03 June 2006

Painkillers and Heart Attacks

Common painkillers such as ibuprofen and diclofenac can double the risk of heart attack, according to a new study. The increased risk only occurs with high doses and leads to attacks in an extra three people per thousand compared with those not taking the drugs.

Colin Baigent, an epidemiologist at Oxford University, who led the research, said people should not be unduly panicked by the findings, which relate to the highest doses given by doctors in extreme cases. "The rate is three heart attacks in every 1,000 patients treated for a year," he said. "For a person who is unable to move unless they take these drugs, they may be willing to accept that risk if [the drug] is giving them back their life."

[Guardian, 02 June 2006]

Ever since Vioxx was banned in 2004 because of studies showing that patients taking the drug were more than twice as likely to have heart attacks, there has been much concern about other painkillers in the market.

The recent study above, published in full in BMJ's current issue, is a meta-analysis that includes analysis of results of 138 separate trials which compared cox-2 inhibitor drugs with a placebo or a cox-2 inhibitor with traditional non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and ibuprofen.

For the brand-conscious: Diclofenac is marketed locally under several brand names, the most notable are Cataflam, Acuflam, Dycon SR, Lofenax, and Voltaren. Ibuprofen, on the other hand, is easily recognized as Advil, Alaxan, Medicol, Midol, and Skelan.

Should you be scared when taking these painkillers? Being scared won't help you a bit, but being cautious can be beneficial. My advice is for you to take note of these essential points:
  1. 3 heart attacks in every 1,000 patients treated for a year - that was the established rate in the study; I would say that the occurrence can still be qualified as rare.

  2. The increased risk was associated with high doses - Dr Baigent said a high dose was considered to be "about twice what the normal person would take." If you are taking any of these painkillers for your headache or an occasional muscular pain, you need not worry.

  3. Arm yourself with common sense - if your pain is too great, and you are already unable to perform your daily tasks, it might be prudent to accept the (small) risk if that means relief and getting back to what you used to do. If you are still in doubt, consult your physician.

  4. Naproxen - of all the painkillers studied, naproxen carried the least risk. If you have a choice, you might opt to go for this drug. Ask your doctor if that's ok.

8 reactions:

ipanema said...


Sensible advice.

My concerns are those of over-the-counter painkillers. Some reach for it everytime they feel pain. Others develop an addiction for painkillers and these form a large part of undocumented cases. Some are not even aware of risks such as what the article mentioned.

My only experience with painkillers was during my back pain complaints. I was given different kinds, depends on which hospital I go to. Moreover, it was difficult when efficacy of painkillers are over, it was excruciating pain from my waist down. My x-rays were negative. But the last hospital I went to ordered an MRI where my herniated disc was now visible for my doctor to recommend an operation.

bayibhyap said...

What about asprin? It's a painkiller too, isn't it? And it helps to dilute blood to some extent to avoid strokes.

Dr. Emer said...

IPANEMA: Sensible advice work only for sensible people, said my friend once. *LOL* Diclofenac and Ibuprofen are sold OTC here, and yes, I do agree that some people tend to overuse them sometimes even for minor aches.

BAYI: Hello there! Aspirin was not specifically mentioned in the study. The concern on painkillers is mostly on the cox-2 types, and diclofenac and ibuprofen as in the study mentioned. I think aspirin is the oldest painkiller around, and yes, it is well-known for its blood-diluting properties... but like the other new painkillers, care and caution should be taken to prevent its misuse. Your doctor would know best what the right dosage should be on a case-to-case basis.

ipanema said...

lol doc. Well, when one is in pain, no one thinks about being sensible anyway, and that moment popping pills would be the most sensible thing to do. :)

Dr. Emer said...

.....until one heart attack occurs and they find out there's a connection with painkiller intake, huh? That's the trouble with short-term solutions --- wisdom is always hindsight. :)

ipanema said...

Usually, how long does it take for FDA to recall, for these are definitely hazardous. Or does our Dept. of Health can do this locally? Am not so sure about laws on this. Who's the right agency? I only know one.

Dr. Emer said...

FDA will recall if there is significant evidence of harm, as proven by studies and investigations. This was the case with Vioxx. The most recent recall I think is Renu, which I also posted weeks ago.

Here? Gaya-gaya lang dito sa atin. If they recall it in the US, they will recall it here. BFAD does it for DOH. Logistics-wise, I don't think they have enough resources and manpower to really conduct a nationwide drug investigation.

ipanema said...

They will wait until someone dies out of complication. I read something on post market effect regarding products which are already out. Some of these are untested, how bad it can be. FDA claimed there are probably thousands out there (this news is lost somewhere in my feeds, can't link, try to track it). As consumers we don't know if everything is safe. Unless a study is made, people will blindly take these medicines.