From the Guidelines
NSAIDs should be avoided in patients with leg swelling, especially those with heart failure, as they can increase fluid retention and worsen the condition. According to the study published in 2020 1, non-steroidal anti-inflammatory drugs (NSAIDs) can increase fluid retention and should be avoided in patients with heart failure. This is because NSAIDs can inhibit prostaglandins that help regulate kidney function, leading to sodium and water retention in the body.
Some key points to consider:
- NSAIDs can cause leg swelling as a side effect due to their impact on kidney function and fluid retention
- Patients with heart failure, kidney disease, or liver problems are more susceptible to this side effect
- Alternative pain relievers like acetaminophen (Tylenol) may be a safer option
- To reduce existing swelling, patients can try elevating their legs above heart level, limiting salt intake, staying hydrated, and avoiding prolonged standing or sitting
It's essential to note that the study published in 2005 1 discusses the use of NSAIDs for tendinopathy pain, but it does not address the specific concern of leg swelling. In contrast, the 2020 study 1 provides more relevant guidance on the use of NSAIDs in patients with heart failure and leg swelling.
In terms of management, patients experiencing leg swelling while taking NSAIDs should contact their healthcare provider promptly. The provider may recommend switching to a different pain reliever or adjusting the treatment plan to minimize the risk of worsening heart failure or leg swelling.
From the Research
NSAIDs and Swelling Legs
- NSAIDs are known to have various side effects, including those that may contribute to swelling in the legs 2, 3, 4
- The use of NSAIDs can lead to sodium retention, resulting in arterial hypertension, heart failure, and atherosclerotic events, which may contribute to leg swelling 2
- Nonselective NSAIDs should be used with caution in patients with a history of cardiovascular disease or chronic renal disease, as they may exacerbate these conditions and lead to leg swelling 5
- The combination of NSAIDs with diuretics and/or renin-angiotensin system inhibitors increases the risk of acute kidney injury, which may also contribute to leg swelling 3, 4
Leg Swelling Causes
- Leg swelling can occur due to various causes, including systemic, superficial, and deep venous, and lymphatic disorders 6
- Venous disorders are one of the most common causes of unilateral lower extremity edema 6
- NSAIDs may not be directly related to the primary causes of leg swelling, but their use can contribute to or exacerbate underlying conditions that lead to swelling 2, 3, 4
Management and Risks
- Management of pain and inflammation must consider the risks associated with NSAID use, including the potential for leg swelling 2
- Alternative drugs, low-dose/short-term use, and non-pharmacologic approaches, such as physiotherapy and exercise, may be used to limit the negative impact of NSAIDs on mortality and morbidity 2
- Patients using NSAIDs, especially in combination with other medications, should be monitored for signs of leg swelling and other adverse effects 3, 4