Should marathon runners use medications?

Robert Galloway and his team have looked at what effect even over the counter medications may have on marathon runners.
Click here for more information on : Marathon damage
T Snell BSc1, Dr RI Galloway MBBS BSc MRCP FCEM 2. 1Brighton and Sussex Medical
2Department of Emergency Medicine, Royal Sussex County Hospital, Brighton and
Sussex University Hospitals (BSUH) & Medical Director, Brighton Marathon.
Background and Aims: There are inherent physiological risks associated with endurance
running, notably to the gastrointestinal, urological and neurological systems. Certain
medications can increase the risk of developing adverse events (AEs). Importantly, the
NSAID class have been increasingly associated with GI and urological AEs via inhibition of
the mucosa-protective and renal-protective functions of prostaglandin E2 (PGE2) and
Prostacyclin (PGI2). Certain medications also increase heatstroke risk. Furthermore,
overhydration can result in exercise-associated hyponatraemia, with current advice now todrink to thirst. This study aimed to investigate medications usage in runners of the Brighton Marathon, AEs experienced and the associations between NSAID usage and GI and urological AEs. A further aim was to analyse blood results from collapsed runners, and
examine their post-collapse health experiences.
Methods: A retrospective cohort study was performed via an online, incentivised
questionnaire, sent to all runners of the 2010-2013 Brighton Marathons (n≈30,000).
Medications taken were ascertained via questions adapted from the International Association
of Athletics Federation (IAAF) anti-doping form. Symptoms experienced as a result of the
race were further determined. Fisher’s exact test was then used to assess associations between NSAID usage and symptom occurrence. Blood results were compared to normal values, and 1-week and 3-month post-collapse health questionnaires interpreted.
Results: A response rate of ~5% was achieved (n=1581, 58.5% male, 41.5% female). 41.8%
of respondents reported the use of one or more medications. NSAID usage was reported in
30.6% of runners. Drugs predisposing runners to heat-related illness were reported but
infrequently. GI symptoms were common with 27.4% reporting at least 1 GI AE as a result of the marathon. Urological and neurological symptoms were reported at the lower rates of 5.8% and 16.2% respectively. Significant associations were seen between NSAIDs and GI AEs (OR 1.73, P<0.0001), but not with urological AEs (OR 1.48, P=0.097). Blood analysis revealed hyponatraemia not to be the cause of collapse (mean (SD)) (141.2 (2.9) mmol/L), but showed consistently raised creatinine (154.1 (38.5) μmol/L). Runners largely made a full postcollapse recovery, however one sufferer of heatstroke experienced ongoing neuropsychiatric symptoms at 3 months.
Conclusions: These results indicate that runners take a wide variety of medications, and add to the emerging evidence base describing the commonality of exercise associated AEs and the detrimental effects of NSAIDs in endurance exercise. Furthermore, the absence of
hyponatraemia associated collapse is an encouraging sign suggesting current advice to “drink to thirst” is recognised and understood.

So keep on running and drinking to thirst and avoid the NSAIDs.

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