Anti-inflammatories and risk of heart problems

[cjsmith]

I keep hearing news of heart problems related to anti-inflammatories. Vioxx, Bextra, Celebrex, and now naproxen sodium (Aleve) have all been found to carry some risk. [Links plagiarized from sunnydale47 with thanks!]

I've never tried Vioxx and probably now never will, although I have an old outdated prescription for it lying around. It's been taken off the market entirely. Bextra and Celebrex do little or nothing for me. Naproxen works.

I can see getting worried about the dangers. I can understand this news being the reason for changing what one would do, if one's pain isn't all that bad to begin with.

My life without anti-inflammatories wouldn't be worth a mouse's fart. I'm going to keep taking Aleve. Of course, I am also going to hope that I'm lucky enough to escape the heart trouble. My life WITH anti-inflammatories is worth keeping.

I am also going to stock up in case the FDA decides for me what risks I can and cannot take.

Comments

[pixiecrinkle.livejournal.com]

I'm a bit concerned about this last round. When the Vioxx thing was announced, I was pissed because that's what I had a script for, but I hadn't taken it in a long time. However, my grandmother, who's on Celebrex for terrible arthritis, stopped taking that when the Vioxx announcement was made. She's incredibly conscientious about her heart health, almost to the point of obsession. I haven't talked to her since the Celebrex study was announced, but I'm going to try to convince her to NOT stop taking it. She wasn't able to get out of bed when she stopped a few weeks ago. I don't want to see her extend her life by living the rest of her life in bed in pain, when she could be out enjoying it as she does now.

[dr-scott.livejournal.com]

Tell your mother that the study which showed additional heart hazard from naproxen sodium showed no additional risk from Celebrex. Additional risk from Celebrex has only been seen in unusually high doses. If it works well for her, any slight additional risk would seem to be acceptable until there's some much more negative data.

And no one should be taking any pain reliever in extreme doses. I've known people to hurt themselves badly with ibuprofen, for example, eaten like candy -- blood thinning, organ damage, immune system suppression, etc.

[cjsmith.livejournal.com]

And no one should be taking any pain reliever in extreme doses.

Wow, spoken like someone who's never had serious pain issues. What would you suggest they do instead? (To put it another way: Raise your hand if you truly believe you would never break under torture.)

[pixiecrinkle.livejournal.com]

I think that depends on the definition of "extreme." Is that "extreme considering risk" or "extreme disregarding risk"?

I took fairly massive doses of tylenol, advil, aleve etc. while in high school because my migraines hadn't been diagnosed yet. I fear I have done myself unnecessary liver damage, because there were better alternatives, though I didn't know about yet. However, if there were no alternatives, and the doctor explained that I'd be doing the damage, I'd have the weigh the damage versus the pain.

[dr-scott.livejournal.com]

I didn't mean to sound too absolutist, and as always these decisions should always be made by the person suffering after as much information as possible about the risks and alternatives is available. I don't think the FDA does a very good job as a "best practices" agency -- I'd rather see them police label claims and purity but otherwise butt out of people's decisions -- but the incidents I'm thinking of tended to be people who are self-medicating for athletic purposes who had been told that very high doses were just fine for keeping joints quiet.

Severe chronic pain sufferers should have every possible treatment available, including opiates, but the "drug war" restrictions on doctors and pharmacies make it really tough to get access to them.

[cjsmith.livejournal.com]

I don't think the FDA does a very good job as a "best practices" agency -- I'd rather see them police label claims and purity but otherwise butt out of people's decisions...

Amen, brother. :-/ Or, heck, publish studies about risk, and THEN butt out of the final decision. I would want that decision to be between the doctor and patient... or between the patient and his or her own Deity.

self-medicating for athletic purposes who had been told that very high doses were just fine for keeping joints quiet.

Heh, yeah. Again, I'm for giving an adult a good risk assessment and then letting him decide, BUT taking high doses of a potentially damaging medication so you can win the track meet does seem a little less... necessary... than taking them so you'll stay away from the sharp knives. :-)

[cjsmith.livejournal.com]

I've taken fairly massive doses of aspirin (before Advil came out), Advil (before Aleve came on the market), and Aleve. I'd call them "extreme" by comparison to the recommended dose on the side of the bottle.

But would I break under torture? Hell yeah.

For me, it wasn't even about the risk. It was about whether I should take enough to stop the pain NOW or enough to stop the pain PERMANENTLY by stopping my life. Seriously. The levels of pain I've had are, well, bad.

So far, there aren't any other (chemical) alternatives. I don't get to look back and say "if only", 'cause sadly, there is no if only. :-( But like yours, my problem was not diagnosed -- well, misdiagnosed for twenty-four years. I'm looking at surgery this spring.

[pixiecrinkle.livejournal.com]

That's definitely where I'll start--unfortunately, grandma is a bit of a stickler for medical info to the point where it gets to be an obsession. We won't get into any of her dietary habits--let's just say she doesn't allow herself much pleasure there at all. She's on a pretty normal dose of Celebrex though, in fact, lower than I was when I tried to take it, so this should help. Thanks.

