New Ibuprofen warning

[Telly]

I picked up a 2-pack of generic Ibuprofen. The box had been redesigned, and prominently displayed in one corner it says "See New Warnings Information".

Comparing the new box to the old, there is a lot more detail. But one new warning caught my eye, I hadn't seen nor heard it before:

"When using this product - Long term continuous use may increase the risk of heart attack or stroke".

That is news to me! I missed something somewhere. What is the mechanism for that ?

 

[Nords]

"When using this product - Long term continuous use may increase the risk of heart attack or stroke".
That is news to me! I missed something somewhere. What is the mechanism for that ?

I think it's a blood thinner. Maybe there's concern that it'll break something loose in your arteries that would have been happily stuck to the wall if you hadn't hit it with ibuprofen.

I've taken 800 mg 3x/day for three months (orthopedic surgeon's advice) with no detectable side effects. Admittedly I took it after a meal with lots of water. I wonder what they consider long-term continuous use?

 

[Patrick]

I think it's a blood thinner. Maybe there's concern that it'll break something loose in your arteries that would have been happily stuck to the wall if you hadn't hit it with ibuprofen.

I've taken 800 mg 3x/day for three months (orthopedic surgeon's advice) with no detectable side effects. Admittedly I took it after a meal with lots of water. I wonder what they consider long-term continuous use?

Interesting. Blood thinners are what they give you after you've had a heart attack or stroke to open up the clog and get the blood flowing again. Don't see how that could cause a heart attack or stroke.

800 mg is a typical prescription dose of Ibuprofen. The recommended dosage on the OTC packages is one or two 200 mg tablets, so that's way under the prescription amount.

 

[eridanus]

Uh oh!

http://www.timesonline.co.uk/article/0,,8122-2207663,00.html

"Analysis of all trials revealing a vascular event linked to the use of painkillers has shown that high doses of two non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen and diclofenac, could cause attacks."

 

[Patrick]

Uh oh!

http://www.timesonline.co.uk/article/0,,8122-2207663,00.html

"Analysis of all trials revealing a vascular event linked to the use of painkillers has shown that high doses of two non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen and diclofenac, could cause attacks."

But "He said that people should not panic at the findings as the heart attack rate was small and related only to patients who took “about twice what the normal person would take”. Some patients are on high doses with their doctor’s approval.

“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. People who are popping these for the odd headache, the risks to them are minimal.”

 

[Rich_by_the_Bay]

Ibuprofen is of the same general group as Vioxx (an NSAID). A subset of NSAIDs called "COX 2 inhibitors" including Vioxx and Celebrex was recently withdrawn or restricted based on a heart attack risk: 1.5 per 100 "person-years" compared to .78 for patients not taking Vioxx (that is, a doubling of the risk, albeit quite small in both groups). This means that you would have to treat 139 people for 100 years to generate one additional heart attack or stroke from taking Vioxx.

While the mechanism of the risk is not known, theory is that they predispose to injury or excessive clot formation of the lining of the blood vessels (ironic since they inhibit platelets, but that is through an unrelated mechanism). The coronary and cerebral vessels are often among the most sensitive to this type of injury.

Not surprisingly a similar effect is now being identified in other NSAIDs, including ibuprofen. In fact, the British Medical Journal report cited elsewhere is actually a metaanalysis rather than a new study, and concluded that the increased risk of heart attack from ibuprofen is 1 patient out of 333 patients treated for a year.

I believe this effect is real. For any individual, it is quite small. If I had a very high risk profile in general, I would probably confine my use of these medications to short intervals. I might also consider less effective but probably safer alternatives like acetaminophen, depending on the severity of my symptoms.

If I decided to continue with high dose NSAIDs, I'd be comfortable that the very small absolute risk to me is clearly justified by the advantages, and I'd take extra good care of my weight, exercise, tobacco use, cholesterol, blood pressure, etc.

<CYA>Of course, check with your own doctor to determine the right decision for you.</CYA>

 

[dumpster56]

Geeesh, when I had my bout with pericarditis I was taking 1600 mgs a day for three weeks then tapered down over the next 5 weeks. Pericarditis was a viral infection of the pericardium around my heart. Gotta say that night having the cardiac cath and two days in ICU was a bummer, however I got to see 5 years ago that at the age of 45 my arteries were clear no blockages! I guess running 10 miles a day for 30+ years helps.

Anyway I still take the blue advil liqua gels after my long runs and I call them my blue M&ms!!

Kinda hooked on them pain pills!!

But then again good scotch over rules the advils!

