistics, over 200 drugs on the market contain acetaminophen, including cough syrups like Taiwan's "Feng Re You" and "You Lu An."
A lack of awareness about acetaminophen-containing products cost 23-year-old American Patrick his life.
After injuring his back, Patrick was prescribed acetaminophen combined with the opioid painkiller codeine during his hospitalization. After discharge, he continued taking over-the-counter acetaminophen for a week. One day, he suddenly developed a high fever and vomiting. Shockingly, the hospital administered a large dose of acetaminophen before diagnosing his liver failure, leading to acute acetaminophen poisoning. Patrick passed away within a week.
Additionally, alcohol increases the risk of acetaminophen poisoning.
Long-term alcohol use makes liver oxidative enzymes abnormally active, causing toxic metabolites of acetaminophen to accumulate in the liver and damage liver cells.
Furthermore, chronic alcoholics or heavy drinkers metabolize acetaminophen faster, requiring higher doses for pain relief, often leading to unintentional overdoses.
In recent years, drug manufacturers have added warnings to their products, advising that those who regularly consume more than three alcoholic drinks per day should take acetaminophen only under a doctor's supervision.
This caution stems from a case in Virginia, where a man took a standard dose of acetaminophen and had a pre-dinner drink, leading to liver failure and necessitating a liver transplant.
Moreover, early hepatitis symptoms are often mild and resemble the common cold, making it easy to misuse acetaminophen products.If the doctor does not immediately detect the soaring SGOT and SGPT levels in the liver and continues to administer acetaminophen, the consequences would be unthinkable.
In the UK, due to the high number of acetaminophen poisoning cases, the government has even strictly limited its sale, allowing only a regulated quantity to be purchased at a time.
Doctors advise that if you have abnormal liver or kidney function, it is best not to take acetaminophen painkillers without professional guidance.
Before using painkillers, always check the ingredient list on the packaging to see how much acetaminophen it contains, to avoid repeated use and increased toxicity.
Do nonsteroidal painkillers harm the kidneys?
Painkillers not only damage the liver but also take a toll on the kidneys. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in particular poses significant risks to kidney health.
NSAIDs work by inhibiting prostaglandins, which are directly involved in the dilation of renal arteries. When renal arteries are suppressed by painkillers, kidney tissues suffer from insufficient blood flow, leading to necrosis due to lack of nutrients.
Moreover, using painkillers daily for more than six months "may already constitute what we call abuse," says Dr. Lin Jie-liang. In contrast, pure acetaminophen causes less kidney damage, but excessive intake can still harm the kidneys.
Foreign studies show that 5–9% of dialysis patients are victims of NSAID abuse. Annually, about 1.7 out of every 1,000 people who abuse painkillers will require dialysis , "a rate comparable to the annual incidence of lung cancer among smokers," warns Dr. Lin Jie-liang, a nephrologist and director of the Toxicology Department at Linkou Chang Gung Memorial Hospital, urging people not to overlook the dangers of painkillers.
Additionally, excessive painkiller use can accumulate in the kidneys, leading to interstitial nephritis, urinary tract tumors, and increased risks of cardiovascular stroke and gastric ulcers. "This is not alarmist talk," Dr. Lin emphasizes. "These cases are not uncommon in nephrology clinics, and the damage is often irreversible."
Worst of all, kidney damage caused by drugs often goes undetected in routine kidney function tests. Dr. Lin considers urine concentration tests one of the viable methods for early detection.
When kidneys are damaged, their ability to concentrate and acidify urine weakens. Therefore, Dr. Lin recommends patients provide their first morning urine for testing. By assessing urine concentration, kidney damage can be inferred, allowing for intervention before it progresses to uremia.
For arthritis patients who must use painkillers long-term, such as those with lupus or rheumatoid arthritis, in addition to strict dosage control, Dr. Li Xiu-shen, head of the Rheumatology and Immunology Department at Taipei Mackay Memorial Hospital, requires regular urine tests, blood pressure monitoring, and blood biochemistry checks to track kidney function changes.
If symptoms like anemia or bone pain appear after long-term high-dose NSAID use, it may indicate kidney problems. Dr. Lin advises getting a kidney function test promptly.
However, for patients who must take daily aspirin to prevent heart disease, Dr. Lin reassures that the preventive dose is too small to cause kidney issues.
It is estimated that over 16,000 Americans die annually from gastric complications caused by NSAIDs. Combining these drugs with alcohol further increases the risk of stomach bleeding.
How to mitigate the stomach-related side effects of painkillers?
Another major issue with NSAIDs is their harm to the gastrointestinal tract, especially for those with weak stomachs or a history of ulcers.
This is because prostaglandins protect the stomach lining, and NSAIDs inhibit their production, relieving pain at the expense of stomach health.It is estimated that more than 16,000 Americans die each year from stomach-related injuries caused by non-steroidal pain relievers. Taking these medications along with alcohol further increases the risk of stomach bleeding.
As for whether combining such drugs with antacids can truly protect the stomach?
