Bayer is running "advertisements...that claim the product reduces men's risk of prostate cancer." Bayer's radio and TV ads falsely claim that selenium, an ingredient of One-A-Day Men's Health Formula and 50+ Advantage, helps prevent prostate cancer."
The National Institutes of Health" "found no evidence the ingredient selenium prevents prostate cancer in men." "The largest prostate cancer prevention trial has found that selenium is no more effective than a placebo," and Bayer therefore "is ripping people off when it suggests otherwise in these dishonest ads." The study was "halted...last October after it became clear that selenium did not prevent prostate cancer."
A complaint has already been filed with the Federal Trade Commission."
Back in 2007, the FTC "ordered Bayer to stop making unproven health claims for a One-A-Day weight loss product and told the company not to make any unsubstantiated claims for any vitamins in the One-A-Day product line." The recent complaint to the FTC urges the commission to "take swift and strong action to get these deceptive Bayer ads off television, radio, and Internet and out of newspapers and magazines or wherever else they may be displayed."
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
*Tune in later for GETTING YOUR MEDICAL TEST RESULTS IS ALWAYS YOUR RESPONSIBILITY
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Showing posts with label aspirin. Show all posts
Showing posts with label aspirin. Show all posts
Friday, August 28, 2009
Sunday, August 2, 2009
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Sunday, July 12, 2009
Part II of II: SHOULD EVERYONE TAKE ASA?
PART II OF II DETRIMENTAL EFFECTS OF ASPIRIN
SHOULD EVERYONE TAKE ASA?
Aspirin and other platelet aggregation inhibitors may increase the likelihood of asymptomatic cerebral microbleeds among older adults. Microbleeding has gained recognition over the past decade as a marker of small-vessel disease in the brain.
The analysis involved 1,062 participants in the longitudinal, population-based Rotterdam Scan Study, all age 60 or older and free of dementia. They underwent MRI over a period of roughly one year to assess the presence and location of microbleeds. Pharmacy records showed that 34.2% had used an antithrombotic drug as an outpatient in the years before their MRI. The study determined that these antithrombotic drug users were more likely to have cerebral microbleeds than nonusers after adjustment for age and sex (odds ratio 1.55, 95% confidence interval 1.14 to 2.09).The association remained after additional adjustment for cardiovascular risk (OR 1.56, 95% CI 1.15 to 2.12).
Antithrombotics were also linked to presence of brain infarcts and high white matter lesion volume, but exclusion of participants with a known history of cerebrovascular disease attenuated these associations.
Location appears to be important: strictly lobular microbleeding suggests cerebral amyloid angiopathy, in which accumulation of amyloid protein leads to degeneration of smooth muscle cells and increases risk of ruptures and hemorrhages. Aspirin users in the population-based study were also more likely to show microbleeding limited to lobular areas of the brain, the researchers reported.
Past microbleeding -- indicated by small deposits of the iron-storing protein hemosiderin on brain scans -- was 71% more common with use of platelet aggregation inhibitors than without antithrombotic drugs.
Exclusive use of platelet aggregation inhibitors accounted for most of the antithrombotics (23.1% of the cohort). Another 5.9% exclusively used anticoagulants. These were overwhelmingly warfarin (Coumadin) and other vitamin K antagonists rather than heparin.
Although not significant, anticoagulants displayed a magnitude of microbleeding risk (OR 1.49, 95% CI 0.81 to 2.67) similar to platelet aggregation inhibitors (OR 1.71, 95% CI 1.21 to 2.41) in the fully adjusted model.
One researcher speculated that "It may be that microbleed formation is more dependent on the sealing of small-vessel-wall defects by platelet aggregation than it is on clot stabilization."
Source reference:
Vernooij MW, et al "Use of antithrombotic drugs and the presence of cerebral microbleeds: The Rotterdam scan study" ARCH NEUROL 2009; 66: DOI: 10.1001/archneurol.2009.42.
