Anti-inflammatories , Not to be taken lightly?
Recent journalistic presentation of findings from a large retrospective Danish study has again raised concerns about Anti-inflammatories. Non steroidal anti-inflammatory drugs (NSAID) reduce locally released prostaglandine a cell hormone which causes heat , swelling , pain and redness at the side if injury / inflammation. They are widely used in the treatment of pain , fever , period control and it is well known that they can increase the risk of bleeding from the stomach and gut, especially in susceptible patients. Vioxx a selective Cox 2 (cyclooxygenase ) enzyme inhibitor was taken of the market in 2004 as it also unduly increased the risk of angina , hear attack and stroke. The reported Danish study , which run from the mid nineties till 2005 has now looked at the effect of Ibuprufen , Naprosyn, Celebrex and Vioxx on cardiovascular disease as well as bleeding. The study looked at thousands of healthy individuals with no other illnesses and their risk, if taking any of these drugs over 5 years. Data were taken from the prescription registry and death registry and than retrospectively analysed. The authors found that low dose Ibuprufen , Naprosyn and Celebrex don’t increase risk of stroke and heart disease but Vioxx ( now of the market) , Diclofenac and high dose Ibuprufen (> 1200 mg/day ) do increase risk of heart disease and stroke. They further confirmed that all NSAID’s increase risk of intestinal bleed. Vioxx more than Naprosyn and all other NSAID’s . Interesting was that all other causes of death are not increased by NSAID use and might even be reduced.
Factors which influence your risk favorably are good health, no other illnesses, younger age, infrequent and not regular use and taking NSAID’s at low doses. Remember that Aspirin, which is a NSAID too, in low dose is proven and used for over 100 years in the prevention of heart disease and certain stroke. Rheumatologist Profesor Milton Cohen coins the key question: “Why are you taking it and how long are you taking it for ?“ It is clearly safer to use simple analgesics like Paracetamol for the long term treatment of most pains and NSAID’s should be ideally reserved for the use in short inflammation flare ups of your condition, like for instance Osteoarthriti,s or should be used to get you ready for your golfing match or windsurfing session rather than taken daily. Remember to use simple strategies for your pain as well: weight loss, diet changes, appropriate exercise, support braces , proper shoes….
Your GP and Pharmacist is well aware of the changes in evidence for side effects of NSAID’s over the last 10 years and will be happy to answer your questions. If you have a history of stomach bleeding , ulcer , indigestion a increased risk of heart disease or heart failure , blood pressure or kidney disease than there should be good reasoning and supervision of a doctor / specialist if you really have to use any of above medicines.
Helko Schenk
Geraldton 13 12 2010
Recent journalistic presentation of findings from a large retrospective Danish study has again raised concerns about Anti-inflammatories. Non steroidal anti-inflammatory drugs (NSAID) reduce locally released prostaglandine a cell hormone which causes heat , swelling , pain and redness at the side if injury / inflammation. They are widely used in the treatment of pain , fever , period control and it is well known that they can increase the risk of bleeding from the stomach and gut, especially in susceptible patients. Vioxx a selective Cox 2 (cyclooxygenase ) enzyme inhibitor was taken of the market in 2004 as it also unduly increased the risk of angina , hear attack and stroke. The reported Danish study , which run from the mid nineties till 2005 has now looked at the effect of Ibuprufen , Naprosyn, Celebrex and Vioxx on cardiovascular disease as well as bleeding. The study looked at thousands of healthy individuals with no other illnesses and their risk, if taking any of these drugs over 5 years. Data were taken from the prescription registry and death registry and than retrospectively analysed. The authors found that low dose Ibuprufen , Naprosyn and Celebrex don’t increase risk of stroke and heart disease but Vioxx ( now of the market) , Diclofenac and high dose Ibuprufen (> 1200 mg/day ) do increase risk of heart disease and stroke. They further confirmed that all NSAID’s increase risk of intestinal bleed. Vioxx more than Naprosyn and all other NSAID’s . Interesting was that all other causes of death are not increased by NSAID use and might even be reduced.
Factors which influence your risk favorably are good health, no other illnesses, younger age, infrequent and not regular use and taking NSAID’s at low doses. Remember that Aspirin, which is a NSAID too, in low dose is proven and used for over 100 years in the prevention of heart disease and certain stroke. Rheumatologist Profesor Milton Cohen coins the key question: “Why are you taking it and how long are you taking it for ?“ It is clearly safer to use simple analgesics like Paracetamol for the long term treatment of most pains and NSAID’s should be ideally reserved for the use in short inflammation flare ups of your condition, like for instance Osteoarthriti,s or should be used to get you ready for your golfing match or windsurfing session rather than taken daily. Remember to use simple strategies for your pain as well: weight loss, diet changes, appropriate exercise, support braces , proper shoes….
Your GP and Pharmacist is well aware of the changes in evidence for side effects of NSAID’s over the last 10 years and will be happy to answer your questions. If you have a history of stomach bleeding , ulcer , indigestion a increased risk of heart disease or heart failure , blood pressure or kidney disease than there should be good reasoning and supervision of a doctor / specialist if you really have to use any of above medicines.
Helko Schenk
Geraldton 13 12 2010
