Paris Marathon

The use of medicines always comes with risks, but your individual risk may vary based on your physiology, you gender, your genetics, and your behaviour. Although much of the focus on drug use in athletes concerns performance enhancement, drug use by athletes can be associated with risks even if not a performance enhancing drug.

Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and diclofenac are widely used as painkillers. They are not banned by the World Anti-Doping Agency (WADA), although some have argued they can increase performance. However, generally they are used by athletes to reduce pain from an injury, or to reduce pain in recovery after an event. Anyone who knows the running community, or who has spotted the used blister strips of NSAIDs on the floor at major marathons, will be aware of this.

The nature of some events, particularly long-distance endurance events, means that athletes might be more at risk of some adverse effects of NSAIDs. The physiological stress of running may make individuals more prone to gastro-intestinal problems, acute kidney damage, or hyponatraemia. Some athletes may also have pre-existing contra-indications, or cautions for use, that they are either ignorant of, or deliberately ignore.

We recently looked at the use of NSAIDs in three athletic clubs, that covered the three disciplines of running, cycling, and triathlon.1 We found high usage of oral NSAIDs (70%), more so in the more impact related sports of running and triathlon. Only a quarter of this use was informed by a pharmacist or a doctor, and the majority from over-the-counter sales. Nearly half of respondents used NSAIDs before or after an event. Some, worryingly, even take them during events.

That people are so ready to take NSAIDS for recovery, and to push through pain to complete events, is a concern. Even post event use, may delay the adaptive response to exercise and be counter-productive to the wider aims of the athlete. As with the wider concerns about NSAID use, the best bet is to avoid use if possible, but at least be aware of the risks you may be taking, particularly in longer endurance events.

Photograph: Start of the Paris Marathon 2011,  Av. des Champs-Élysées, by Anthony Cox

  1. Rudgard WE, Hirsch CA, Cox AR. Amateur Endurance Athletes’ use of non-steroidal anti-inflammatory drugs: a cross sectional survey. International Journal of Pharmacy Practice. 2019;27:105-107 : LINK