COMMENT:
This brings up the question as to the indications for everyone—healthy with minimal cardio-vascular risks and those with greater risks taking small doses of aspirin as prophylaxis for heart attacks and stroke, as well as the advanced elderly.
Aspirin is enormously useful as a prophylactic for cardiovascular events including myocardial infarction and ischaemic stroke. There has been concern, however, that aspirin can also increase hemorrhagic strokes and cause gastrointestinal bleeding. This study investigated the balance of positive and negative effects, and the results indicate no overwhelming difference. For individual patients, therefore, it depends on whether it is better to risk an MI or a gastrointestinal bleed says findings in the Lancet, Volume 373, Issue 9678, Pages 1849 - 1860, 30 May 2009 doi:10.1016/S0140-6736(09)60503-1
These findings "challenge guidelines that endorse the use of aspirin for primary prevention as a general public health policy and reinforce the need to take each patient's preferences and goals.
Researchers undertook an analysis of six primary prevention trials encompassing some 95,000 individuals at low-average risk assigned to take aspirin or no aspirin. Aspirin was associated with a significant reduction in risk for serious vascular events (0.51% vs. 0.57% per year), but the net effect on stroke was not significant. Aspirin increased risks for major gastrointestinal and extracranial bleeding. Therefore everyone using aspirin in the primary prevention of cardiovascular disease is "of uncertain net value," reports this Lancet meta-analysis.
Why?
This major study shows that although regular use can cut the rate of non-fatal heart attacks, it can also increase the risk of internal bleeding by a third.
Healthy adults who take daily aspirin to prevent heart attacks could be doing more harm than good, warn researchers. The researchers "found that healthy people who take aspirin reduced their already small risk of heart attack or stroke by 12 percent, while the small risk of internal bleeding is increased by a third." This means there were five fewer non-fatal heart attacks for every 10,000 people treated. This pro was was offset by the con of a comparable increase in bleeding -- one extra stroke and three cases of stomach bleeding per 10,000 people treated."
Meanwhile, the secondary prevention studies showed that where patients were taking aspirin to prevent a repeat attack -- aspirin reduced the chances of serious vascular events by about one-fifth and this benefit clearly outweighed the small risk of bleeding.
Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ILLEGAL USE OF OPIOIDS
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
SHOULD EVERYONE TAKE ASA?
Aspirin and other platelet aggregation inhibitors may increase the likelihood of asymptomatic cerebral microbleeds among older adults. Microbleeding has gained recognition over the past decade as a marker of small-vessel disease in the brain.
The analysis involved 1,062 participants in the longitudinal, population-based Rotterdam Scan Study, all age 60 or older and free of dementia. They underwent MRI over a period of roughly one year to assess the presence and location of microbleeds. Pharmacy records showed that 34.2% had used an antithrombotic drug as an outpatient in the years before their MRI. The study determined that these antithrombotic drug users were more likely to have cerebral microbleeds than nonusers after adjustment for age and sex (odds ratio 1.55, 95% confidence interval 1.14 to 2.09).The association remained after additional adjustment for cardiovascular risk (OR 1.56, 95% CI 1.15 to 2.12).
Antithrombotics were also linked to presence of brain infarcts and high white matter lesion volume, but exclusion of participants with a known history of cerebrovascular disease attenuated these associations.
Location appears to be important: strictly lobular microbleeding suggests cerebral amyloid angiopathy, in which accumulation of amyloid protein leads to degeneration of smooth muscle cells and increases risk of ruptures and hemorrhages. Aspirin users in the population-based study were also more likely to show microbleeding limited to lobular areas of the brain, the researchers reported.
Past microbleeding -- indicated by small deposits of the iron-storing protein hemosiderin on brain scans -- was 71% more common with use of platelet aggregation inhibitors than without antithrombotic drugs.
Exclusive use of platelet aggregation inhibitors accounted for most of the antithrombotics (23.1% of the cohort). Another 5.9% exclusively used anticoagulants. These were overwhelmingly warfarin (Coumadin) and other vitamin K antagonists rather than heparin.