"Hardly," says Jiang Shaoqing, a clinical pharmacy expert specializing in cancer medications and well-versed in pain relievers, currently a pharmacist at Taipei Veterans General Hospital. He dismissively refutes this notion, describing it as a "false sense of security." He believes this approach may instead reduce the absorption of painkillers. Clinically, it has been observed that unless antacids are taken every two hours, they do not effectively prevent ulcers. The typical dosage is insufficient to lower stomach acid.
However, for patients with arthritis who must rely on anti-inflammatory painkillers for relief, stronger stomach medications—such as proton pump inhibitors (brand names like Losac and Takepron)—can be used to reduce the occurrence of stomach ulcers, Jiang points out.
Because early-stage stomach ulcers often cause no noticeable symptoms, Li Xiushen, director of the Rheumatology and Immunology Department at Taipei Mackay Memorial Hospital, also reminds patients taking non-steroidal anti-inflammatory drugs (NSAIDs) to inform their doctor immediately if they experience pale complexion or black stools.
As for whether people with Helicobacter pylori (which clinically increases the risk of stomach ulcers and gastric cancer) can take NSAIDs, the issue remains controversial. Some scholars argue that H. pylori is an infection that stimulates the stomach to produce prostaglandins, and taking aspirin can inhibit prostaglandins, thereby speeding up healing.
On the other hand, some doctors believe H. pylori should be eradicated before taking such medications. However, if NSAIDs are only taken 2–3 times a month, they rarely cause severe stomach damage. Generally, it is recommended to eat something before taking NSAIDs or to take them with food, such as crackers or milk, to reduce stomach irritation.
Some doctors opt for newer COX-2 inhibitors (such as Celebrex or Vioxx), which have fewer stomach-related side effects. Additionally, pharmacist Jiang Shaoqing warns that people with asthma or nasal polyps should avoid NSAIDs, as they can worsen allergic reactions.
Studies show that 4–20% of people experience bronchial constriction or even death after taking these drugs. Therefore, if you fall into this category, do not purchase painkillers on your own. Moreover, new research suggests that patients with irritable bowel syndrome (IBS) should avoid any aspirin-containing painkillers, as these drugs can cause gastrointestinal side effects and even worsen the condition.
### Safe Use of Painkillers
If painkillers are necessary, how can they be used to minimize harm to the body?
■ **Use painkillers only when necessary, and for short durations.**
"Painkillers should only be used as a last resort," says Lin Jieliang. Most nephrologists do not prescribe painkillers for more than three days, and once the pain subsides, the medication should stop immediately. (Post-surgical patients are an exception.) Even arthritis patients who live with chronic pain are advised: "If you're not in pain, try not to take painkillers." Responsible orthopedic and rheumatology doctors will repeatedly remind patients of this. Dr. Li Xiushen believes arthritis treatment should be phased: anti-inflammatory painkillers can help during acute flare-ups, but afterward, patients should rely on exercise, rehabilitation, and rest to manage pain.
■ **Drink plenty of water and urinate frequently.**
When taking painkillers, it is essential to drink ample water—at least 2,000–3,000 cc per day—to help flush the drug's toxins from the body. Dr. Lin Jieliang considers this insufficient: "You should urinate at least 7–10 times a day."He pointed out that some people are prone to sweating or dehydration, especially children who may experience vomiting and diarrhea when they have a fever, leading to reduced urine output. This makes it difficult for the body to metabolize medications, so increased water intake is necessary.
Research abroad has shown that the harmful effects of painkillers are more severe in subtropical regions, possibly due to the hot climate, excessive sweating, and reduced urination, which hinder the adequate elimination of drug toxins.
■ Avoid Mixing Painkillers
Unless directed by a doctor, it is best not to mix two or more types of painkillers. Combining painkillers can amplify their side effects and increase toxicity to the liver and kidneys. For example, compound cold medicines or painkillers containing both aspirin and paracetamol should be "avoided as much as possible," according to Lin Jieliang. It is safer to use single-ingredient medications. Especially avoid taking two single-ingredient drugs simultaneously (such as swallowing one paracetamol pill followed by an aspirin pill), as this increases liver and kidney toxicity. If two medications must be taken, they should be spaced at least 4 to 6 hours apart to avoid interactions.
■ Understand the Limits of Painkillers
Painkillers cannot treat all types of pain. They are generally only effective for pain caused by superficial skin or organ tissue damage and transmitted via nerves, such as headaches, toothaches, or menstrual cramps. Conditions like stomach pain, dull aches, or trigeminal neuralgia cannot be relieved by ordinary painkillers.
Jiang Shaoqing believes that doctors should carefully assess a patient's pain to determine the most suitable medication. For instance, if a patient describes numbness or stabbing pain, it may be caused by neuropathy, which standard painkillers cannot effectively address.
Listen to the Voice of Pain
However, pain is the body's warning signal of maladaptation and requires attention and proper management. Therefore, when pain strikes, take a moment to reflect on what might be wrong with your body or lifestyle, rather than relying solely on medication to escape the problem or ignoring the need to investigate the root cause. Sometimes, simple changes in habits, rest, exercise, or even weight loss can improve pain.
Physician and writer Zhuang Yu'an shared that he found an emotional and stress outlet through watching movies, helping him forget his pain—"loving movies, not loving paracetamol." Only by identifying the true cause of pain can you discover your own "paracetamol."