Anti-inflammatories , Not to be taken lightly?

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

Insomnia , Sleep problems

Insomnia , difficulty to fall asleep, maintain sleep, or early waking seem to be incredibly common , in fact repeated studies have shown that up to 30 % of the Australian population suffer or perceive to suffer from poor sleep. Sleep deprivation is used as psychological torture but yet few people have died in the natural world of lack of sleep. Sleep , length and needs are often overrated and lead to anxiety and worry which in turn reinforce sleep disturbance – a very vicious cycle to break. Sleep need vary hugely between people and generally fall from 17 hours in babies to 8 hours to 30y-somethings and less than 6 hours in the elderly. Important is a fresh and regular awakening.
A number of reasons for sleeplessness are accepted, age might be a normal cause, medical reasons like the need to pass water more often overnight, pain , breathing problems , medicines taken for other conditions , smoking before bed time, excess and late use of alcohol and drugs, stress , bereavement, anxiety , depression can all cause poor sleep. Have a chat with your doctor , or get some information to explore sleep hygiene and causes you can correct yourself like room temperature , comfortable bedding , darkness of room and reduced noise exposure. Good leaflets are available at
www.patient.co.uk “Insomnia”, “Sleep problems”
www.abc.net.au/health pulse series “INsomnia” ,”Do natural Sleep Pills work?”
Australian Sleep association “Insomnia & Sleep health”
Advice on good Sleep hygiene can be found there or in discussion with your Doctor/psychologist. Simple things to remember is not to worry about sleep, to stay active , not to take naps, have a bedtime routine, No to coffee , nicotine, tea , chocolate and other stimulants. If not able to sleep get up read a boring book or watch a boring programme , drink a hot malty or milky drink and return when tired.
Medications while effective in the short term (sedating antihistamines , benzos…) have side effects , quickly become useless and some can lead to rapid addiction and dependence. Modern ones especially if used with alcohol (Zopilone/ Zolpidem) can have bizarre side effects but might still be safer to use. (Night walking)

Beware natural therapies of unproven effect and composition, While prescription Melatonin (Sleephormone) might have a place in treatment of severe jet lag or psychiatric illness , over the counter melatonin is severely diluted and propably not effective. Some Antidepressants are sedating and might be a safe option but should be reserved for underlying emotional issues , which if improved can better sleep dramatically. Try to self diagnose , better sleep routine and hygiene but see your doctor if you suspect underlying medical , emotional issues as discussed above .

Geraldton 9 2 2010

Older people on 'drugs cocktail'

Nearly half of over 65s are taking five or more drugs, and without regular reviews this may be both dangerous and costly to them and Medicare.
Inevitably people do get put on more drugs when they get older because they suffer from more chronic conditions - this is often the right thing to do, but the problem is we don't necessarily know how these drugs are going to work in combination and lots of people are not taking them as prescribed.
A british study showed 60% of 500 polled believed they may be suffering side-effects from the drugs, but many did not tell a doctor.
Many of these drugs are on repeat prescriptions, and could have been prescribed for conditions the patient no longer has.
The The Royal Pharmaceutical Society of Great Britain polled 457 people aged 65 and above on their medications - which included prescriptions, drugs bought over the counter and herbal medications.
The Studies conclusion urges, all older people to request a medication review from their doctor and pharmacist.
The same study shows one in five are not taking medications as prescribed, and one in seven do not take their pills at the recommended time.
The medication of older people has long been an area of concern: the combination of ageing bodies less able to cope with drugs, treatment by multiple doctors ( a particular problem in Australia where patients are often not registered with one practice alone) treatment for multiple conditions, and known problems in adhering to the instructions, all raise the risk of side effects.
As many as 17% of hospital admission are due to these adverse reactions, and it is estimated that over three-quarters of these "are predictable and preventable",
A team of of a well-trained professionals (Pharmacist and GP ) could potentially pick up problems. Medicare has long recognized this and funds a yearly comprehensive medication review in team work between your GP and Pharmacist. Both conduct an interview with you , the GP often does some tests or collects results of recent investigations and copies these into a letter to your pharmacist requesting a Medication Management Review. In Medicine it’s true that 2 cooks are often better than one.
GPs are excellent at prescribing, but they are not always so good at knowing when to stop, and they may not always have the time to conduct a thorough review. That's where the well-trained pharmacist has a key role.
It is vital to inform your GP and Pharmacist if you take over the counter medications , vitamins , trace elements or alternative medicines. It pays to stick with one General Practice and one Pharmacy so they both have a comprehensive understanding of your problems, allergies and treatments. Discuss your eligibility for a Home Medicines Review on your next visit to your Doctor or Pharmacist!

Helko Schenk
GMG
29 7 2009