I’m sure you’ve seen multiple commercials on TV that proclaim:
“What sinus headache? Stiff joints? Tough cramps? Nighttime pain? Make all your pains a distant memory with Advil®, the world’s #1 choice. Nothing is proven stronger or longer lasting.” 
Let’s review the latest data on Advil, also known as Ibuprofen, and all other non-steroidal anti-inflammatory drugs (NSAIDs) , like Aleve (Naprosyn), Celebrex, Orudis, Mobic, Indomethacin, Diclofenac, etc. These are among the most commonly used drugs in the U.S and the World. Indeed, on any given day more than 30 million Americans use NSAIDs to soothe headaches, sprains, arthritis symptoms, and other daily discomforts, according to the American Gastroenterological Association. Most of them don’t require a prescription.
But lately there has been growing evidence that NSAIDs may not be as safe as people think they are.
As early as 2005, the FDA warned that taking NSAIDs increases the risk of having a heart attack or stroke. 
The latest data shows that the risk of cardiac arrest increases by a third for those who take ibuprofen for 30 days leading up to a cardiac arrest, and the risk is doubled for those taking diclofenac. 
NSAIDs also increase the risk for heart failure by almost 20%. 
Other studies have shown that people have the greatest risk of suffering a heart attack during the first month of taking NSAIDs and when switching to higher doses. 
Now, the latest warning, especially for men!
NSAIDs can cause “low T”. They can cause adult male reproductive problems by decreasing production of testosterone, even more than well known endocrine disruptors, like phthalates, bisphenol A (BPA) and its analogs. 
NSAIDs can also affect fertility, and has been associated with increased time to get pregnant. 
An inverse relationship was recently reported between endurance exercise training and male health. 
Regular use of NSAIDs also has been associated with reduced muscle mass and strength, and depressed mood and fatigue. 
So, why do we take them for muscle pain?
Studies have questioned their value in the healing process of bone, muscle, tendon, and ligament injuries and their use carries the risk of potentially serious adverse effects. Animal and human studies have linked NSAID use to poor fracture healing. 
They impair the tendons and delay healing of ligaments. 
And of course, we’ve all heard about the risk of potentially serious adverse effects on various systems:
- GI tract, like ulcers, indigestion, bleeding, perforation, heartburn, liver damage
- Renal function, like renal failure, protein in the urine, swelling
- Cardiovascular problems, like elevated blood pressure
- Respiratory, like worsening asthma, nasal congestion and allergies
- Hearing loss and causing ringing in the ears (tinnitus)
For safer alternatives and other health advice, please schedule an appointment with Dr. Koganski at 215-750-7000 or www.NewtownInternalMedicine.com</p
 Sondergaard KB, et al. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study. European Heart Journal – Cardiovascular Pharmacotherapy. Published online December 24 2016.
 Andrea Arfè, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study.BMJ 2016; 354 doi:https://doi.org/10.1136/bmj.i4857.
 Bally M. et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017;357:j1909, http://dx.doi.org/10.1136/bmj.j1909.
 D M Kristensena, et al. Ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism. PNAS. January 8, 2018, doi:10.1073/pnas.1715035115 PNAS January 8, 2018.
 Smarr MM, et al. (2016) Urinary paracetamol and time-to-pregnancy. Hum Reprod 2016 Sep;31(9):2119-27. doi: 10.1093/humrep/dew172. Epub 2016 Jul 13.
 Hackney AC (1996) The male reproductive system and endurance exercise. Med Sci Sports Exerc 28:180–189.
 Moore RA, et al. Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain 2015 Oct;19(9):1213-23. doi: 10.1002/ejp.649. Epub 2014 Dec 22.
 Bhattacharyya T, et al. Nonsteroidal antiinflammatory drugs and nonunion of humeral shaft fracture. Arthritis Rheum. 2005;53:364-367.
 Elder CL, et al. A cyclooxygenase-2 inhibitor impairs ligament healing in the rat. Am J Sports Med. 2001;29:801-805.