Anti-inflam. Meds.

[labrat]

Dear Dr.,
With all the negative press about Vioxx, Celebrex and possibly Advil/Naprosyn, do you think that ibuprofen also carries a risk?  

At what point are people becoming too afraid and good medicines for the proper person/problem are being eliminated?  

I understand the problems with Vioxx and Celebrex, but how do the older anti-infl. fit in to the overall picture as their mechanisms are different?

Thanks and a very Happy and Healthy New Year!

[CCF-M.D.-MJM]

Hello,

Good question.  There is a clear risk of Vioxx > Celebrex.  There is also data that Naprosyn increases cardiovascular risks.  I haven't seen data on advil (generic ibuprofen) yet, but it wouldn't surprise me if there was some increased risk, although I suspect it will be small.

I read an interview from Dr. Robert Califf from Duke University.  He addressed the lack of data about overall risk benefit for taking these drugs: pain relief versus risk of GI bleeding, cardiovascular events.  Studies independent of the pharmaceutical industry are necessary to clarify these questions.

It will likely come down to informed risk: benefit decisions by physicians and patients regarding when to treat pain with these medications and when not to.  The ibuprofen and naprosyn are relatively safe, but they are not without risk.

The mechanisms are similar.  Vioxx and Celebrex block an enzyme called COX-2, which is induced from inflamatory processes.  Ibuprofin and similar other medications treat the COX enzyme which is active in most tissue.  The presumed benefit of COX-2 inhibitors is that they do not affect the stomach and have a decreased risk of ulcers.  It is not too suprising that there is some overlap in complications.  For now it seems the higher the specificity for the COX-2 enzyme, the greater the cardiovascular risk (vioxx as the greatest specificity for cox-2).

I hope this helps.  I am not telling my patients to stop ibuprofen, but you should take it only when needed in reasonable amounts.

[Jackie5910]

My opinion....all drugs can have side effects.  There is no such think as an absolute safe drug whether prescription or over the counter.  My goal is always to take as few as possible.  I can no longer take any NSAIDS and can only take tylenol once in a while and even that has side effects and problems associated with it.  I have seen terrible side effects from ibuprofen.

[hankstar]

I read about a study some months that suggest naproxen might help reduce heart attack risk, NOW THIS. This is starting to become alarming,Even though Aspirin has shown to reduce heart attack risk and actually help save lives during an heart attack, one has to wonder IF ASPIRIN will be next on the list!!

Like I said once before usually every 2-5 they come up with conflicting studies, though I must admit the vast majority of medications are safe when taken in the prescribed manner.

But with all this one can't help but wonder WHAT's NEXT? I take 325mg of Aspirin everyday for AS , but has always avoided anything stronger.

[hankstar]

that should read 2-5 years.

[Barbarella]

Again, doctors cannot come to an agreement whether patients should take Celebrex or not.  My husband takes 200mg Celebrex and his doctor said only 400-800 mg can have serious side effects.  A friend of mine also takes 200mg of Celebrex (no serious health problems only arthritis) and her doctor told her to stop taking Celebrex the minute the news came out about possible heart attacks as a side effect. Why is this drug not pulled off the market like VIOXX has? Its in the same family doing the same as VIOXX has. Listen to the business news and all you hear is "how low the stock market fell after VIOXX was pulled off the market, and will the drug company recover", and "how the stock market is doing since the news came out about Celebrex, and now Aleve". Sometimes I wonder what is more important? The stocks people invested in for these drugs or the health of the people taking these drugs".

[nymomof5]

as an arthritis sufferer...things have gotten grim for me.  its my hip..and i have pain 24/7  but am not a medicine taker.  before reqesting medicine from my orthopedic surgeon i did research online about vioxx and celebrex.  i saw online for myself that vioxx had a high number of heart problems in people...so i went with celebrex.  i never took the celebrex though as i am not a medicine taker. plus since i have moderate to severe mitral valve regurgitation i am reluctent to take any medicine that might effect my heart. but i do take ibuprofen when needed for the pain..once a day at most and can only hope it does not effect my heart or stomach.  i need hip replacement surgery for my hip when i'm ready anyway, so i guess i'm lucky cause once i have the surgery..i won't need the meds anymore!

