Vioxx & COX 2 Inhibitors: It's Not Clots

[tobagotwo]

COX2 inhibitors, like Vioxx, Bextra, and others interfere with the production of prostaglandins. Generally a good thing, short-term; reducing fever, swelling, and body aches.

However, there's a catch. According to research by Winthrop University hospital researchers in NY, published in the Arthritis Research and Therapy Journal, prostaglandins have yet another function: they remove cholesterol from the body's cells, including skin and blood cells. This falls in line with the research that didn't show the same negative cardiovascular effects with the lower dosages of Vioxx:

http://www.winthrop.org/newsroom/press/release.cfm?id=297

The research appears to show that the controversial "clot" theory, where NSAIDs "somehow" encouraged clot formation, seemed faulty and weak, and the actual mechanism is more likely to be associated with the retention of lipids in the body's cells, caused by the greater antiprostaglandin effects of higher doses of the COX2 inhibitors.

Best wishes,

 

[Susan BAV]

...The research appears to show that the controversial "clot" theory, where NSAIDs "somehow" encouraged clot formation, seemed faulty and weak, and the actual mechanism is more likely to be associated with the retention of lipids in the body's cells, caused by the greater antiprostaglandin effects of higher doses of the COX2 inhibitors...

So what does this mean for the theory that NSAIDS like Tylenol and Advil can be contraindicated for those on aspirin therapy? My mind is on "slow" today.

 

[tobagotwo]

Aspirin is an NSAID. Tylenol is not.

The NSAIDs warning is probably predicated on stomach irritation and possible bleeding, basically entreating people not to mix NSAIDs without considering overall dosage. (NSAID = Non-Steroidal Anti-Inflammatory Drug.) Most NSAIDS work by inhibiting Cyclooxygenase (COX) enzyme activity, which affects prostaglandins. This reduces swelling and pain. NSAIDs include common drugs like aspirin, ibuprofen, and Naproxen sodium, as well as the more heavy-duty hitters, such as Vioxx, Bextra, Celebrex, and other anti-arthritic drugs.

Of the NSAIDs, naproxen sodium (Aleve) is usually considered the mildest on the stomach (and is thus sometimes acceptable for use wiht Coumadin ACT), but most versions of naproxens do contain sodium (concern for those who have severe hypertension). NSAIDs can also slow down the secretion of sodium and lithium from the body, and can have an anticoagulative effect that will not register in INR readings.

Tylenol can be mixed with aspirin in moderation. Extra-Strength Excedrin is a blend of aspirin, acetaminophen (Tylenol's active ingredient) and caffeine.

Going over dosage is not a good idea. Acetaminophen is an extremely safe drug with very few drug interactions when taken at the recommended dosages, but can destroy your liver or be deadly when too much is taken at once, or over time with excessive alcohol.

Best wishes,

 

[Susan BAV]

I'm going to have to try to find what I think I read about this all. I thought somewhere I had read that when you're on aspirin therapy, taking Tylenol and Advil can interfere with the thinning/anti-coagulation properties. Thanks, Bob.

 

[tobagotwo]

Tylenol has been said to reduce the platelet-lubricating properties of aspirin. However, when Tylenol is used occasionally for a headache, or for a few days for a fever, the effect isn't that much overall. In some instances, other NSAIDs can also conflict with aspirin's anticoagulative effects. However, the reduction is temporary and incomplete.

Standard Advil is ibuprofen, which is an NSAID. It can be mixed with the daily baby aspirin dose (81mg) for occasional use, but shouldn't be mixed with full doses of aspirin or other NSAIDS. I don't know how well or whether ibuprofen and acetaminophen get along. If they did, I imagine someone would have marketed it by now.

NSAIDs are best taken with food, to reduce the chance of stoomach upset.

Best wishes,

 

[Susan BAV]

...I don't know how well or whether ibuprofen and acetaminophen get along...

I have also read [somewhere] that those two do not get along. Seems like it might have been related to some organ toxicity or something, but I'm not sure. Thanks again.

 

[Susan BAV]

I have also read [somewhere] that those two do not get along. Seems like it might have been related to some organ toxicity or something, but I'm not sure. Thanks again.

I did a really quick web search. There was a bit of conflicting advice on it and mostly older information. But there also was a good reminder for patients to check with their pharmacists about possible interactions; they're on the ball and that's always a good idea.

Reminds me that many years ago I read in Dear Abbey that some antibiotics interfere with oral contraceptives. Shortly thereafter, I went to a family doctor with a sinus infection. He prescribed an antibiotic and I asked him about what I had read in Dear Abbey. He was pretty bumptious in his rude reply and dismissed the old wive's tale. I checked with the pharmacist and he politely and intelligently offered me the same warning as I had read in the Dear Abbey column; the antibiotic I had been prescribed was the very one that was the worst offender!

Fast forward to several months later when I was back in to see that family doctor with another sinus infection. Interestingly, during that visit when he also prescibed the same antibiotic, he gave me a fairly arrogant dissertation on how some antibiotics interfere with oral contraceptives... I think I'd heard that somewhere before...

Bottom line -- check with your pharmacist.

 

[PJmomrunner]

I don't know how well or whether ibuprofen and acetaminophen get along

I've been told they actually do get along. Since ibuprofen is processed through the kidneys and acetaminophen is processed through the liver they can be taken together. I was told this recently by a general surgeon who prescribed Darvocet-N (which contains acetaminophen) for one of my teenagers because she wanted us to be able to double up if we felt we needed more anti-inflammatory help. My kids' pediatrician when they were little also used to tell us to use one in between doses of the other so that the kids were getting an anti-inflammatory every 3 hours instead of every 6. I didn't know until recently about the liver/kidney thing. Maybe Al will confirm this?