No medicine is free from risk of side effects

DEAR DR. ROACH: I am a 66-year-old senior in relatively good health. I have occasional body aches after work-out activity and sometimes just age-related stiffness. I usually take one Advil to get me through the day or to help me sleep. I do this maybe three times a week.

I am concerned about detrimental side effects, such as damage to the stomach lining or liver damage, and I just read about Advil potentially causing some dizziness. (I do occasionally get mildly dizzy after floor exercises).

Could you please enumerate a few painkiller medications that are more benign and do not cause stomach irritation or other detrimental side effects? — F.B.

ANSWER: Unfortunately, there are no medicines (prescription, over-the-counter or supplements) that are free from the possibility of side effects. What works well for one person may not work or might cause terrible side effects for another, so it’s important to know the choices.

The oldest option, still used by many, is aspirin. Aspirin works fine for most people and doesn’t cause them problems. However, aspirin is probably the most likely to have side effects, and in high doses can be quite toxic. It is the most likely to cause bleeding, has the highest risk for stomach damage, can affect the acid-base balance of the body and should not be used in children with fever, due to the risk of Reye’s syndrome. I seldom recommend aspirin for treatment of mild pain.

There are over 20 different nonsteroidal anti-inflammatory drugs — called NSAIDs, including ibuprofen (Advil, Nuprin and many others) and naproxen (Naprosyn, Aleve and many others). These have less bleeding risk than aspirin (but still have some), irritate the stomach less (but can still cause ulcers) and with long-term use, can cause kidney damage. They also increase heart risk, especially in people who already have heart blockages or those who are at high risk. Dizziness isn’t a common side effect, but is certainly reported. On the other hand, with 20,000 tons of ibuprofen produced each year, there are many rare side effects reported. In my experience, most people do well with these, but taking lower doses for shorter times reduces side effect risk. People who need to be on them long-term should be monitored for development of side effects.

The COX-2 inhibitors, such as celecoxib (Celebrex), are a subset of NSAIDs with a lower risk of stomach problems, and are about as effective at pain relief.

Acetaminophen (Tylenol) is probably the safest option, but it also can cause problems. Very high doses can cause severe liver disease. Chronic use can lead to kidney disease in some people. Doses need to be adjusted in people who regularly use alcohol.

DEAR DR. ROACH: After one has his or her gallbladder removed, are there any cancer risks, health problems or the like? — K.C.

ANSWER: Several studies have shown that people with a history of gallstones or removal of the gallbladder are at higher risk for colon cancer. This doesn’t mean you shouldn’t get your gallbladder out if you need to; it means that you should be particularly careful to get your recommended colon cancer screening regularly. The cancers are more likely in the first part of the colon, so a colonoscopy is the best option for screening.