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Warning: Common Pain Relievers Unsafe for Heart Patients: Fortunately, there are alternatives for those needing daily pain relief.

Over-the-counter (OTC) drugs are considered generally safe, which is why the U.S. Food & Drug Administration (FDA) allows them to be sold without a prescription.

However, patients with coronary artery disease should use caution when taking OTC nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with heart failure should avoid them completely.

"Heart attack, stroke and heart failure risk increase when NSAID use begins and climb with increasing dosages and length of use," says Steven Nissen, MD, chairman of Cardiovascular Medicine at Cleveland Clinic.

A Roller-Coaster History

NSAIDs are widely used for mild to moderate pain relief, particularly from arthritis. "Nonselective" OTC NSAIDs include ibuprofen (Advil[R], Motrin[R]) and naproxen (Aleve[R]). "Selective COX-2 inhibitors" are available by prescription.

All NSAIDs reduce sodium excretion by the kidneys, which raises blood pressure.

Introduced in the 1960s, COX-2 inhibitors were quickly embraced. In no time, however, it became clear that the drugs were associated with an increased risk of heart failure and heart attack.

In 2004, the COX-2 inhibitor rofecoxib (Vioxx[R]) was pulled from the U.S. market when it was found to be responsible for causing more than 140,000 heart attacks.

The FDA mandated a cardiovascular safety trial of celecoxib (Celebrex[R]). This trial, spearheaded by Dr. Nissen, compared moderate doses of celecoxib to ibuprofen and naproxen in 24,081 arthritis patients at increased cardiovascular risk needing daily pain relief. The cardiovascular risks from celecoxib were no greater than those conferred by the other NSAIDs.

"Ibuprofen was particularly hazardous," says Dr. Nissen.

Safe Pain Relievers

The best bet for pain relief is aspirin. Aspirin is an NSAID, but it does not increase heart risk. Acetaminophen (Tylenol[R]) may be an alternative if taken in small doses and regular alcohol consumption is avoided.

"We don't want heart failure patients to be in pain, so sometimes we have to treat them with NSAIDs. In these cases, we use the lowest dose for the shortest length of time," says Dr. Nissen.

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Title Annotation:RISK REDUCTION
Publication:Heart Advisor
Date:Feb 22, 2019
Previous Article:After a Heart Attack, Your Risk of Stroke Is Elevated: Addressing any risk factors can lower the likelihood you will suffer another serious...

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