Although not significant, anticoagulants displayed a magnitude of microbleeding risk (OR 1.49, 95% CI 0.81 to 2.67) similar to platelet aggregation inhibitors (OR 1.71, 95% CI 1.21 to 2.41) in the fully adjusted model.
One researcher speculated that "It may be that microbleed formation is more dependent on the sealing of small-vessel-wall defects by platelet aggregation than it is on clot stabilization."
Source reference:
Vernooij MW, et al "Use of antithrombotic drugs and the presence of cerebral microbleeds: The Rotterdam scan study" ARCH NEUROL 2009; 66: DOI: 10.1001/archneurol.2009.42.
COMMENT:
This brings up the question as to the indications for everyone—healthy with minimal cardio-vascular risks and those with greater risks taking small doses of aspirin as prophylaxis for heart attacks and stroke, as well as the advanced elderly.
Aspirin is enormously useful as a prophylactic for cardiovascular events including myocardial infarction and ischaemic stroke. There has been concern, however, that aspirin can also increase hemorrhagic strokes and cause gastrointestinal bleeding. This study investigated the balance of positive and negative effects, and the results indicate no overwhelming difference. For individual patients, therefore, it depends on whether it is better to risk an MI or a gastrointestinal bleed says findings in the Lancet, Volume 373, Issue 9678, Pages 1849 - 1860, 30 May 2009 doi:10.1016/S0140-6736(09)60503-1
These findings "challenge guidelines that endorse the use of aspirin for primary prevention as a general public health policy and reinforce the need to take each patient's preferences and goals.
Researchers undertook an analysis of six primary prevention trials encompassing some 95,000 individuals at low-average risk assigned to take aspirin or no aspirin. Aspirin was associated with a significant reduction in risk for serious vascular events (0.51% vs. 0.57% per year), but the net effect on stroke was not significant. Aspirin increased risks for major gastrointestinal and extracranial bleeding. Therefore everyone using aspirin in the primary prevention of cardiovascular disease is "of uncertain net value," reports this Lancet meta-analysis.
Why?
This major study shows that although regular use can cut the rate of non-fatal heart attacks, it can also increase the risk of internal bleeding by a third.
Healthy adults who take daily aspirin to prevent heart attacks could be doing more harm than good, warn researchers. The researchers "found that healthy people who take aspirin reduced their already small risk of heart attack or stroke by 12 percent, while the small risk of internal bleeding is increased by a third." This means there were five fewer non-fatal heart attacks for every 10,000 people treated. This pro was was offset by the con of a comparable increase in bleeding -- one extra stroke and three cases of stomach bleeding per 10,000 people treated."
Meanwhile, the secondary prevention studies showed that where patients were taking aspirin to prevent a repeat attack -- aspirin reduced the chances of serious vascular events by about one-fifth and this benefit clearly outweighed the small risk of bleeding.
Older age, male sex, diabetes, and high blood pressure were associated with significantly elevated absolute ischemic stroke and major coronary event risk, but also with significantly increased risk of major extracranial bleeding and at least a trend for hemorrhagic stroke as well.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ILLEGAL USE OF OPIOIDS
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Saturday, July 11, 2009
Part I of II: IS IT SAFE TO TAKE ENTERIC COATED ASPIRIN?
Even low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage.
The small bowel was shown to be damaged by low-dose ASA even on a short-term basis in twenty healthy volunteers (age range, 19-64 years) who underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days.
Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.
Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).
CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.
E. Smecuol Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 7(5):524-9 (2009)
COMMENT:
The efforts to generate safer NSAIDS and aspirins includes enteric coated and slow release formulations. But these “safer” formulations simply shift the damage of these agents to a more distal site in the intestinal tract.
This study documents that even in the short term and in healthy controls a short course of enteric coated ASA can damage the small intestinal mucosa.
Half of the healthy study population showed mucosal damage.
This study must be taken into consideration by patients and their providers.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for PART II of II SHOULD EVERYONE TAKE ASA?
