Posted on 09/13/2006 8:14:50 PM PDT by neverdem
Studies raise new concern about other medications
ASSOCIATED PRESS
Worried that your painkiller could trigger a heart attack or dangerous stomach bleeding?
New reports on painkiller risks, based on reviews of dozens of studies including hundreds of thousands of patients, indicate most patients should try naproxen, an older anti-inflammatory drug.
Experts say it doesn't raise heart attack or stroke risk -- a major worry for older people -- and naproxen is inexpensive because generic versions have been around for years. Available over the counter, it's taken by millions of Americans.
The drawback is that like most painkillers, it can irritate the stomach, so doctors say some people may also need to take one of the newer acid reflux drugs.
"I do think we should start with naproxen in the vast majority of cases," said Dr. Steven Nissen, head of cardiology at the Cleveland Clinic and president of the American College of Cardiology. "It's about balancing the cardiovascular and gastrointestinal risk."
The new reports were published Tuesday ahead of schedule on the Web site of the Journal of the American Medical Association because of their public health implications. They will be published in the Oct. 4 issue of the journal.
Along with the good news about naproxen, the two studies raise new concerns about a few painkillers, particularly diclofenac, which has been on the market since 1988. The commonly used anti-inflammatory drug, also sold as Voltaren and Cataflam, carries as high a risk of heart attack or stroke as Vioxx.
The new analyses also provide even more evidence of the dangers to the heart and kidneys posed by Vioxx, which was pulled from the market two years ago.
The latest findings should help patients and doctors confused about painkiller safety since news began unfolding about the risks of Vioxx, Bextra and other non-steroidal anti-inflammatory drugs.
Based on a study that group did with Hartford Medical School, patients should wait seven years before trying a new drug, Sasich said. By then, safety problems usually become clear. Patients also should review the Food and Drug Administration guide to NSAIDS on its Web site or ask a pharmacist.
Those especially worried about safety could try pain ointments first, said Dr. Richard Jermyn, director of the University Pain Care Center in Stratford, N.J. If they don't help, he suggests Tylenol, then naproxen or ibuprofen before resorting to Celebrex, a Pfizer Inc. drug in the same class as Merck & Co.'s Vioxx. He urges patients on any of those drugs to get liver and kidney function tests every six months.
The heart risks from diclofenac were reported by researchers at the University of Newcastle in Australia. That report recommends regulators review whether diclofenac should stay on the market.
The FDA said in a written response that none of the new information warrants a change in its regulations on NSAIDs.
The same report also showed increased cardiovascular risk with another old but less-used drug, indomethacin, and "probably" the same with the newer Mobic, Dr. David Graham, an FDA drug safety expert critical of the agency's handling of Vioxx concerns, wrote in an editorial.
Mobic, made by Boehringer Ingelheim Corp., is widely used in Australia, and many U.S. patients were switched to it amid worries that all the cox-2 inhibitors -- the class that includes Vioxx and Celebrex -- increased cardiac risk.
Graham, who was not writing on behalf of the FDA, noted that even Celebrex -- considered a good alternative drug by some experts -- increased heart risks at high doses.
The second review, by researchers at Harvard's medical and public health schools and Brigham and Women's Hospital, covered only the cox-2 drugs and focused on less-publicized problems, including abnormal heart rhythms and kidney-related disorders. It found those risks are not raised by Celebrex or other cox-2 drugs sold in foreign countries, but Vioxx increased the risk of kidney problems about 50 percent and nearly tripled the risk of potentially deadly heart rhythms.
That could add to the more than 16,000 lawsuits already filed against Merck. In addition, the review of cardiovascular studies found that Vioxx increased heart attack and stroke risk right away -- not after 18 months' use as Merck has argued in defending against lawsuits -- and that the drug was particularly dangerous at doses above 25 milligrams per day.
Merck said in a statement that data from previous studies contradict "the interpretations published today" in JAMA that short-term Vioxx use raises heart attack and stroke risk.
THE RANKINGS
According to a report in the Journal of the American Medical Association, the painkiller naproxen has less of a cardiovascular risk than other drugs. Here are the rankings of risk estimates, from lowest risk estimate to highest risk estimate:
1. Naproxen
2. Celebrex
3. Ibuprofen
4. Other anti-inflammatory drugs
5. Mobic
6. Vioxx
7. Voltaren
See the articles here: Search results for Aleve warning
12 hours for me. In my case it works even better than Darvon Compound 65, without the pesky need to get an Rx
Now I'm on something called Relafen. Seems to help somewhat but I feel dragged out all of the time. I'd rather have the pain.
ANYONE who takes any kind of pain killer like Naproxen, aspirin, tylenol, etc should be taking DGL - deglyccerized licorice.....it protects your stomach. (But, most doctors don't know this.)
I, personally, stay away from Tylenol. I take another med that can cause liver problems, and I have to get liver function tests every 6 months because of it. I choose Ibuprophen, and stay away from Tylenol. I have also given up drinking any alcohol because I don't want to "tax" my liver anymore than it already is from the drug I have to take.
Before I was put on Vicodin by my neurosurgeon, my GP put me on Darvocet after Voltaren didn't do anything at all for me after having used it ocasionally during the five previous years. My doctor's instructions were to only take Darvocets at least six hours apart. I could feel them start to wear off at four hours.
It's letting other folks be the guinea pigs while the adverse effects get a fuller vetting.
You and me both...I avoid them all, as much as possible. Even advil at multiple doses can eat my tummy...
Are you an adult?
I suggest you try something called "asprin."
If you need something more, contact a doctor who isn't afraid to proscribe more potent painkillers.
It caused problems with focusing my eyes, plus it raised the pressure in my eyes & it can also cause early onset of cataracts! So, as glorious as this report sounds, there are always side effects & before taking any med, you should look up the side effects on the net.
Some of these vision problems are not readily apparent til you've been on the med for several months & the pressure in the eyes is not apparent til a doctor looks at you. In other words, you have no symptoms that the pressure is up.
Hydrocodone is a medium strength opiate painkiller. It does not have much if any anti-inflammatory action. Most preparations come as a combination with either aspirin or acetominophen (Vicodin). It is closely related in potency with oxycodone whcih combined with acetominophen is Percodan.
For some reason narcotic painkillers and me do not mix.
IIRC, that's a synthetic opioid analgesic. This story is mostly about NSAIDs, Non-Steroidal Anti-Inflammatory Drugs, and their later cousins, COX-2 inhibitors.
2,140 results on Google if you spell it right (with only one c), only 2 if you spell it that way! But thanks for the tip!
My doctor prescribed Celebrex but it does not work any better than the Excedrin I was taking. What dose of Naproxen are you using?
That can be a problem. Even oncologists are getting gun shy. Those of us that need narcotics for pain relief are very concerned.
I am unable to take anything containing Codeine but that is because Codeine is a derivative of Morphine which makes me throw up. Of course I did not discover that until after an operation and was given a shot for pain. Threw up for 2 whole hours. Never again!!!
sorry.....from memory I was wrong....
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