July 23, 2012

NSAIDs -- "One of the Most Dangerous Classes of Drugs for Older People"

That quote above comes from Are Your Prescriptions Killing You?, Armon Neel's new book. In it, he devotes a chapter to NSAIDs, nonsteroidal anti-inflamatory drugs. Most of us have taken these drugs at one time or another. Many people take them every day.

Co-authored by AARP Bulletin consulting editor Bill Hogan, the book was published this month. I did a post last week on its warnings about statins, drugs widely used to control cholesterol. In that post, I detailed Neel's substantial credentials as an award-winning geriatric pharmacist.

NSAIDs are used to treat arthritis, joint pain, headaches, and other kinds of pain. They are available in both prescription and over-the-counter forms. The most common OTC NSAIDs are:
  • Aspirin with brand names like Bayer and Bufferin
  • Ibuprophen such as Advil and Motrin
  • Naproxen such as Aleve and Midol
But the NSAIDs list contains many other brand names. For the full catalogue, see http://www.nsaidslist.com/.

NSAIDs As "Phanthom Killers"
That quote is the title of Neel's chapter on NSAIDs. Here's how he summarizes the risk:
The main problem with NSAIDs are that they increase gastrointestinal irritation (which can lead to erosion of the protective lining of the stomach), assist in the formation of GI bleeds, and decrease the cohesive properties of platelets that are needed to form blood clots. What's more, the regular use of NSAIDs can cause cardiovascular disease.
More than 14 million Americans with arthritic conditions use NSAIDs on a regular basis, Neel says. Studies show that up to 60 percent of them will experience adverse gastrointestinal effects as a result of taking NSAIDs, and more than 10 percent of them will stop taking the pills because of troublesome GI symptoms.

Based on those numbers, Neel estimates "you've got at least 8.4 million people who experience adverse GI effects from the drugs and at least 1.4 million who just stop taking them because of those effects."`

Neal cites one study which found that 71 percent of the subjects who used NSAIDs had an injury in their small intestines, compared with five percent of those who didn't use NSAIDs. He also says the latest studies show that all NSAIDs can increase blood pressure and stroke risk.

NSAIDs account for 43 percent of all drug-related emergency room visits, and many of those visits are avoidable, according to Neel. A 2001 study estimated that 42 percent of emergency rooms visits were precipitated by NSAIDs prescribed unnecessarily.

The risk of GI complications from NSAIDs is compounded, Neel says, when the drug is used together with alcohol or corticosteroids or anticoagulants.

Older People At Greater Risk
The risk from NSAIDs goes up with age, with dose, and with duration of treatment. Neel warns:
So if you are an older person who's been taking NSAIDs for a while -- or you've been taking pain medications without knowing whether or not they're NSAIDs -- you'd do well to take stock of your NSAID use right away.
Older people tend to take pain medications more often or in larger doses, and often in combination with other powerful drugs. But, Neel says, because older people are more likely to have reduced liver and kidney function, they should take NSAIDs in lower doses than younger people, if they take them at all.

As he was finishing the book, Neel turned on the TV and saw a new Advil commercial featuring Regis Philbin, the 80-year-old TV personality. At first, Neel didn't notice the small line of type in the commercial that warned, "Ask a doctor if you are age 60 or over."

Neel says he's sure Advil manufacturer Pfizer intended the caution to go unnoticed and that -- by featuring Regis and his 70-year-old wife, Joy -- the drug company was "aiming squarely for an older target market that it knows, with certainty, is the most susceptible of being harmed by its product."

Alternatives to NSAIDS
Neels says the use of NSAIDs "places the patient at a high risk for serious problems, when a general analgesic, such as acetaminophen, would have done the job just fine." And that's exactly what I occasionally take for arthritic lower back pain -- CVS's "Arthritis Pain Relief," basically 650mg of acetaminophen.

I know from my own research that this drug creates its own problems, so I use it cautiously. Researchers in the UK reported last November that people who take more than the recommended dosage of Tylenol or other acetaminophen products for even a few days may risk fatal liver damage.

Overdosing may be done deliberately in attempting to relieve pain.  But for us oldsters it may result from forgetfulness.

While acetaminophen can reduce pain, it doesn't reduce inflammation, as NSAIDs can.

1 comment:

Linda F said...

thanks for the detailed warning, John.