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
The small bowel was shown to be damaged by low-dose ASA even on a short-term basis in twenty healthy volunteers (age range, 19-64 years) who underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days.
Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.
Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).
CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.
E. Smecuol Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 7(5):524-9 (2009)
COMMENT:
The efforts to generate safer NSAIDS and aspirins includes enteric coated and slow release formulations. But these “safer” formulations simply shift the damage of these agents to a more distal site in the intestinal tract.
This study documents that even in the short term and in healthy controls a short course of enteric coated ASA can damage the small intestinal mucosa.
Half of the healthy study population showed mucosal damage.
This study must be taken into consideration by patients and their providers.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for PART II of II SHOULD EVERYONE TAKE ASA?
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Thursday, June 4, 2009
Experts Warn Against Long-Term Use Of Common Pain Pills
Experts Warn Against Long-Term Use Of Common Pain Pills—Especially In Seniors
Aspirin and ibuprofen are staples in just about every medicine chest and first aid kit. They’re sold over the counter, and they’re not expensive.
Most people don’t think twice about taking them.But NSAIDS are dangerous especially in seniors.
BRAND NAMES of just a few NSAIDS— Cataflam®; Flector®; Solaraze®; Voltaren — Aleve® [OTC]; Anaprox®; Anaprox® DS; EC-Naprosyn®; Mediproxen [OTC]; Midol® Extended Relief; Naprelan®; Pamprin® Maximum Strength All Day Relief [OTC] — Apo-Keto-E®; Apo-Keto®; Novo-Keto; Novo-Keto-EC; Nu-Ketoprofen; Nu-Ketoprofen-E; Oruvail®; Rhodis SR™ ; Rhodis-EC™ ; Rhodis™ Flexin® ; Indocin®;
Seniors especially those over age 75 should be very careful about taking NSAIDS on a long term basis. An expert panel of American Geriatrics Society pretty much bumped all non-steroidal anti-inflammatory drugs, or NSAIDs, off the list of medicines recommended for adults ages 75 and older with chronic, persistent pain and on a long term basis. Long-term use of drugs like ibuprofen, naproxen and high-dose aspirin is so dangerous, the panelists said, that elderly people who can’t get relief from alternatives like acetaminophen [Tylenol] may be better off skipping to stronger pain medications like opiates.
All this despite the fact that NSAIDs are known to be effective for chronic pain conditions that often plague older adults — and despite the fact that opiates can be addictive.
There really continues to be a significant amount of unrecognized and untreated pain in older people, and it’s a huge problem. Chronic pain is rampant among the elderly, affecting an estimated 25 to 50 percent of elderly people living in the community and up to 85 percent of nursing home residents. Often caused by degenerative spine conditions, arthritis and cancer or cancer treatment, chronic pain takes a powerful toll on quality of life. Untreated, chronic pain can disrupt sleep and affect mood, restrict mobility and lead to depression, anxiety and isolation, experts say. It can also contribute to falls, which lead to further complications and often death.
“We’ve come out a little strong at this point in time about the risks of NSAIDs in older people,” said the chair of the panel that made the recommendations and a professor of geriatrics at the University of California, Los Angeles. “We hate to throw the baby out with the bathwater — they do work.But it looks like patients would be safer on opioids than on high doses of NSAIDs for long periods of time,” he said, adding “that for most elderly, the risk of addiction appears to be low.”
RISKS OF CHRONIC NSAID USE
The risks from chronic use of NSAIDs are myriad. They can cause life-threatening ulcers and gastrointestinal bleeding, a side effect that occurs more frequently and with greater severity as people age. Some NSAIDs may increase the risk for heart attacks or strokes, and they don’t interact well with drugs used to treat heart failure. NSAIDS can make high blood pressure worse, even uncontrollable, and impair kidney function. And the list of potentially hazardous interactions with other drugs is a long one, experts say. Younger people can use this class of medicine with limited risks. In older persons, it’s a different story. Physical changes make them more sensitive.