[cjsmith.livejournal.com]

Amen. Life is for living; if I can't live it, go ahead and put me in the ground.

eeks

[lesliepear.livejournal.com]

I'm begining to wonder about the FDA. Seems like every medicine is taking a risk.

I took Celebrex briefly for some ankle pain. Probably not long enough and too long ago to do any harm. I've taken aleve, but usually take ipufrofin or tylenol.

At least the levoxyl I need to take (as I have no thyroid now) is safe. And cheap.

Re: eeks

[cjsmith.livejournal.com]

I'm begining to wonder about the FDA.

I wonder too. We're not alone; some people believe it should be up to the doctor and patient to determine whether a risk is worth taking in that patient's case.

I take Tylenol for the kinds of pain that it helps with. Sadly, that's not much. For the direct nerve pain, Aleve is it. :-/

Re: eeks

[lesliepear.livejournal.com]

I'm sorry you have such pain - did the feet numbing help at all?

Re: eeks

[cjsmith.livejournal.com]

Oh, the bad pain I have isn't the feet. It's the herniated nerves in the belly. The feet were never anywhere near as bad as the abdominal pain -- they were just *fixable*, so I went ahead and got them fixed. :-) My feet are pretty inflamed now, producing a level of pain I'd call an "annoyance". That's expected to subside in the next few weeks. Then I can tell whether the treatment was successful.

[dieppe.livejournal.com]

Newflash! Life Causes Death...Film at 11...

I know we should be wary of drug side effects and possible long term consequences, but as you say, you take the drug that helps you the most... Or course it'd be ironic if what you really needed was marijuana but we'd never know if that would be the one to help, ya know?

(Under the "if you're stoned you can't feel pain" theory... Not that I've ever tried it, mind you.. ;) )

[cjsmith.livejournal.com]

Life Causes Death...Film at 11...

Well, there is that. :-)

For me it's really about whether life would be WORTH LIVING without the help that the drug can provide. I think most folk have absolutely no idea what serious, long-term, chronic, and *severe* pain can do to someone. If I'm already at the point where I can calmly say I'd rather not live than go back to that, then a small risk of death does seem better than not taking the Aleve.

[kimatha.livejournal.com]

I was talking with my mom today about this stuff and chronic pain. I think there are a lot of people who would gladly accept the increased risk in exchange for having day-to-day mobility and manageable levels of pain. Aleve doesn't work for me, but Advil works on my TMJ pain and Exedrin works on all other headaches. If either of those were recalled, I would have a lot more sick days.

[cjsmith.livejournal.com]

If either of those were recalled, I would have a lot more sick days.

*nod*

It's funny how we can talk about "quality of life" as something worth considering for a cat or dog, but somehow there's a wild reaction when we start talking about risk assessment for humans.

[ambar.livejournal.com]

That's partly because no one goes to jail for euthanizing a cat or a dog.

[cjsmith.livejournal.com]

Yeah, and I'd classify that as effect rather than cause. There's something that stops humans from *thinking*, where human death is concerned.

[oddhack.livejournal.com]

I suspect the FDA is less relevant to the continued availability of most of these drugs than is the ABA. Surely a flood of lawsuits will hit soon.

OTOH, 2005 may be a good time to pick up some cheap pharmaceutical stocks.

[cjsmith.livejournal.com]

Ooo, good point! :-)

[firecat]

My life without anti-inflammatories wouldn't be worth a mouse's fart. I'm going to keep taking Aleve.

I'm going to continue taking Aleve too.

Statistics are fun.

The study on Aleve was only on Alzheimer's patients, who are mostly elderly and therefore already at greater risk of heart attack and stroke than young/middle-aged people. The full story said "about 70 patients of the 2,500 suffered stroke or heart attack, including 23 deaths, and that there were about 50 percent more such events in the naproxen arm of the study than in the placebo division." That means 2.8 percent of these patients had heart attacks and strokes. If there were "50 percent more events" among patients who were taking Aleve, I think that means something like 4 percent of these patients suffered heart attacks and strokes.

So - we're talking about a less than 1.5 percent increase in absolute risk (as opposed to a 50 percent increase in relative risk), among a fairly small number (about 830) of elderly Alzheimer's patients. This isn't what I would call a definitive study of the safety of Aleve, especially given that this is a drug that's been out for 30 years and that means there is a lot of data about what it does to the body.

I think the increased risk is sufficient for them to stop the study. But I definitely don't think the data is sufficient to consider taking Aleve off the market.

nodnod

[cjsmith.livejournal.com]

I agree that the increased risk does not seem large to me. (But then, "large" is a subjective judgment, and me, I'm already heavily biased in favor of using the stuff.) I also agree that this study is not at all a full picture.

I don't know much about the Celebrex study. 3.4 times (or 2.5 times) WHAT risk? The FDA did consider taking that one off the market. Fortunately for several people I know, they haven't taken that step.