Naproxen Sodium

[tobagotwo]

There has been recent discussion about a possible link between Aleve (naproxen sodium) and cardiac problems over time, similar to the types associated previously with Vioxx and other Cox2 inhibitors.

As many on ACT use Aleve for pain relief, here is Bayer's response:

http://biz.yahoo.com/prnews/061116/nyth213.html?.v=5

There have been a growing number of sensationalist, often pseudoscientific medical reports by the press over the last few years. Be wary of these "courageous health news reporters," and look for all the facts before showering them with praise and awe. When things are found to be not so evil and dangerous after all, they are seldom around to print retractions.

 

[Phyllis]

Thanks for that, Bob- I use it often for arthritis in the knee!

 

[Lisa in Katy]

I personally think that Vioxx was a good drug as well. I read recently where after 14 years, silicone breast implants are once again being used and they were linked to all kinds of things. I think much of the hype comes from the jealous competitors.

 

[hensylee]

Mother had arthritis in the extreme and she finally decided that Alleve was the best of all the pain relievers she had taken and continued it until her death still swearing by it. I took one this week for some pain that I had and it relieved it post haste. I took another one this morning and again it helped. I try not to take any nsaids unless I really, really need it because I am sensitive to anything that upsets my stomach. I do believe my mother was correct in what she said. Celebrex is good, but it tends to upset.

 

[tobagotwo]

A lot of the hype comes from media types who want recognition. And it's encouraged by greedy lawyers who stand to make an ill-gotten fortune off the spoils. Silicone breast implants have been exonerated by two decades of studies, but a lot of people made money off the "evil" manufacturers of these items.

We do need people to blow the whistle, but the press is rarely accurate in the way they do it. The problem is that these things are staged as fright stories to get people's attention, and their dangers are blown out of proportion.

What of the millions of people whose lives were improved with Vioxx and Celibrex and the other NSAIDS that actually helped the inflammation as well as quelling the pain? Now there's just naproxen sodium (not if some people have their say!), aspirin (for now...), acetaminophen (Tylenol) and narcotics.

Of course, these drugs don't do as much about the inflammation either, so the joint damage will now accelerate on all those who have been "saved" from those terrible(?) drugs. I guess the artificial joint makers and the surgeons will make the money instead. Of course, people will die and have strokes from those surgeries too, but who will be adding up those numbers and comparing them to how many might have had heart attacks on the NSAIDS?

Next, the press will be outraged at the public shame of how many people with arthritis are hooked on narcotic painkillers, and blaming the doctors and the makers of narcotics for it. Betcha these crusading young reporters don't live with arthritis pain.

The coated stents they are now beating their chests about have a one-in-500 chance of cardiac issues. Does any article say what the odds are without the stent? Or say what the odds are when an uncoated stent or a balloon angioplasty restenoses? If not, then in what way is anyone assessing their relative risks? I've even seen suggestions now that they should leave clogged arteries alone entirely. Isn't that what was killing people with strokes and heart attacks in the first place?

I'm not defending drug-eluting stents or NSAIDS, per se. I'm just saying there's no context in the press releases that allows us to do anything but become righteously indignant toward something that we're basically still entirely ignorant about. All drugs and medical devices have risks, and the risks should be weighed against the alternative.

Shellfish and peanuts have risks for some people. Should they be banned? Should the Carter family be sued for selling peanuts to a public that didn't know that a tiny percentage of them would be tragically allergic? Why didn't the Carters warn us?

Let's see - if the overall odds on valve surgery are about 2%, they're ten times greater than the stent thing. Perhaps we should all sue the valve makers, as they are the ones who are greedily encouraging this surgery for their own profit. We just have to forget about that little fact that we all would have died from our valve issues without them...

Best wishes,

 

[Wise]

Good info brother Bob. Sometimes I wish the media would just shut up. My wife and I sometimes question what we should take for pain because of the many, oft conflicting, media stories advising all of us of such. We just end up confused really. We talk to our pharmacist and doctors if we have questions and hope for the best. But, just wanted to tell I appreciate your perspective on this; I think you've summed it up rather nicely.