 

[Patrick]

I might also consider less effective but probably safer alternatives like acetaminophen, depending on the severity of my symptoms.

Isn't acetaminophen bad for your liver?

 

[dumpster56]

Isn't acetaminophen bad for your liver?

Yes when you combine alcohol. If you take it over a long period of time yes there can be toxicity, the problem with taking tylenol for me is the pain stems from inflammation which acetominophen does nothing.

<img border="0" src="http://tickers.TickerFactory.com/ezt/d/4;10707;0/st/20061222/e/To+ER/k/f821/event.png"></a>

 

[Rich_by_the_Bay]

Isn't acetaminophen bad for your liver?

Yes, if you take too much. For osteoarthritis of the knees it works as well as NSAIDs.

 

[BarbaraAnne]

Rich,

What about extra-strength Excedrin(aspirin, acetaminophen,caffeine)? I have been taking it for quite awhile for the arthritis in my knees and hips (sports injuries in my youth). I sometimes worry about the long term use. I take 2 tablets twice a day. It seems that once you take Excedrin, nothing else works.

Thanks...

 

[Rich_by_the_Bay]

What about extra-strength Excedrin(aspirin, acetaminophen,caffeine)? I have been taking it for quite awhile for the arthritis in my knees and hips (sports injuries in my youth). I sometimes worry about the long term use. I take 2 tablets twice a day. It seems that once you take Excedrin, nothing else works.

Excedrin and the older Anacin are odd birds. It seems that caffeine, in addition to amplifying pain relievers a tiny bit (at least for headaches), essentially has a withdrawal syndrome which includes, suprise surprise.. headache. Think weekend morning headache after 5 days of 3+ caffeinated drinks a day during the work week.

So folks would get a tension headache, start taking Excedrin or Anacin for a while, and when they would stop or cut back, they would get a caffeine withdrawal headache. What did they then do? Took more Excedrin. In some cases, the original headache was from caffeine withdrawal (coffee, cola, etc.)!

Can't argue with success in any individual case, but for routine osteoarthritis plain acetaminophen, ibuprofen, aspirin (if you have no risks for its side effects) all work about the same, some preferring one or the other. Not sure what the logic of combining aspirin, caffeine, and acetaminophen is other than the above. Long term use of even low dose aspirin is clearly if not frequently a cause of digestive bleeding (gastritis). Ibuprofen is much less likely to cause that, and acetaminophen not at all.

 

[Khan]

Excedrin and the older Anacin are odd birds. It seems that caffeine, in addition to amplifying pain relievers a tiny bit (at least for headaches), essentially has a withdrawal syndrome which includes, suprise surprise.. headache. Think weekend morning headache after 5 days of 3+ caffeinated drinks a day during the work week.

So folks would get a tension headache, start taking Excedrin or Anacin for a while, and when they would stop or cut back, they would get a caffeine withdrawal headache. What did they then do? Took more Excedrin. In some cases, the original headache was from caffeine withdrawal (coffee, cola, etc.)!

Can't argue with success in any individual case, but for routine osteoarthritis plain acetaminophen, ibuprofen, aspirin (if you have no risks for its side effects) all work about the same, some preferring one or the other. Not sure what the logic of combining aspirin, caffeine, and acetaminophen is other than the above. Long term use of even low dose aspirin is clearly if not frequently a cause of digestive bleeding (gastritis). Ibuprofen is much less likely to cause that, and acetaminophen not at all.

I was in that headache/Excedrin feedback loop many years ago.

BTW, I find my arthritis pain has for the most part gone away since retirement.

 

[Telly]

Thanks for all the info. I missed the latest Ibuprofen story when it was out.

I avoid Acetaminophen. It just never worked for me. Also concerned that the overdose amount is not that far from the usual dose. It didn't start out that way, heard that much later after liver damage reports came in.

Anacin has always worked the best for headaches for me. Better than plain aspirin. I have also found out, at least for me, that I need to eat something after taking Anacin or Ibuprofen for a headache. It doesn't need to be much, just something to eat. If I don't, it won't work. And if I just try eating something, no pain reliever, that doesn't work, either. Your headache may vary

 

[Nords]

I have also found out, at least for me, that I need to eat something after taking Anacin or Ibuprofen for a headache. It doesn't need to be much, just something to eat. If I don't, it won't work. And if I just try eating something, no pain reliever, that doesn't work, either. Your headache may vary

If that headache was caused by dehydration, a big glass of water might work better than food & painkillers...

... but the food keeps the ibuprofen from chewing away at your stomach lining too much.