Anti-Inflammatory Drugs
All NSAIDs May Be Linked to MI Risk,
Study Indicates
Selective and nonselective nonsteroidal anti-inflammatory
drugs (NSAIDs) are associated with an increased risk of a
first Myocardial Infarction, results of an observational
study suggest. Diclofenac and ibuprofen seem to pose about
as much risk as the COX-2 inhibitor rofecoxib, the study
authors say.
Rofecoxib (Vioxx) was withdrawn from the pharmaceutical
market at the end of September 2004 after use of the drug
was tied to adverse cardiac effects. Since then, however,
questions remain, such as whether all NSAIDs share these
harmful effects.
Drs. Julia Hippisley-Cox and Carol Coupland,
from the University of Nottingham, UK, conducted a population-based
nested case-control study using the QRESEARCH database of
information from UK general practices. They report their
findings in the June 11th issue of the British Medical Journal.
Their
study included 9218 cases of a first MI in people between
the ages of 25 and 100 during study period from 2000 to 2004,
and 86,349 controls matched by age, calendar time, gender
and practice.
The authors identified all prescriptions for
NSAIDs for each case and control in the 3 years before their
index date (specifically celecoxib, rofecoxib, ibuprofen,
diclofenac, naproxen, other selective NSAIDs and other nonselective
NSAIDs). Their multivariate analyses adjusted for comorbidities,
medications, and other confounders.
"We think that enough concerns exist to warrant a reconsideration
of the cardiovascular safety of all NSAIDs," the investigators
conclude.
In an associated editorial, Dr. Peter Juni, from
University of Berne in Switzerland, and colleagues urge that
these data be "interpreted with caution," given that they
are observational and other trials have yielded discrepant
results.
What is called for now, they contend, are complete
meta-analyses, which should "help decision making about issues
such as the need for additional trials... to establish the
best and safest treatment for patients with musculoskeletal
pain."
BMJ 2005;330.
NSAIDs and Musculoskeletal Treatment: What Is the
Clinical Evidence?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
are commonly prescribed for musculoskeletal injuries because
the conditions are believed to be inflammatory in nature.
However, because inflammation is a necessary component in
the healing process, decreasing inflammation may prove counterproductive.
Also, many tendon injuries called 'tendinitis' are, in fact,
degenerative and not inflammatory conditions. An analysis
of the pathophysiology and healing of musculoskeletal injuries
questions the use of NSAIDs in many treatment protocols.
Because NSAIDs have profound side effects, they should not
automatically be the first choice for treating musculoskeletal
injuries.
Steven D. Stovitz, MD // NSAIDs
and Musculoskeletal Treatment: What Is the Clinical Evidence? //
The Physician and SportsMedicine 2003 (Jan); 31 (1)
Use Caution With Pain Relievers
Acetaminophen can cause liver injury through
the production of a toxic metabolite. The body eliminates
acetaminophen by changing it into substances (metabolites)
that the body can easily eliminate in the stool or urine.
Under certain circumstances, particularly when more acetaminophen
is ingested than is recommended on the label, more of the
harmful metabolite is produced than the body can easily eliminate.
This harmful metabolite can seriously damage the liver.
The
signs of liver disease include abnormally yellow skin and
eyes (jaundice), dark urine, light-colored stools, nausea,
vomiting, and loss of appetite. The signs can be similar
to flu symptoms and may go unnoticed for several days if
consumers believe their symptoms are related to their initial
illness. Serious cases of liver disease may lead to mental
confusion, coma, and death.
Steven D. Stovitz, MD // Use
Caution With Pain Relievers // FDA Consumer
magazine January-February 2003
Acetaminophen use in children: more
is not better
Acetaminophen is the active ingredient
in Tylenol and other fever and pain relievers..At least 24
children in the US have died and three have required liver
transplants after receiving accidental overdoses of acetaminophen.
All the children involved were aged 10 years or younger,
and 21 were aged 2 years or younger. Parents may have given
acetaminophen longer than is recommended "because fever persisted."
Heubi
JE, Bien JP // Acetaminophen
use in children: more is not better //
J Pediatr 1997 (Feb); 130 (2): 175-177
NSAIDS Associated with Kidney Disease
Nephrotic syndrome due to membranous nephropathy
should be recognized as an idiosyncratic drug reaction to
many NSAIDS. In addition to diclofenac and fenoprofen, which
have previously been implicated, ibuprofen, nabumetone, naproxen,
and tolmetin were found to be associated. Because withdrawal
of the drug may result in prompt and complete recovery of
normal renal function, a history of NSAID intake should be
sought in patients with membranous nephropathy.
Radford MG
Jr, Holley KE, Grande JP, Larson TS, Wagoner RD, Donadio
JV, McCarthy JT // Reversible
membranous nephropathy associated with the use of nonsteroidal
anti-inflammatory drugs // JAMA 1996 (Aug 14);
276 (6): 466-469
NSAIDS Side-Effects Epidemic
"There is an
epidemic of adverse drug reactions to NSAID's. The Food and
Drug Administration believes anywhere from 10,000 to 20,000
deaths each year are the result of severe bleeding caused
by NSAID's. It is a big problem."
Dr. James F. Fries. Professor
of Medicine at Stanford University School of Medicine // in Marsa L. "America's
Other Drug Problem," // Los Angeles Times Magazine,
September 29, 1996
Gastro-intestinal Peforation and
NSAIDS
Current studies lack appropriate data on
aspirin and other risk factors for gastrointestinal perforation.
The aim of this study was to obtain the best estimate on
aspirin and nonaspirin nonsteroidal anti-inflammatory drug
(NSAID) use in these patients. NSAID use is strongly associated
with an increased risk of both upper and lower gastrointestinal
perforation. The high prevalence of aspirin (over-the-counter)
use suggests that future introduction of new NSAIDs may not
have a major impact on decreasing gastrointestinal complications
if other measures are not taken.
Lanas A, Serrano P, Bajador
E, Esteva F, Benito R, Sainz R // Evidence
of aspirin use in both upper and lower gastrointestinal perforation //
Gastroenterology 1997 (Mar); 112 (3): 683-689
Which is Safer: Cervical Manipulation
or Anti-Inflammatory drugs?
A review of the literature
to evaluate the risk of serious injury or death resulting
from cervical manipulation and to assess the evidence that
cervical manipulation is an effective treatment for mechanical
neck pain was performed. Another review of the literature
to assess the risks and effectiveness of nonsteroidal anti-inflammatory
drugs (NSAIDs), which are often used as the "conventional" first-line
treatment for similar musculoskeletal conditions
As for
comparative safety, the best available evidence indicates
that NSAID use poses a significantly greater risk of serious
complications and death than the use of cervical manipulation
for comparable conditions. In conclusion, the best evidence
indicates that cervical manipulation for neck pain is much
safer than the use of NSAIDs, by as much as a factor of
several hundred times. There is no evidence tha indicates
NSAID use is any more effective than cervical manipulation
for neck pain.
Dabbs V, Lauretti WJ // A
risk assessment of cervical manipulation vs. NSAIDs for
the treatment of neck pain // J Manipulative
Physiol Ther 1995 (Oct); 18 (8): 530-536