By: Dr. Geoffrey Modest
The FDA recently reinforced their existing warning label on the use of non-aspirin NSAIDs and the increased chance of heart attack or stroke (this warning is already on the over-the-counter ones). Their comments:
–the risk of heart attack or stroke can occur within the first weeks of taking NSAIDs
–the risk is greater with higher doses
–although they acknowledge that newer information suggests some differences in NSAID risk, they do not feel it is sufficient to attribute either higher or lower risk to any individual agent
–the increased heart attack/stroke risk is not limited to those with known heart disease or increased risk factors form heart disease, though since their absolute risk is higher in general, they have greater risk of NSAID-induced heart attack or stroke
–those with known heart disease or risk factors are even more likely to die of a heart attack or stroke in the first year after their heart attack
–there is increased risk of heart failure with NSAIDs]
Those of you who have been reading these blogs for awhile know that I have real concerns about the overuse of a couple of drug classes in particular: PPIs and NSAIDs. This link goes through some of the details from a Danish study — see here and includes some of the data suggesting that there are significant differences between the different NSAIDs. Though I use them quite sparingly, I think the data supporting naproxen over the others is pretty good. However, a large impetus to my doing lots of steroid injections, especially in the elderly, is to spare using systemic NSAIDs (this includes not just joint injections for OA, gout, pauciarticular RA, tendinitis, but I have also had great outcomes at time from injecting discrete back muscle spasms). I also use more topical drugs (topical capsaicin, diclofenac, lidocaine).
See here for the latest blog on PPIs.