I remember working in retail pharmacy in the 1980s and 1990s when NSAIDs were all the rage. This class of drugs was one of the most commonly prescribed. As the years went on, we all became aware of the problems associated with this class of drugs. The first problem that became obvious was that patients who used these drugs on a regular basis were developing gastric ulcers and GI bleeding. For that reason, it was advised that these medications be taken with food. One company even developed an NSAID product that contained an additional drug that was purported to protect the lining of the GI tract from injury.
After this era, a new sub-class of these drugs--known as "COX-2" inhibitors came onto the US marketplace. This class of drugs possesses all the benefits of the original NSAID drugs--but did not have the GI side effects of the original NSAID drugs. Three COX-2 Inhibitors (Bextra®, Vioxx®, and Celebrex®) were launched in the US market in the late 1990s-early 2000s. A few years later, Bextra® and Vioxx® were quickly removed from the market due to increased risk of cardiovascular events.
At this time, only Celebrex® remains on the US market, even though this product has the same issues as its other two class mates. The prescribing information for this product contains "black box warnings" for risk of GI bleeding and risk of severe cardiovascular and thrombotic events.
Last month, the results of study known as "The Safety of NonSteroidal Anti-Inflammatory Drugs" (aka SOS) was published in the BMJ, a British Medical Journal. The study involved over 92,000 patients across Europe and was conducted over a ten year period. The conclusion of the study (you can read more here) was that use of NSAIDs is associated with an increased risk of hospitalization for heart failure. The odds of this happening were dependent on which NSAID was used and were also dose-dependent. Interestingly, Celebrex® (celecoxib) was associated with a lower risk than the original NSAIDS in the study. The results of this study are going to be reported at the American Heart Association meeting this November.
The NSAIDs are a very powerful and very useful class of medications. But one must also consider the risk to benefit ratio when using these drugs. As always, less is more!
Sources: MedPageToday;Robin S. Kaplan; Cnn Money; Epocrates; Wikipedia; Wikimedia
After this era, a new sub-class of these drugs--known as "COX-2" inhibitors came onto the US marketplace. This class of drugs possesses all the benefits of the original NSAID drugs--but did not have the GI side effects of the original NSAID drugs. Three COX-2 Inhibitors (Bextra®, Vioxx®, and Celebrex®) were launched in the US market in the late 1990s-early 2000s. A few years later, Bextra® and Vioxx® were quickly removed from the market due to increased risk of cardiovascular events.
At this time, only Celebrex® remains on the US market, even though this product has the same issues as its other two class mates. The prescribing information for this product contains "black box warnings" for risk of GI bleeding and risk of severe cardiovascular and thrombotic events.
Last month, the results of study known as "The Safety of NonSteroidal Anti-Inflammatory Drugs" (aka SOS) was published in the BMJ, a British Medical Journal. The study involved over 92,000 patients across Europe and was conducted over a ten year period. The conclusion of the study (you can read more here) was that use of NSAIDs is associated with an increased risk of hospitalization for heart failure. The odds of this happening were dependent on which NSAID was used and were also dose-dependent. Interestingly, Celebrex® (celecoxib) was associated with a lower risk than the original NSAIDS in the study. The results of this study are going to be reported at the American Heart Association meeting this November.
The NSAIDs are a very powerful and very useful class of medications. But one must also consider the risk to benefit ratio when using these drugs. As always, less is more!
Sources: MedPageToday;Robin S. Kaplan; Cnn Money; Epocrates; Wikipedia; Wikimedia
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