[Barbarella]

I agree with the last two posts.  My husband is on 200 mg Celebrex and as I stated above his doc said "only 400-800 mg can have dangerous side effects".  My husband developed large hives, welts and itching on different parts of his body.  He told his doctor and asked him if Celebrex could be the cause, his doctor said "no".  I researched it on the Internet and came across that one of the side effects for Celebrex IS INDEED HIVES AND ITCHING.  What scares us if doctors say a certain side effect is not caused by a certain drug, but we find on the Internet other wise which btw is posted by medical people.  If we the laymen can find out about these side effects why can't doctors find out about it?? I know they are very busy, but if a patient reports a side effect and takes a certain drug I think the doc should at least find out if not right there and then tell the patient he/she will call the patient back and tell them what he/she found out about side effects or let the nurse call the patient.

[Barbarella]

I forgot to mention or take the patient off the drug to see if the certain side effects go away.

[nymomof5]

i'd just like to add in regards to looking side effects up on the internet...if i could go online and see for myself that vioxx had a high rate of heart problems, why can't anyone else including the people who are now pulling vioxx from the market or say, why couldn't the FDA if they approve these meds..why couldn't they see the side effects listed for vioxx.  i went
online and reviewed vioxx and then celebrex and chose celebrex solely based on the info i found listed in the side effects section.  i could have told anyone that vioxx had a high death rate..i saw it myself online...this news should not have been a surprise to anyone who checks out their medicine before taking it. do doctors even know the full side effects of the drugs they prescribe?  like with the hives...she found that side effect listed.  although i had gotten the celebrex from my surgeon..i knew from looking online that celebrex caused heart problems too, only not to the high degree that vioxx did. but thats also why i never took it..i just wanted it in case my pain got worse, since it was pretty bad at the time.  but also as a migraine sufferer...i got some imetrex (sp?) from my pcp... but never took that because they advertised that healthy people could have heart trouble too and its a good thing i never took it as my cardio said i shouldn't take it in light of my bad leaky mitral valve.  seems like i just like to have medicine on hand in case i need it..but i never seem to be able to bring myself to actually take it as i am medicine phobic. i can take tylenol and more recently i have worked the courage to take motrin..lol

[whelans5]

I am a medicine phobic too.  If I get lots of strong palps when taking a new drug I believe it is the drug.  Who knows, maybe it is sometimes.  Prepulsid did a number on me!  Later found out people were dying and that it was taken off the market.  Lately, I thought my Motilium (Domperidone) gave me palps.  Not sure.  Anyone know anything about Motilium?

Also, I have a question about "structurally normal heart".  I read on another question that someone had written and she has a leaky valve, but a normally structured heart.  What qualifies as structurally normal? I would think a leaky valve is not structurally normal.  I ask because I have Bicuspid Aortic Valve which means I have only two valve flaps instead of three.  Two of them are fused together, a congenital defect.  I also have mild regurgitation.  Other than that, everything else is normalor so the docs say.  Does this mean I have a structurally normal heart?

Connie

[Barbarella]

I totally understand your phobia about meds, but what is a person to do who has to take meds for high BP or a heart problem?  As for arthritis people might get by with an over the counter drug, but even these drugs can have side effects.  But when it comes to high BP there is no over the counter drug, and people have to make the choice to take the prescription drugs and take a chance of serious side effects or don't take any meds and take the chance of having a stroke, heart attack or damage to the organs from the high BP.  I'm lucky and have no side effects from the BP meds I have to take, but I know people who had powerful side effects from BP meds and therefore had to be switched half a dozen times.  I also read somewhere that you can be on meds for a long time with no side effects and all of a sudden you can get them or even have an allergic reaction after some time.  It does not have to be right away.  Sometimes it can be as simple as a certain food which does not agree with the meds.

