| Is My Arthritis Medication Safe? |
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Since Vioxx (rofecoxib), a drug used for the treatment of arthritis, has been pulled off the market, people are wondering if the medicine they take for their arthritis is safe. Vioxx, was voluntarily pulled off the market in 2004 when the manufacturer realized that the drug was putting people at a much higher risk for heart attack and stroke. In fact, some studies have found that Vioxx increased the risk of heart attack or stroke by as much as 5 times when Celebrex Celecoxib (Celebrex) is a medication that is in the same class of drugs as Vioxx. This class of drugs does have its advantages. They are powerful pain relievers that do not cause the amount of stomach upset that traditional NSAIDS (ibuprofen (Motrin), diclofenac (Voltaren), meloxicam (Mobic), and naproxen (Aleve)) tend to cause. Celebrex has shown evidence of increased cardiovascular risk at higher doses.4,5,6 But even doses as low as 200mg daily have shown a slight increase in risk of cardiovascular problems.3,5,6 Unlike Vioxx, Celebrex has not been shown to increase kidney problems or arrhythmias.2 NSAIDS NSAID (which stands for Nonsteroidal Anti-Inflammatory Drugs) have been looked at to see if they carry the same risks as Vioxx and Celebrex. Naproxen (Aleve) and piroxicam have been shown NOT to increase the risk for cardiovascular events. 3,7 Diclofenac (Voltaren) and Indomethacin (Indocin) were associated with and increase in cardiovascular events.3,7 Ibuprofen was not associated with an increased risk at lower doses, however, one trial showed an increase risk in patients who have already had a heart attack.3,5 Aspirin has been shown to have a protective effect on the heart and is not associated with a greater risk of cardiovascular problems. Many studies have shown that taking aspirin, especially after a heart attack, can prolong life. It has been suggested that the protective effect of aspirin can be inhibited by some of the NSAIDS above, especially ibuprofen. The real world implications for this interaction have not been established though.8 For people who are on aspirin who also use ibuprofen occasionally, the FDA recommends taking ibuprofen at least 30 minutes after or at least 8 hours before the aspirin.8 What Does It All Mean? If you require an NSAID for chronic pain relief, naproxen may be the safest choice with regard to increasing the risk of heart attack or stroke. Naproxen has the potential to cause an upset stomach. If you experience this, you can add a drug called a ‘proton pump inhibitor’. Examples of proton pump inhibitors include Prevacid and Protonix. If you find yourself needing to use Celebrex, try to stay below 200mg per day. If you take aspirin and require an NSAID for chronic pain, you may want to try using a non-NSAID first like acetaminophen (Tylenol). If you must take ibuprofen, try taking it either 30 minutes after or 8 hours before the aspirin. If you work closely with your doctor and your pharmacist, you will be able to make the most of your pain treatment regimen.
Author: Christi Larson, Pharm. D. Dr. Larson is a Clinical Infusion Pharmacist, author of Empowered Medicine; A Guide for Consumers and creator of www.empoweredmedicine.com. You can read more about her by visiting www.EmpoweredMedicine.com and clicking on the 'About Us' tab. EmpoweredMedicine.com is committed to providing evidence-based medical information.
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