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YOU AND A: ARTHRITIS DRUGS; Pain and Confusion
[FINAL Edition]
The Washington Post - Washington, D.C.
Subjects: Health hazards; Product safety; Prescription drugs; Arthritis
Author: Francesca Lunzer Kritz
Date: Sep 4, 2001
Start Page: F.01
Section: HEALTH TAB

Well, no. To some experts, they suggest reason for concern. One study showed twice as high a rate of cardiovascular events for people taking Vioxx as for those who took naproxen, another pain reliever. However, the absolute incidence was low: 1.3 percent for the Vioxx group versus 0.67 for those taking naproxen. What isn't clear is whether Vioxx increased risk by causing blood platelets to clump together and thereby promoting a clot, or whether naproxen protected some people from heart attacks by keeping platelets from clumping together.

A second study compared Celebrex to two other drugs commonly prescribed for arthritis: ibuprofen and diclofenac (Cataflam and Voltaren). Researchers found more heart attacks in the Celebrex group than other groups, according to Eric Topol, the study's lead author and chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, although he said the difference was not statistically significant. However, some patients in this study also took aspirin, which can protect the heart from clots and heart attacks. The other two studies compared Vioxx with other arthritis drugs, and also included some aspirin-takers. Taken together, says Topol, the four trials consistently showed a small excess of cardiac events among the patients taking Vioxx or Celebrex.

If Celebrex or Vioxx gave you relief, chances are good your doctor will simply try another NSAID, such as aspirin, ibuprofen or nabumetone (Relafen). [John Klippel] noted that while NSAIDs are chemically similar, people respond differently to them, so that if one doesn't work for you, another might. Some doctors prescribe misoprostol (Cytotec), a synthetic prostaglandin, along with NSAIDs to replace stomach-protecting enzymes that NSAIDs wipe out. A fairly new drug, Arthotec, combines diclofenac, an NSAID, and misoprostol in a single pill. A simple pain reliever such as acetaminophen (Tylenol), which doesn't have the gastrointestinal side effects of NSAIDs, may work fine for some patients but for others may not provide sufficient relief.

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