Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study
Open accessAbstract
Objectives: To prevent pain inhibiting their performance, many athletes ingest over-the-counter (OTC) analgesics before competing. We aimed at defining the use of analgesics and the relation between OTC analgesic use/dose and adverse events (AEs) during and after the race, a relation that has not been investigated to date. Design: Prospective (non-interventional) cohort study, using an online questionnaire. Setting: The Bonn marathon 2010. Participants: 3913 of 7048 participants in the Bonn marathon 2010 returned their questionnaires. Primary and secondary outcomes: Intensity of analgesic consumption before sports; incidence of AEs in the cohort of analgesic users as compared to non-users. Results: There was no significant difference between the premature race withdrawal rate in the analgesics cohort and the cohort who did not take analgesics (‘controls’). However, race withdrawal because of gastrointestinal AEs was significantly more frequent in the analgesics cohort than in the control. Conversely, withdrawal because of muscle cramps was rare, but it was significantly more frequent in controls. The analgesics cohort had an almost 5 times higher incidence of AEs (overall risk difference of 13%). This incidence increased significantly with increasing analgesic dose. Nine respondents reported temporary hospital admittance: three for temporary kidney failure (post-ibuprofen ingestion), four with bleeds (post-aspirin ingestion) and two cardiac infarctions (post-aspirin ingestion). None of the control reported hospital admittance. Conclusions: The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted AEs that increase with increasing analgesic dose. Analgesic use before endurance sports appears to pose an unrecognised medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.
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Up to 93% of endurance runners are naïve to any contraindications of NSAID use.
“Importantly, up to 93% of endurance runners are naïve to any contraindications of NSAID use [195], indicating the need for greater education in this respect.”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [195]
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Cites
Prostaglandins and Inflammation
Ricciotti, E., & FitzGerald, G. A. (2011) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.110.207449 · Cited by 3,852 · see citing works
Hyponatremia among runners in the Boston Marathon.
Almond, C. S. D., Shin, A. Y., Fortescue, E. B., Mannix, R. C., Wypij, D., Binstadt, B. A., Duncan, C. N., Olson, D. P., Salerno, A. E., Newburger, J. W., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043901 · Cited by 553 · see citing works
Cannon, C. P., Curtis, S., FitzGerald, G. A., Krum, H., Kaur, A., Bolognese, J. A., Reicin, A. S., Bombardier, C., Weinblatt, M. E., van der Heijde, D. M. F. M., et al. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69666-9 · Cited by 527 · see citing works
Mohlenkamp, S., Lehmann, N., Breuckmann, F., Brocker-Preuss, M., Nassenstein, K., Halle, M., Budde, T., Mann, K., Barkhausen, J., Heusch, G., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn163 · Cited by 487 · see citing works
Noakes, T. D., Sharwood, K. A., Speedy, D. B., Hew, T. D., Reid, S., Dugas, J. P., Almond, C. S. D., WHARAM, P. C., & Weschler, L. B. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0509096102 · Cited by 330 · see citing works
Effect of running intensity on intestinal permeability
Pals, K. L., Chang, R.-T., Ryan, A. J., & Gisolfi, C. V. (1997) · Journal of Applied Physiology · doi:10.1152/jappl.1997.82.2.571 · Cited by 282 · see citing works
Maximum Strength-Power-Performance Relationships in Collegiate Throwers
STONE, M. H., SANBORN, K., OʼBRYANT, H. S., HARTMAN, M., STONE, M. E., PROULX, C., WARD, B., & HRUBY, J. (2003) · Journal of Strength and Conditioning Research · doi:10.1519/00124278-200311000-00019 · Cited by 254 · see citing works
The Use of Drugs and Nutritional Supplements in Top-Level Track and Field Athletes
Tscholl, P. M., Alonso, J. M., Dollé, G., Junge, A., & Dvořák, J. (2009) · The American Journal of Sports Medicine · doi:10.1177/0363546509344071 · Cited by 164 · see citing works
Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition.
