NSAIDs: FDA Warning on Bextra, Celebrex (cont.)

In addition, these drugs can be safely taken for up to 10 days at over-the-counter doses without worrying about increased risk of heart attack and stroke. What we don't exactly know is what the risk is if someone takes these drugs for a few days to a week or so, every month, maybe for menstrual pain, headaches etc. It's likely the risk associated with this use is minimal, if any.

If you need these medications for more than 10 days check with your doctor. In addition to the heart risk, taking these drugs for more than 10 days increases the risk of stomach ulcer bleeding which can also be very severe.

MODERATOR:
The one NSAID not included in the warnings is aspirin. Why?

SMITH:
There is much evidence that aspirin decreases the risk of heart disease. That's why aspirin was not included in this warning. Aspirin can increase the risk of stomach ulcer bleeding however. Therefore it should be taken regularly only under the care of a doctor.

It's important to keep in mind that if you're taking aspirin for heart disease prevention it can normally be taken at a low dose of 81 milligrams and give you the same protection as the higher dose.

MODERATOR:
Let's clarify the role of Tylenol (acetaminophen) in all of this discussion of NSAIDs.

SMITH:
Tylenol is not an NSAID. Therefore, it's not included in this warning. Tylenol relieves pain in another way but isn't particularly effective for inflammation. Tylenol can be safely taken at the over-the-counter dose. It's important to not take more Tylenol than recommended as that can lead to liver damage.

MEMBER QUESTION:
Is Plaquenil considered an anti-inflammatory drug? Can Plaquenil and aspirin be taken together?

SMITH:
Plaquenil is not an anti-inflammatory drug and does not apply to this warning. Yes, you can take aspirin and Plaquenil together if your doctor has suggested you do so.

MEMBER QUESTION:
Why is it doctors will keep on giving you anti-inflammatory drugs, just different ones, even though they don't seem to take your inflammation down at all?

SMITH:
We often have to try several different anti-inflammatory drugs to find the right one for an individual. This includes finding one that doesn't cause side effects as well as finding one that best relieves the pain and inflammation.

If you're not having any response to multiple anti-inflammatory drugs, it makes me think you need different and stronger medication. Since I don't know your diagnosis, I can't make suggestions as to what other drugs may be needed.

MEMBER QUESTION:
So if Vioxx is off the market, which I never took, and Celebrex didn't really help, and now with Bextra off the market, people should consult their doctors to see what other alternatives are available for pain relief?

SMITH:
There are over 20 available prescription anti-inflammatory drugs on the market. There is a complete list of these drugs in the WebMD Special Report on painkillers. You should talk to your doctor about the available options to see which one might work best for you.

MEMBER QUESTION:
I had a double bypass in October of 2004 and am currently on Ibuprofen 600 3-4 times a day for back pain. Should I be concerned with these new warnings?

SMITH:
The new warning does apply to ibuprofen. You are taking a prescription-strength of ibuprofen. Given your previous heart problems that does make it more of a concern.

However, there really is not much, if any, research to directly implicate ibuprofen as causing heart attacks and strokes. Some research has suggested that it may even decrease the risk. But since we really don't know at this point, the FDA is recommending language about the warning on all of these drugs. I would talk to your doctor about this, but again, it may not really be much of an option for you to not take the drug. And any increase in risk is likely small.

MEMBER QUESTION:
What is your opinion of the risk of using 200 milligrams of Celebrex intermittently (maybe once every 4-5 days) to alleviate my joint aches and stiffness? I was diagnosed with OA and Celebrex works better and longer than over-the-counter NSAIDs. Cardiovascular events have occurred in my family of origin, but I am now 66 years old and apparently heart healthy.

SMITH:
Even taking Celebrex on a daily basis at 200 milligrams a day has not been linked to an increase in heart attacks and strokes. Therefore, taking it intermittently is unlikely to be an issue. One thing to keep in mind is that Celebrex has not been shown to relieve pain and inflammation better than other NSAIDs. It is much more expensive if that's a concern for you, however.

MEMBER QUESTION:
If I have kidney problems, how often should I have them checked, being on anti-inflammatory drugs?

SMITH:
All of the NSAIDs can increase the risk of kidney problems. Cox-2 inhibitors, which include Celebrex, were developed to potentially decrease this risk. This hasn't exactly panned out however. As far as how often you need to get your kidneys checked, that depends on how severely your kidneys are affected and what other problems you have. But you definitely need to have regular checkups at least every few months or so.

MODERATOR:
Dr. Smith, we are almost out of time. Before we wrap things up for today, do you have any final words for us?

SMITH:
First of all, if we didn't have a chance to get to your question, check out the WebMD Special Report: Painkillers Under Fire ; hopefully this will help you find your answer.

But I want to be sure to point out that these drugs have their definite benefits. Many of us need to take them in order to maintain our quality of life. If you don't need them every day, don't take them every day.

But if you do, take them and don't worry yourself to death about the risks of heart attacks and strokes. The risk is likely minimal, but it's a real risk. Just talk to your doctor about other ways you can lower your risk of heart disease and stroke. That's my plan and that's what I recommend for all other arthritis and pain sufferers out there.

MODERATOR:
We are out of time. Thank you Dr. Smith for joining us today. And thank you, members, for your great questions.

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