 

[lcwhitney]

Anaprox is not A cox-2 inhibitor, it is just a plain old NSAID closely related to the original NSAID aspirin!which welearned aboutfrom our native americans

Lettitia

 

[Bryan B]

Interesting timing on this thread. I have sworn off all opiates (unless my pain index is 8+ i.e. major surgery or major injury) because I had such a hard time getting off of them after being on them for 6 months (OHS & then sternum complications). I have been playing A LOT of golf this summer/fall...even got a part-time job at the golf course I play at for the free golf. My sternum still gets "achy" from playing so much so I had been taking ibuprofen with moderate relief...but I had to take 3 of the 200mg tablets before I played and 3 more that night after playing. I decided to switch to the naproxen and they work much better for me. I take 1 of the 220mg tablets before I play and most of the time I don't need to take one that night after playing. I have worked in the pharmacy biz since 1984 and the prescription drug with the same ingredient (Naprosyn) has been around since then. I'm kind of surprised that they would just now discover this. And it's my understanding that all of the first generation NSAIDS work in the same way. So if naproxen can cause heart problems when taking it over extended periods than it would be logical to assume that ibuprofen and other first generation NSAIDS would too. I'm a believer that it's never a good idea to take an OTC product on a daily basis anyway. If you're having pain every day you should talk to your doctor (who knows your medical history) and let him decide which medication is right to control your pain.

 

[hensylee]

Many years ago I had a rx for Naprosyn and it was really cheap - about $5.00. I didn't want to take nsaids so the next time dr wanted to give it to me I refused. I was young enough then to bear with it til it passed. As mentioned in another thread I took one last Wednesday evening and one yesterday (actually I had forgotten about naproxen until daughter bought some for her pain when I visited her for a week). This morning my other daughter told me she has been getting up with pain so she tried one this morning after me telling her about my experience and turns out her pain is already relieved some. I won't take one every day but when pain is pretty awful, I will certainly find my way to the naproxen bottle. I agree that over the counter meds should be taken on an as needed basis.

 

[tobagotwo]

There has been recent discussion about a possible link between Aleve (naproxen sodium) and cardiac problems over time, similar to the types associated previously with Vioxx and other COX2 inhibitors.

This wasn't lumping naproxen with the COX2 inhibitors: it was associating Vioxx with them. However, if it was unclear, I'm glad you made the point.

There were several things that weren't pointed out very often in the painkiller furor. For Vioxx and most others, the raised risk only came after six months of continuous use. And it only came with higher dosages. The lower dosage of Vioxx didn't produce the problem even with extended use. Nonetheless, Vioxx was voluntarily withdrawn from the market, and no longer helps anyone. Bextra was also withdrawn, although its profile wasn't as good as the others anyway. Celebrex was also slammed, but the FDA has allowed it to be continued because the risk/benefit ratio is still favorable overall, as long as the patients are aware of the potential for added risk.

COX2-specific inhibitors do generally need to build up in the system to have their most useful effect (which is why you wouldn't take them with a headache: they have a delayed effect, needing a day or two of taking them to start achieving results). However, there could easily be a schedule that allows the drug to flush out of your system every so often, if higher and continuous doses are needed.

You should be aware that the jury is still out for many of the nonspecific NSAIDS as well. We may face the prospect of losing them as well:

From Merck (http://www.vioxx.com/rofecoxib/vioxx/consumer/index.jsp)

The U.S. Food and Drug Administration and Health Canada have concluded that an increased risk of serious thrombotic cardiovascular adverse events is associated with all COX 2 selective NSAIDs. In addition, these regulatory agencies concluded that, although long-term placebo-controlled data are not available for non-selective NSAIDS, the current data suggests that COX 2 selective NSAIDs and non-selective NSAIDs have similar cardiovascular risk profiles.

From the FDA (http://www.fda.gov/cder/drug/advisory/COX2.htm)

A number of non-selective NSAIDs (prescription and non-prescription (over-the-counter (OTC)) are approved for marketing in the United States....

Long-term controlled clinical trials have not been conducted with most of these NSAIDs. However, the available data suggest that use of these drugs may increase CV risk. It is very difficult to draw conclusions about the relative CV risk among the COX-2 selective and non-selective NSAIDs with the data available.

