Flutterby™! : NSAID painkillers, stroke and heart attack 2011-01-18 18:10:48.872675+00

NSAID painkillers, stroke and heart attack

2011-01-18 18:10:48.872675+00 by Dan Lyke 4 comments

An SE link to Study Links NSAIDs With Higher Risk of Heart Attack, Stroke, led me to track down the original. The difficulty I had finding it once again shows the abysmal state of journalism world-wide. The MedBioWorld.com article linked to the source

The study is Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis Trelle et al. The summary article in BMJ is Cardiovascular safety of NSAIDs:

The controversy and confusion about the cardiovascular safety of drugs to relieve chronic musculoskeletal symptoms provides an important lesson. Drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety.

The drugs were naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib (Vioxx), and lumiracoxib. Of those, "Naproxen seemed least harmful", which is a bit surprising that it's safer than ibuprofen.

#Comment Re: made: 2011-01-18 19:21:46.270017+00 by: mvandewettering

Very interesting. As a sufferer from intermittent knee and hip pain related to an old bicycling injury, I've used ibuprofen for years, largely because I have found it to be most effective, especially in comparison to aspirin or Tylenol. I also suffer from migraines about once a year, and 800mg of ibuprofen (and sleep) usually stops them from becoming a multi-day affair. So my use is intermittent. But because of family history and my somewhat high LDL cholesterol levels and blood pressure, I'm reconsidering usage of ibuprofen, which does seem to carry some cardiac risk. I'm not a huge fan of acetaminophen, because of its risk of serious complications in the case of overdose, and frankly because I've never found it to be especially effective.

For better pain relief you can try the synergy of naproxen and Tylenol as their pharmacological mechanisms are different. Many who get no relief from acetaminophen do find significant improvement from the combination. For those who are specifically naproxen intolerant, ibuprofen and acetaminophen is also a valuable combination.

Tylenol is acetaminophin, which is somewhat unique in over the counter drugs because the ratio between an effective dose and a lethal dose is quite small.

I've always thought of ibuprofen as pretty benign drug, and many athletes pop 'em like candy to avoid post-workout aches and pains, so it was somewhat surprising to read this. But I also don't take any painkiller lightly, so from a personal standpoint it's kind of a "meh" report.

Old injuries and the wear and tear of age can be immobilizing. Am I better off just sitting around, or do I take a minor risk and be able to do most of the things that I want to do? For me that is not a choice.

Tylenol can cause liver damage and death. The recommended upper limit for is 4g/day in four doses. The severity of the damage done by the acetaminophen metabolite is not linear with dose, but practically discontinuous at the level of overdose which depletes liver glutathione. Accidental overdosing can be ameliorated with a cysteine derivative if taken within 12 hours of overdose. As usual many studies done on Tylenol use and liver toxicity have produced varied results in terms of demonstrating damage to healthy individuals, the active alcoholic, users of alcohol and the malnourished.

By the way, work has suggested that using ibuprofen will reduce the effectiveness of aspirin's attenuation of platelet aggregation. Last I saw is that aspirin should be taken no less than an hour before taking ibuprofen, or at least eight hours after taking ibuprofen.