[hankstar]

Happy New Year.

Motilium is used for nausea and vomiting, as far i know it does not have any more unusual side effects to worry about than most medications. Watch out with liver disease.

Trivial to trace tricuspid and mitral valve regurgitation along with mild MVP would qualify as a structurally normal heart. Trace regurgitation of the mitral and tricuspid valves is seen on about 20-30% of all echos. mild MVP is common also and is considered a structurally normal heart.

A biscupid aortic valve is not a normal finding, so therefore is would be considered a structural abnormality, in most cases it just needs to be watched for the development of moderate to severe regurgitation. It may never need replacing , sometimes unfortunately it does. Anyone with a biscupid aortic valve should have an echo at least every 2-3 years depending, some more often.

Just follow your doctor instructions and you should be just fine, if in doubt , get evaluated by another cardiologist at a very reputable hospital. In the meantime relax, the fact that is has not progressed is a good sign. With just a biscuspid aortic valve with mild regurgitation that does not progress, PVCs and palpitations in general does not portend an adverse prognosis.

Check with your doctor if concerned , my understanding only, not grounded in stone, all the best for 2005.

[whelans5]

Hankstar, once again you are such a wealth of knowledge.  I find it hard to believe you are only my age. I notice you are a night owl like me too.  It's 1:05 am here. I feel like such a baby being so worried about my heart. UGH!

These darned palps are so aggravating.  I know I've had them for atleast 19 years, but still, I worry.

Thanks for the reply.

Oh, I researched Motilium and under the rare side effects it had palpitations listed.  The doc has my mom on motilium too and at the same dosage and they don't seem to bother my her though and she gets palpitations too.  So, looks like mom's got a 3 month supply of motilium for free.

Happy New Year!

Connie

[whelans5]

I posted a response, but it didn't seem to go through.

Thank you for writing back. You are such a wealth of information.

Maybe someday I will learn to not be so frightened by palps.  You think I would have learned after having them for 19 years!  They didn't seem to scare me when I was younger.  The older I get the more frightened I become.  Maybe I will devote my time to finding a cure. haha.  Boy would that generate a lot of cash!

Thanks Hanstar and have a Happy New Year.

Connie

[nymomof5]

i know what you mean about high blood pressure meds...i have always had normal blood pressure but last year it was high..but i think its due to my panic attacks and finding out i am gonna most likely need mitral valve surgery one day.  but i am due for a check up now and am actually very much wondering what my blood pressure will be...but i would take blood pressure meds if i have to..it would be hard and might take me days to take it like it took me to start taking my zoloft, but i've heard that high blood pressure is so bad for you that if you have to take meds to get it down its better then living with the high blood pressure which could do more damage. but i still always have a hard time taking meds..any medicine.  and this is sad..but i have in years past ...when taking a medicine..even like tylenol..i get so nervous..that i start to panic. as soon as i take the meds...even before they are in my stomach probably, i'm like grabbing on to the sink, thinking i am dying from the meds...lol..its crazy...i can take motrin and tylenol now without that happening..since i have to take them quite a bit with my arthritis.  but each time a medicine is recalled, it does tend to make a person wonder about other medicine!  happy new year to all!  ellen

[MaryRoe]

I have had a heart attack some time in the past few years.  This I learned recently.  Nothing showed this heart attack but a Cardiac MRI butI knew I had suffered some sort of a cardiac event a few years ago but no one listened to me.

In 1995, I suffered a severed trigeminal nerve stemming from dental work.  I lived on Advil.  Lots of it.  I was put on celebrex and baclofen for about 6 months also. 100mg. Celebrex for this pain.  I also took Neurontin till I could not take walking into walls any more.  The pain from this nerve injury was enormous.  RSD even set in.

Last year for a brachial Plexus injury, I was given 2 months supply of 50mg. Vioxx for 2 months. Like a good girl, I took it all.