Nieman, D. C., Henson, D., Dumke, C., Oley, K., McAnulty, S., Davis, J., Murphy, E., Utter, A., Lind, R., McAnulty, L. S., et al. (2006) · Brain, behavior, and immunity · doi:10.1016/j.bbi.2006.02.001 · Cited by 158 · see citing works
NSAID Use Increases the Risk of Developing Hyponatremia during an Ironman Triathlon
WHARAM, P. C., Speedy, D. B., Noakes, T. D., Thompson, J., REID, S. A., & Holtzhausen, L. (2006) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000210209.40694.09 · Cited by 153 · see citing works
Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation
Hasson, S., Daniels, J. C., Divine, J. G., et al. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199301000-00003 · Cited by 145 · see citing works
Use of NSAIDs in triathletes: prevalence, level of awareness and reasons for use
Gorski, T., Cadore, E. L., Pinto, S. S., Silva, E., Correa, C. S., Beltrami, F. G., & Kruel, L. F. M. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.062166 · Cited by 140 · see citing works
Page, A. J., Reid, S. A., Speedy, D. B., Mulligan, G., & Thompson, J. (2007) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e31802b5be9 · Cited by 98 · see citing works
Ample Use of Physician-Prescribed Medications in Finnish Elite Athletes
Alaranta, A., Alaranta, H., Heliövaara, M., Airaksinen, M., & Helenius, I. J. (2006) · International Journal of Sports Medicine · doi:10.1055/s-2006-923811 · Cited by 86 · see citing works
Scott, P. A., Kingsley, G. H., & Scott, D. L. (2008) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2008.07.013 · Cited by 82 · see citing works
Faecal blood loss in response to exercise.
Robertson, J. D., Maughan, R. J., & Davidson, R. J. (1987) · BMJ · doi:10.1136/bmj.295.6593.303 · Cited by 76 · see citing works
Donnelly, A., McCormick, K., Maughan, R. J., Whiting, P. H., & Clarkson, P. M. (1988) · British Journal of Sports Medicine · doi:10.1136/bjsm.22.1.35 · Cited by 74 · see citing works
Gastrointestinal Problems in Runners
Simons, S. M., & Kennedy, R. G. (2004) · Current Sports Medicine Reports · doi:10.1249/00149619-200404000-00011 · Cited by 73 · see citing works
Effect of Aspirin and Ibuprofen on GI Permeability during Exercise
Lambert, G. W., Boylan, M., Laventure, J.-P., Bull, A. J., & Lanspa, S. J. (2007) · International Journal of Sports Medicine · doi:10.1055/s-2007-964891 · Cited by 70 · see citing works
The Use and Abuse of Painkillers in International Soccer
Tscholl, P. M., Feddermann‐Demont, N., Junge, A., & Dvořák, J. (2008) · The American Journal of Sports Medicine · doi:10.1177/0363546508324307 · Cited by 67 · see citing works
Use of permitted drugs in Italian professional soccer players
Taioli, E. (2007) · British Journal of Sports Medicine · doi:10.1136/bjsm.2006.034405 · Cited by 66 · see citing works
Gastrointestinal Bleeding in Marathon Runners
Halvorsen, F.-A., Lyng, J., & Ritland, S. (1986) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365528609015168 · Cited by 62 · see citing works
Transient oliguria with renal tubular dysfunction after a 90 km running race
IRVING, R. A., NOAKES, T. D., RAINE, R. I., & VAN ZYL SMIT, R. (1990) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199012000-00004 · Cited by 41 · cited 5× · see citing works
“GI-bleeding 22 (2) 46 (8) 6 (16) 74 (4) 0 (0) 3 (1) 0 (0) 3 (<1)”
InfluentialNon-steroidal anti-inflammatory drugs in athletes
Lippi, G., Franchini, M., & Guidi, G. C. (2006) · British Journal of Sports Medicine · doi:10.1136/bjsm.2006.027342 · Cited by 34 · see citing works
Abuse of medication during international football competition in 2010 – lesson not learned
Tscholl, P. M., & Dvořák, J. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090806 · Cited by 32 · see citing works
Boulter, J., Noakes, T. D., & Hew‐Butler, T. (2011) · PubMed · Cited by 31 · see citing works
Non-steroidal anti-inflammatory use in the XV Pan-American Games (2007)
Silva, E. R. D., Rose, E. H. D., Ribeiro, J. P., Sampedro, L. B. R., Devos, D. V., Ferreira, A. F. M. S. C., & Kruel, L. F. M. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.065342 · Cited by 29 · see citing works
[Mesenterial anemia as a cause of jogging anemia?].
