Which of the following is not an adverse drug event associated with non‑steroidal anti‑inflammatory drug (NSAID) use: myalgia, bleeding, hypertension, or renal impairment?

Myalgia is NOT an Adverse Drug Event Associated with NSAID Use

Myalgia (muscle pain) is not a recognized adverse drug event of NSAIDs—in fact, NSAIDs are commonly prescribed to treat myalgia and musculoskeletal pain. 1 The other three options—bleeding, hypertension, and renal impairment—are all well-established adverse effects of NSAID therapy.

Why the Other Options ARE Adverse Drug Events

Bleeding

• NSAIDs significantly increase gastrointestinal bleeding risk, which is one of the most common and serious adverse effects. 1
• NSAID use has surpassed H. pylori as the most commonly identified risk factor among patients with bleeding ulcers, found in 53% of cases. 1
• The average relative risk of developing a serious GI complication is 3- to 5-fold greater among NSAID users than nonusers. 1
• NSAIDs cause approximately 100,000 hospitalizations annually in the United States due to GI bleeding and related complications. 1
• The antiplatelet effects of NSAIDs further compound bleeding risk, particularly when combined with anticoagulants (increasing GI bleeding risk 5-6 fold). 1, 2

Hypertension

• NSAIDs cause hypertension by increasing mean blood pressure by approximately 5 mm Hg through inhibition of prostaglandin-mediated vasodilation and sodium excretion. 3
• The American Academy of Family Physicians confirms that NSAIDs can worsen congestive heart failure and increase blood pressure. 1
• Blood pressure increases occur immediately upon treatment initiation and escalate with both dose and duration of use. 3
• NSAIDs interfere with multiple classes of antihypertensives, including ACE inhibitors, ARBs, and beta-blockers, potentially destabilizing previously controlled hypertension. 3

Renal Impairment

• All NSAIDs can cause acute renal failure, particularly in patients with risk factors such as advanced age, pre-existing renal impairment, heart failure, or concurrent use of ACE inhibitors/ARBs. 1, 4
• The American Academy of Family Physicians recommends avoiding NSAIDs in patients with pre-existing renal disease, congestive heart failure, or cirrhosis to prevent acute renal failure. 2
• NSAIDs block prostaglandin-mediated renal vasodilation, which is essential for maintaining adequate kidney perfusion in at-risk patients. 2, 4
• Chronic NSAID use can result in chronic kidney disease, renal papillary necrosis, and acute interstitial nephritis. 4, 5

Common Pitfall to Avoid

Do not confuse myalgia as a side effect with the musculoskeletal conditions that NSAIDs are designed to treat. 1 NSAIDs are specifically indicated for persistent musculoskeletal pain and inflammatory conditions—they relieve myalgia rather than cause it. The well-documented adverse effects of NSAIDs involve the gastrointestinal tract (bleeding), cardiovascular system (hypertension, MI, stroke), and kidneys (acute and chronic renal impairment). 1