Is it really safe to take these pain pills?

Dr Sarah Jarvis answers your health questions this month

QI occasionally take ibuprofen tablets for aches and pains, but a friend with arthritis has been advised by her doctor to stop taking them because they’re linked to heart and kidney problems. So why are they still freely available?

AI’ve seen many patients worried by recent scare stories about ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDS). Mostly, I’ve been able to put their minds at rest. Almost all the studies linking anti-inflammatories to heart disease or heart failure have involved people taking tablets every day, and often at up to twice the usual daily dose. They’ve also included older people (average age 77) with raised blood pressure/cholesterol, heart disease or diabetes, who are already at high risk of heart failure.

Some anti-inflammatories, such as diclofenac, are known to be much more closely linked to heart attacks than others. And taking high doses of ketorolac regularly can increase your risk of heart failure by 83% – but UK doctors know about these problems and rarely prescribe either tablet. Ibuprofen and naproxen, by contrast, have a lower risk – and then only if taken every day. If you’re young and healthy, your chance of heart failure is probably no more than 1 in 1,000 – so even if the risk is increased by 20%, that still means only 1 in 800 people will have a problem.

That’s not to say we can scoff anti-inflammatories with gay abandon. They can occasionally cause a flare-up of asthma if you’re a sufferer. Older people are at much higher risk of heart failure, and anti-inflammatories can cause kidney damage in those with existing kidney problems. They can also cause inflammation of the stomach lining – again, more common when high doses are taken regularly.

So really it’s a question of weighing up the risks and benefits. Taking anti-inflammatories occasionally is highly unlikely to cause any problems, especially if you’re in good health. But if you take them for more than a few days, you should probably take an acid-suppressant medicine to protect your stomach. And if you’re at risk of heart or kidney problems, your GP would be quite right to suggest you think about an alternative treatment.

QMy mum, who’s 78, has been offered the shingles vaccine – but my dad, who’s 85, hasn’t. Is this ageism?

AShingles is a miserable condition, but you can’t catch it. The zoster virus lives on, dormant, in your nervous system after you have chickenpox, and for some reason gets reactivated as shingles years later. It causes a painful blistering rash on one side of your body only.

The shingles vaccine was introduced in 2013, and with time will be offered to everyone when they hit 70. For the first few years, there will be a catch-up programme.

The likelihood of developing shingles increases as you get older, probably because your immune system becomes less efficient. At the same time, the risk of serious complications, such as post-herpetic neuralgia (long-term nerve pain), increases. The vaccine works very well for people in their 70s – cutting the risk of shingles by over 50% and of potentially sight-threatening eye complications by 75%. Unfortunately, however, it’s less effective for people in their 80s.