Kehl, O., Jäger, K., Münch, R., Bühler, H., Segantini, P., Bollinger, A., & Ammann, R. W. (1986) · PubMed · Cited by 17 · see citing works
Mahler, N. (2001) · Therapeutische Umschau · doi:10.1024/0040-5930.58.4.226 · Cited by 15 · see citing works
Acute renal failure in a marathon runner: role of glomerular bleeding intubular injury
Meur, Y. L., Paraf, F., Szelag, J. C., et al. (1998) · The American Journal of Medicine · doi:10.1016/s0002-9343(98)00241-1 · Cited by 13 · see citing works
[Drug use in participants of the Bonn Marthon 2009].
Brune, K., Niederweis, U., Kaufmann, A., et al. (2009) · PubMed · Cited by 10 · see citing works
Self-citationSchwartz, J. G., Merkel-Kraus, S., Duval, S., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(10)61625-7 · Cited by 4 · see citing works
[Emergency checklist: renal colic].
Ka, B., & Zwißler, B. (2009) · PubMed · Cited by 3 · see citing works
CrossRef Listing of Deleted DOIs
(2007) · CrossRef Listing of Deleted DOIs · doi:10.1007/s11932-004-0011-3 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [5]Brune K Niederweis U Krämer B Sport und Schmerzmittel: Unheilige Allianz zum Schaden der Niere. Deutsches Ärzteblatt 2008; 105: 1894– 900
- [19]Mahler N Misuse of drugs in recreational sports. Ther Umsch 2001; 58: 226 31 11344954
- [27]Tokmakidis SP Kokkinidis EA Smilios I The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise. J Strength Cond Res 2003; 17: 53– 9 12580656
Cited by
Sorted by citations
Tiller, N. B., Roberts, J. D., Beasley, L., Chapman, S., Pinto, J. M., Smith, L., Wiffin, M., Russell, M., Sparks, S. A., Duckworth, L., et al. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0312-9 · Cited by 164 · see citing works
“Importantly, up to 93% of endurance runners are naïve to any contraindications of NSAID use [195], indicating the need for greater education in this respect.”
BackgroundWilson, P. B. (2020) · Journal of Dietary Supplements · doi:10.1080/19390211.2018.1492484 · Cited by 15 · see citing works
- Authors
- Küster, M., Renner, B., Oppel, P., Niederweis, U., & Brune, K.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Corresponding author
- Brune, Kay
- ORCID
- Renner, Bertold
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2013
- Volume
- 3
- Issue
- 4
- Pages
- e002090
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3641448
- OpenAlex
- W2163446924
- Cited by
- 88
- References
- 34
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 5 · 2021: 13 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 6 · 2016: 4 · 2015: 6 · 2014: 2 · 2013: 4
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- OPUS FAU (Kooperativer Bibliotheksverbund Berlin-Brandenburg (KOBV), on behalf of the Universitätsbibliothek Erlangen-Nürnberg) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Social Sciences › Sociology and Political Science › Doping in Sports
- Keywords
- over-the-counter analgesics, marathon runners, endurance sports, adverse drug reactions, ibuprofen, aspirin, gastrointestinal adverse effects, renal adverse effects, cardiovascular adverse events, analgesic dose
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