Osteoarthritis...New Risk Associated With the Use of NSAIDs and Aspirin

The risks of heart attack and stroke with the use of Vioxx has been widely reported in the press and it has been removed from the market by the FDA.  A single Cox II inhibitor (Celebrex) remains available by prescription and another Cox II inhibitor (Arcoxia) is under review by the FDA for potential approval.  Today a panel recommended to the FDA that Arcoxia be rejected because of potential cardiovascular adverse events.  Cox II inhibitors were developed to decrease the chance of stomach ulcer and gastrointestinal (GI) bleeding which sometimes occur in patients taking nonsteroidal anti-inflammatory drugs.  Common examples of these drugs include ibuprofen (Motrin), Advil, Aleve, Indocin and others.  They are often very effective in relieving arthritic pain.  Even the common drug aspirin...which relieves pain and reduces fever...can occasionally cause GI bleeding.  This bleeding can be serious and even result in death...about 16,000 patients die each year in the US from GI bleeding secondary to the use of NSAIDs.  To avoid these complications researchers developed Cox II inhibitors...GI bleeding occurs less frequently with Cox II inhibitors.  However, cardiovascular complications have caused great concern to patients and care givers.

New information about patients with osteoarthritis, who also have a high cardiovascular risk, suggests that if using low dose aspirin...for their heart disease...and ibuprofen they have significantly increased risk of having a heart attack.  However, the risk for heart attack was not increased in similar patients if they took aspirin and Naproxin or Celebrex.  Researchers suggested that the ibuprofen may "interfere with the blood thinning properties of aspirin". 

For high risk cardiac patients not taking aspirin the rate of heart attacks was higher for those taking the Cox II inhibitor Celebrex, but not the other two NSAIDs studied...ibuprofen and Naproxen.  The importance of this study is not only, that side effects...sometimes serious...can occur with these drugs, but also it is important to know that interactions between drugs can diminish beneficial effects or even increase the rate of serious complications. 

 Remember, it is important that your physicians/caregivers know each drug/herbal that you take.  Also, take these arthritic medications under the control and over sight of your physician.  If you are at risk for heart disease and have osteoarthritis or pain and are taking aspirin routinely...don't also take ibuprofen.   If you have any concerns about using NSAIDs ask your physician for details about their use, interactions and complications.