As doctors and patients grow increasingly leery of the safety of prescription pain relievers and look for alternatives, experts say they need to bear in mind the downside of taking cheaper, over-the-counter medications.
People in pain who are concerned about the safety of drugs such as the Cox-2 inhibitors Vioxx, Bextra and Celebrex should not begin to gulp down aspirin and ibuprofen, which cause tens of thousands of deaths and hospitalizations annually from gastrointestinal complications, they say.
"We need to remember why Cox-2 inhibitors were invented in the first place," said Dr. Jay Goldstein, a professor of medicine at the University of Illinois at Chicago and a national expert on nonsteroidal anti-inflammatory drugs, or NSAIDs.
The story of Cox-2 inhibitors, which were designed to minimize stomach ailments caused by most pain relievers but have recently been implicated in the development of heart disease, is a reminder that all drugs carry risks.
NSAIDs are the most widely used family of drugs in the United States. They are effective at reducing mild pain, and one - aspirin - has been shown to help prevent heart disease. The drugs are generally safe, but all have a known side effect: They increase the risk of gastrointestinal bleeding.
People who regularly take traditional NSAIDs have about three times the risk of developing bleeding ulcers as people who don't take the drugs. By one estimate, 16,000 Americans die and 100,000 are hospitalized each year because of gastrointestinal bleeding caused by NSAIDs.
A decade ago, before the advent of Cox-2 inhibitors, the leading cause of death in women older than 65 in the United Kingdom was bleeding from aspirin-related ulcers, said Dr. Joel Levine, director of the colon cancer center at the University of Connecticut Health Center.
The risks of gastrointestinal problems among NSAID users are highest for people older than 65, people who have a history of ulcers, those who take the drugs in high doses, and people who take anti-coagulants or steroids such as prednisone.
Those problems spurred drug companies to develop Cox-2 inhibitors in the 1990s. They found that by selectively blocking the enzyme Cox-2, which is associated with inflammation, they could retain the pain relief of NSAIDs and reduce the risk of bleeding.
The new drugs cut the rate of gastrointestinal problems caused by pain relievers in half. But in the past three months, it has been reported that Cox-2 inhibitors and naproxen - which is sold in prescription form and over-the-counter as Aleve - may increase the risk of heart attacks and strokes. And that has many people rethinking pain-relief strategies.
One alternative is acetaminophen (Tylenol). Acetaminophen is not as good at relieving pain, doctors say, but it does not cause the gastrointestinal problems that NSAIDs do.
The Hartford Courant is a Tribune Publishing newspaper.