Heed warning labels on over-the-counter medicines to prevent further damage.

Ibuprofen became available without a prescription in 1984, and the painkiller has been something of a wonder drug ever since. It reduces swelling and fever, and eases the pain of everything from cramps to runner’s knee. And, aside from rare gastrointestinal problems, it seemed almost side-effect free.

But in the wake of discoveries that prescription COX-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) like Vioxx and Bextra (the latter now off the market) can greatly increase the risks of cardiac problems, health officials began to worry that the drugs’ over-the-counter NSAID sisters, including ibuprofen (sold as Advil, Motrin, and Nuprin) and naproxen (Aleve), could also pose risks.

The first long-term OTC-NSAID studies won’t be completed until 2010. In the meantime, the U.S. Food and Drug Administration (FDA) announced that all NSAIDs, except aspirin, may increase patients’ cardiovascular risks.

So, should you stop taking ibuprofen? That depends. If you have a history of heart disease or numerous risk factors, OTC NSAIDs could increase the chances of cardiovascular problems, counteract the preventive effects of aspirin, and in-crease blood pressure. “If you’re in a high-risk category, you should avoid these drugs,” says JoAnn E. Manson, MD, chief of preventive medicine at Brigham and Women’s Hospital, in Boston. But there are exceptions: Because NSAIDs are so effective, cardiologists often allow even high-risk heart patients to take them—under their oversight—to resolve the intense pain of diseases such as rheumatoid arthritis.

If you’re at low risk, “the safest thing to do is to stop taking ibuprofen, but it’s a highly effective and low-cost therapy,” says A. Mark Fendrick, MD, professor of internal medicine at the University of Michigan School of Medicine, and an expert on the safety of OTC medicines. “If a patient’s cardiac risk is low, I would say take the lowest possible dose for the shortest possible time.”

After all, other painkillers have their own risks. Aspirin has heart-bolstering effects in low doses, but prolonged, high doses can lead to life-threatening, bleeding stomach ulcers, kidney damage, and hearing loss. And although acetaminophen (Tylenol) hasn’t been shown to have the heart or gastrointestinal concerns of NSAIDs, if overused or combined with alcohol, it can harm the liver.

“That’s why all these drugs have recommended dosages and warnings,” says Noel Bairey Merz, MD, medical director of women’s health at the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles. “Problems happen when people ignore labels. Taking a bigger dose may make you feel good—like smoking or eating fast food—but it’s unhealthy.”

By Josh Garskof