Now, I hear that one must of taken 18 months of Vioxx or Celebrex to potentially cause a heart attack.  I am wondering if the 2 months of the highest dose of Vioxx brought other heart events to surface with me thus also finding a hidden heart attack.

Recently, I saw where liquid Ibuprofen for children has caused serious side effects and a death.  

It would not surprise me if Ibuprofen will be tagged next.

I never took Aleve.   Wonders never cease.

[Barbarella]

Don't worry yet about possible surgery for your mitral valve.  I have a leaking mitral valve too.  First the echo showed a "severe" leakage.  I had to go through this TEE test (transesophogalechocardiogram) and this test showed only a "mild" leakage.  Why the echo showed "severe" I was given all kinds of answers for that i.e. because of the way I was breathing because of anxiety, maybe because of the Tech who did the echo.  The TEE test is a lot more accurate than the echo is.  I also had an EKG which showed that I had a "previous" heart attack which I never had because all the following EKG's did not show a previous heart attack.

I too did suffer from panic attacks and I have severe white coat hypertension, and did not want to take BP meds until I landed in the ER, and the Cardiologist told me "its not just white coat anymore".  You're right when it comes to BP you cannot afford to worry about side effects you have to take the meds unless you don't care if you stroke out or damage your organs from the high BP.

For the poeple who have the phobia about meds, the television commercials or the warnings in magazines for sure don't help.  First they advertise and tell people to "ask their doctors if this medicine is right for you" and right after that they slam you with tons of side effects.  Just turn the page on one of the advertisements in magazines the whole back page is full of side effects.  On one hand they want to sell their products and on the other hand they are covering their butts by telling you all of the side effects so they wont get sued.

[Donna W.]

I believe that Viox, Celebrex, and Bextra can cause heart problems with out taking for the 18 months that they claim!     I am 45, and diagnosed with mitrovalve prolapse at 22. I have always been active and atletic, with no heart problems. 2 years ago, I had a back injury, and was taking Naproxin quite regularly. My FP, and neurologist, and physisist all gave me hadfulls of samples of the above, and, I was under the impression that they were for pain, and that I should still take the Naproxin. 1 Dr. told me to also take valuim with the mix. This did a toxic shock to my system, and caused dramatic vision problems, neck tightness, severe mugraines, an onset of high blood press spikes, which not only damaged a valve that will deff. need surgery, but I am certain that I had a TIA. I suffered an enorous fog,for 3 weeks, quit my job, went into the hosp. Tests did not support my opinion except a carotid artery test where there was an irregularity. They did it again, and it looked different. Well, these symptoms do come & go.
It took me almost a year to be able to concentrate and I still have difficulty crittically thinking. I can't handle any kind of stress at all. I read on the web that valuim will double the dose of viox, bextra, and celebrex and naproxin. Then if you take 2 of the above together you double the dose again. I can't take any anti inflamiitory meds any more, my heart races out of my chest. When your blood press spikes, your heart blows up like a baloon, the valves do not stretch, and stay damaged.
I think the drug manufacturers are so irrisponsible to pass out cases of those drugs to dr.s with no instructions on how the dose should be taken. The dr.s don't write the doseage down on the boxes. I still have bags full of samples. They loaded me up filled my pocketbook, gave me brown paper bags full and handsfull. I looked into the class action suite, and you need to have taken the drug for 18 months. I think major damage can be done in alot less time than that. I'll never be the same.-mentally, and heart wise. As far as the neck and back pain, I found great success with a chiropractor that practices a method called tu nai. 8 min and I was out of so much pain. I had cervical bone and lumbar misalignment, herniated disks, and pinched nerves.This causes major muscel spasms up and down the back. The meds cause neck stiffness in addition to the other things, and that restricts circulation and blood flow to the brain, especially with the cervical cranial compression that I had. Too many doctors- the best in phila. no answers. It has been a year since my episode. It is nice when i finially one day after a manuall treatment walked out of mh "walking coma"