10 February 2011

Be Careful What Anti-Inflammatory Drugs You Use!

I don't regularly use any of these pain relievers, but I am surprised by this study. It is really another warning about non-steroidal anti-inflammatory drugs or NSAIDs. They are showing that they have cardiovascular risks higher than previously thought. This is not good and is encouraging more investigation – which may lead to more being removed from the market.

It would seem that these would have been safe, but more studies are showing that they are not as safe as we would like. And even the some of the more common pain relievers are now being found unsafe. This is a blow to many of us with diabetes that wish to avoid using steroids to relieve pain for some conditions.

Prior meta-analyses did not resolve the debate as they failed to include all the available evidence. This new network meta-analysis which is published online, January 11, 2011 in the British Medical Journal, includes all available evidence.

Investigators expected to see an increased risk but was surprised by the magnitude of the signal. Also they cited that the doses were high, they felt that this was clinically relevant. Investigators admitted they were shocked by the two and four-fold increase of risks. This new study, by including all 31 trials and over 116,000 patients, were able to see the increase in patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.

The authors recommend that physicians use special care to evaluate patients prone to cardiovascular problems and use NSAIDs at the lowest possible dose and for as short a period as possible. They also would like to see black box warnings added to all products still available on the market.

Although naproxen seemed the least harmful in this study, there are major concerns about the gastrointestinal safety of the drug. Because it is necessary to add another drug to protect the stomach, this is not an ideal drug. It requires determining the benefits and risks.

Until further studies are completed, it may be necessary for physicians to carefully evaluate patients for the benefits and risks of NSAIDs and limit their use when possible.

Read the article about NSAIDs here.

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