Common painkillers like diclofenac and acetaminophen are used by millions of people every day to relieve pain and reduce inflammation.
They are usually considered safe and easy to tolerate. However, a new study from the German Cancer Research Center and the University of Freiburg shows that these drugs might have unexpected effects in people with liver cancer.
The research, led by Dr. Ursula Klingmüller and Dr. Jens Timmer, found that these painkillers can change how liver cancer cells handle iron. Iron is an important mineral that helps the body produce red blood cells.
When the body doesn’t get or use enough iron, it can lead to iron deficiency and anemia, a condition where the blood doesn’t carry enough oxygen.
In this study, scientists discovered that taking diclofenac or acetaminophen can raise the levels of a hormone called hepcidin in liver cancer cells. Hepcidin controls how much iron the body absorbs from food and how much is released from storage areas like the liver.
When hepcidin levels are too high, the body absorbs less iron and keeps it locked away in storage. As a result, there’s not enough iron available to make red blood cells, and this can lead to anemia.
The study was done using human cell lines and found that these effects were mainly seen in cancerous liver cells—not in healthy liver cells. The researchers used advanced tools, including protein analysis and mathematical modeling, to understand exactly how these drugs were causing changes in the cells.
They discovered that two specific pathways in the cells—called IL-6 and BMP—were being activated by the painkillers. These pathways are responsible for increasing hepcidin production.
This finding is important because many cancer patients already struggle with anemia, which can make them feel weak and tired and can also affect how well they respond to cancer treatment. If common painkillers are making this problem worse, doctors may need to find new ways to manage pain in cancer patients.
Dr. Klingmüller emphasized that this effect may not have been known before. “Our results in human cell lines suggest that the use of common painkillers in cancer patients could have unintended side effects on iron metabolism,” she said.
The study also offers hope. According to Dr. Timmer, their computer models show that it might be possible to block the BMP pathway to stop the hepcidin levels from rising. This could help prevent iron deficiency in patients who need to take these drugs.
This study was a joint effort by researchers from several major institutions in Germany, including the German Cancer Research Center, Heidelberg University, Heidelberg University Hospital, Leipzig University Hospital, and the University of Freiburg.
More research is needed to see if the same results happen in real patients, but the findings already point to the need for more personalized pain treatments for people with cancer. It also shows how important it is to look at the full effects of medications, especially in people with complex health conditions like cancer.
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The study is published in Cell Systems.
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