All sponsors of non-selective NSAIDs will be asked to conduct and submit to FDA a comprehensive review and analysis of available controlled clinical trial databases pertaining to their NSAID product(s) to which they have access to further evaluate the potential for increased CV risk.

Again, I'm not defending these drugs specifically. My concern is that they and others were useful to many people, and in a press-fed atmosphere of emotional backlash rather than reason, any value that these medicines might bring with altered administration profiles is destroyed and lost, like a downtown store being smashed and looted to no one's real gain.

Now, doctors are adding more medications for their patients with the drug-eluting stents, such as Plavix, which carry their own risks. Are these risks being balanced against the stent's risks, or is the use of these drugs just knee-jerk appeasement for their insurance companies? Are they responding to their patients' true needs, or to pacify public concern that has been fomented by the press?

We know that politicians, who have free access to expert opinions and massive amounts of study data, screw things up badly enough when they try to regulate things. So why should we trust a kangaroo court of half-informed reporters to do the same thing simply by manipulating public opinion? I've watched a number of reports on heart valve issues, and it becomes plain over time that the health news press frequently doesn't have a clue what they're talking about...

Best wishes,

 

[Nancy]

There is NO drug that doesn't have some kind of side effect, and in higher doses, any of them could cause much harm.

Joe has been on enough medicines in his long heart history, that I can see what happens quite graphically.

In addition to just normal side effects, people who are older or have compromised systems such as renal insufficiency, pulmonary problems, CHF etc, have to be very careful about any medicine building up in their systems. They may need a much lower dose than those with normal body clearances.

Most doctors will just start out someone like Joe on the normal dose, and then never check him out for unwanted problems. The best doctors are much more careful with a person like Joe.

Then there are the interactions that constantly have to be checked out, both with prescription and OTC drugs.

I just caught one the other day. Joe's doc prescribed Ranitidine for his stomach issues. That would have been OK. Medco prescription plan refused to pay for it and switched it to Cimetidine which is similar but has an interaction with Metoprolol that Ranitidine does not have. I had to argue with the pharmacist. I returned the pills and got my money back. All concerned should have known about the interaction. I found out about it, so why can't the professionals find out the same thing. The script is still up in the air until Monday.

Hype about many drugs is truly overblown, but I wonder about some of the bad press coming from some of the issues I've mentioned above.

Many here are on multiple meds. All need to check out everything they take thoroughly both scripts or OTC, even if you think your doctor or pharmacist has done it. Do it again yourself to be sure.

Some of Joe's worst side effects have come from interactions or too high a dose.

http://www.medscape.com/druginfo/druginterchecker?src=google

 

[Lisa in Katy]

On this same topic - several years ago I read about a study that linked childhood leukemia with hot dogs. The press of course had a field day with it. However, when you read more, the "study" seemed to be as follows - after interviewing several children with childhood leukemia, they found that all of these children loved and ate hot dogs. Therefore, there must be a link. Now I'm not saying that hot dogs are good for you, but I think that most of the problem comes from the total lack of nutritional substance. I remember something long ago about nitrates, but haven't heard anything lately.

And yet....cigarettes continue to be sold!

 

[tobagotwo]

You might be interested to note that the study that accuses aspirin of being link to Reyes Syndrome was done the same way. In the study, several things, including TV viewing, had much higher correlations with Reyes than aspirin.

Interesting followup on COX2 inhibitors. They may have found the problem. They do have an effect on at least one COX1 enzyme.

From the Imperial College, in London: http://www3.imperial.ac.uk/newsande...wssummary/news_28-11-2006-16-32-0?newsid=3001

The new study, by researchers from Imperial College London and Queen Mary's School of Medicine and Dentistry, reveals that although COX-2 inhibitors target only COX-2, they also inhibit the enzyme COX-1 within the endothelial cells that line all blood vessels.

COX-1 in these cells makes prostacyclin, which thins the blood. Where this is inhibited there is a greater chance of blood clotting, which, if the drugs are used regularly, may increase the risk of heart attacks and strokes.

Wouldn't it be a hoot if the safety requirement for Vioxx and Celebrex turned out to be that people who take it should also take a daily aspirin...

Best wishes,