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Heart Association Says Use Pain Killers With Fewest
Risks
New advisory on taking COX-2 inhibitors and
non-steroidal anti-inflammatory drugs by American Heart Association
March 25, 2005 - Confused about which painkillers
are safe to use? A new American Heart Association science advisory on
the use of COX-2 inhibitors and other non-steroidal anti-inflammatory
drugs (NSAIDS) suggests this simple rule of thumb: Use the drug with the
fewest known risks.
The advisory affirms the cautions issued by the
U.S. Food and Drug Administration (FDA) in February 2005.
This rule means that potent drugs like the COX-2
inhibitors Celebrex (celecoxib) and Bextra (valdecoxib) should be held
in reserve, generally for short-term use, said Joel S. Bennett, M.D., a
hematologist and a member of the writing group that drafted the
advisory.
The association advisory comes in response to
several reports that COX-2 inhibitors increase cardiovascular risks and
is published in Circulation: Journal of the American Heart Association
Bennett, who is a professor of medicine at the
University of Pennsylvania, explained that COX-2 drugs were developed
with the idea of having a good pain reliever that wouldnt upset the
stomach, which sounded great. But that good idea was questioned when
reports surfaced that long-term use of one of the drugs, rofecoxib
(Vioxx), was associated with increased heart attacks and strokes.
Merck, the company that makes Vioxx, voluntarily
removed it from the market in September 2004 when it received evidence
that daily use of the drug for more than 18 months increased the risk of
blood clots. Since then, the FDA has conducted hearings into other
COX-2 inhibitors.
The American Heart Association advisory recommends
physicians weigh the benefits and risks before prescribing Celebrex or
Bextra. Because the risks of adverse effects of COX-2 inhibitors are
likely greatest in patients with or at high risk for cardiovascular
disease, the statement suggests limiting the use of COX-2 drugs to those
who have no appropriate alternatives. The lowest recommended dose
should be given for the shortest duration necessary.
The advisory also addresses the use of other
popular pain relievers such as aspirin and ibuprofen (Advil, Motrin).
Consumers are warned that all over-the-counter drugs should be used in
strict accordance with label directions and that if an over-the-counter
NSAID is needed for more than 10 days, consult a physician.
We are recommending that patients use some common
sense in selecting a medication to treat pain, Bennett said. In terms
of drug choice, one rule is always best and it holds whether you are
treating cancer or treating a headache: use the safest medicine first.
Medications such as aspirin and acetaminophen
(Tylenol) in recommended doses and durations have minimal toxicity,
which makes them good first choices, he said. If those medicines dont
work, try a stronger NSAID such as naproxen (Aleve).
Bennett noted that low-dose aspirin is recommended
to reduce the risk of second heart attacks and that many people having a
heart attack are given aspirin to limit heart muscle damage.
Co-authors are Alan Daugherty, Ph.D.; David
Herrington, M.D., M.H.S.; Philip Greenland, M.D.; Harold Roberts, M.D.,
and Kathryn A. Taubert, Ph.D.
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