NSAID Dangers

The latest news from the European Society of Cardiology (ESC) 2010 Congress points out that some of our most popular over-the-counter drugs are not abiding by the  principle of “Primum non nocere” – first do no harm.  They are, in fact, causing stroke and heart attacks!

I’m referring to the nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), Voltaren (diclofenac), and others.  It turns out these popular drugs are silently killing us and we need to raise the alarm bell while offering a better alternative.

Well known side effects of NSAIDs include gastritis or stomach ulcers, high blood pressure or kidney damage.  About once every year we have a patient nearly die from a bleeding ulcer caused by the normal use of an NSAID!  What will it take until we stop recommending these dangerous medications?  Perhaps the latest salvo from the medical literature will finally bring much needed attention to the side effects of these popular drugs.

Presenting a study at last week’s European Society of Cardiology (ESC) 2010 Congress, Dr Gunnar Gislason (Gentofte University Hospital, Hellerup, Denmark) said the results could have “massive public-health implications” noting that the short-term use of NSAIDs was associated with an increased risk of stroke in a Danish population study including only healthy individuals.

“First we found an increased risk of heart attack with NSAIDs.  Now we are finding the same thing for stroke.  This is very serious, as these drugs are very widely used, with many available over the counter.  We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully.”

Co chair of the session at which the study was presented, Dr Robert Califf (Duke Clinical Research Institute, Durham, NC), agreed that the results raised a major public-health issue, especially in the US, where many NSAIDs were available without a prescription.

Results showed that NSAID use was associated with an increased risk of stroke, ranging from about 30% with ibuprofen and naproxen to 86% with diclofenac.

Dr Gislason believes the harmful effects of these agents are relevant to huge numbers of people.  “If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk.  It is an enormous effect.”

Another study, published in the January 26, 2009 issue of the Archives of Internal Medicine, shows dose-related increases in risk of death and rehospitalization for heart failure or heart attack with all NSAIDs.

Remember Vioxx (rofecoxib), the arthritis drug made by Merck?  According to the British medical journal, The Lancet, the actions of both Merck and the US Food and Drug Administration (FDA) contributed to the nearly 30,000 excess cases of heart attacks and sudden cardiac deaths that resulted from the use of the drug between 1999 and 2003. While Merck sought to cover up the danger of its own drug to protect its bottom line, the US government aided the company by approving sale of the drug without conducting any serious investigation into potential harmful consequences of its use.

More frightening, a large randomized trial, publicly identified as a safety study for Vioxx, was designed and carried out specifically to promote the drug to primary-care physicians with the intent of expanding its sales, conclude researchers, on the basis of an analysis of internal company documents.  According to the authors, led by Dr Kevin P Hill (McLean Hospital, Belmont, MA), their analysis shows that the Assessment of Differences Between Vioxx and Naproxen to Ascertain Gastrointestinal Tolerability and Effectiveness (ADVANTAGE) trial was a “seeding” trial, designed to seed the field of potential prescribers with positive Vioxx experiences and enhance their goodwill toward the company as the FDA’s review of the drug was under way.  Further, they note, the company kept its intended purpose for the trial secret from institutional review boards and participating physicians and patients.

Given the risks of NSAIDs what’s one to do when they need something to combat inflammation?  There are plenty of options that are quite effective and much safer.  First, start with diet.  Eliminate foods that cause inflammation, such as sugar and saturated fats.  Add foods that lower inflammation, such as fresh fruits and vegetables.

Omega-3 oils (think fish oil, flaxseed) are anti-inflammatory and help stop the inflammation caused by omega-6 oils (think red meat, dairy).  I recommend at least 2000mg daily of omega-3 oils, either in our diet or with supplements.

Many herbs work just like the NSAIDs to block the enzymes that fuel inflammation.  Some of the best are turmeric, boswellia and devil’s claw.  I recommend a product called Zyflamend which has 8 phytonutrients that combat inflammation, including Holy Basil, turmeric, ginger, green tea, rosemary, oregano, and more.

Pycnogel (from the French maritime pine) has a huge amount of science showing its remarkable anti-inflammatory properties, and just last year it was shown to be one of the few compounds that actually slow the progression of arthritis.  Sulfur donating compound such as glucosamine sulfate and MSM work well.

Systemic enzyme therapy is another super anti-inflammatory treatment, using enzymes that are formulated to be absorbed into the bloodstream where they activate proteins called macroglobulins, turning them into dynamos that mop up inflammatory chemicals.  Wobenzym is a famous brand of systemic enzyme that has been used by millions of people in Europe, with a successful record for over 40 years.

For acute inflammation, such as a sprained ankle or an overused muscle, don’t forget ice.  The cooling effect of ice will do more to reduce pain and swelling than most any medication.  Use ice for about 15 minutes every hour and keep a cloth between it and the skin to prevent it from causing frostbite!

One of my favorite songs is Bob Dylan’s “Don’t Think Twice Its Alright”.  In the case of modern pharmaceuticals I would encourage you to shed Bob’s advice and do think twice before taking common medications that might not be alright.


Author

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).   Call (970) 245-6911 for an appointment or more information.

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