These are just a few of the adverse effects listed in Boxed warnings for all ages:
Anaphylactoid reactions; Bleeding/hemostasis: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Cardiovascular events: [U.S. Boxed Warning]: NSAIDs are associated with an increased risk of adverse cardiovascular thrombotic events, including MI, stroke, and new onset or worsening of pre-existing hypertension. Concurrent administration of ibuprofen, and potentially other nonselective NSAIDs, may interfere with aspirin's cardioprotective effect.
Gastrointestinal events: [U.S. Boxed Warning]: NSAIDs may increase risk of gastrointestinal irritation, inflammation, ulceration, bleeding, and perforation. These events may occur at any time during therapy and without warning. Skin reactions: NSAIDs may cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN); discontinue use at first sign of skin rash or hypersensitivity. Visual disturbances: Prolonged use may cause corneal deposits and retinal disturbances; discontinue if visual changes are observed. Elderly: The elderly are at increased risk for adverse effects (especially peptic ulceration, CNS effects, renal toxicity) from NSAIDs even at low doses.
NEW GUIDELINES
The geriatrics society’s new guidelines say NSAIDs should be considered “rarely” in the population of frail elderly people, and used “with extreme caution” and then only in “highly selected individuals.” For those patients with moderate to severe pain that diminishes the quality of life, opiates may be considered, the guidelines suggest, after both the patient and caregiver are screened for prior substance abuse.
In Summary the Geriatrics Society Changes Its Pain Management Guidelines. In its first revision since 2002, the society makes several recommendations, among them- Older patients with moderate-to-severe pain are candidates for opioid therapy and should only "rarely" receive nonselective NSAIDs and COX-2 selective inhibitors.
• Acetaminophen should be the "initial and ongoing" drug treatment for persistent — "particularly musculoskeletal" — pain.
• Nonselective NSAIDs and COX-2 selective inhibitors may be considered "with extreme caution" for patients in whom "other (safer) therapies have failed."
• Patients with fibromyalgia or neuropathic pain are candidates for adjuvant analgesics.
• Breakthrough pain should be treated with short-acting, immediate-release opioids.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Aspirin and ibuprofen are staples in just about every medicine chest and first aid kit. They’re sold over the counter, and they’re not expensive.
Most people don’t think twice about taking them.But NSAIDS are dangerous especially in seniors.
BRAND NAMES of just a few NSAIDS— Cataflam®; Flector®; Solaraze®; Voltaren — Aleve® [OTC]; Anaprox®; Anaprox® DS; EC-Naprosyn®; Mediproxen [OTC]; Midol® Extended Relief; Naprelan®; Pamprin® Maximum Strength All Day Relief [OTC] — Apo-Keto-E®; Apo-Keto®; Novo-Keto; Novo-Keto-EC; Nu-Ketoprofen; Nu-Ketoprofen-E; Oruvail®; Rhodis SR™ ; Rhodis-EC™ ; Rhodis™ Flexin® ; Indocin®;
Seniors especially those over age 75 should be very careful about taking NSAIDS on a long term basis. An expert panel of American Geriatrics Society pretty much bumped all non-steroidal anti-inflammatory drugs, or NSAIDs, off the list of medicines recommended for adults ages 75 and older with chronic, persistent pain and on a long term basis. Long-term use of drugs like ibuprofen, naproxen and high-dose aspirin is so dangerous, the panelists said, that elderly people who can’t get relief from alternatives like acetaminophen [Tylenol] may be better off skipping to stronger pain medications like opiates.
All this despite the fact that NSAIDs are known to be effective for chronic pain conditions that often plague older adults — and despite the fact that opiates can be addictive.
There really continues to be a significant amount of unrecognized and untreated pain in older people, and it’s a huge problem. Chronic pain is rampant among the elderly, affecting an estimated 25 to 50 percent of elderly people living in the community and up to 85 percent of nursing home residents. Often caused by degenerative spine conditions, arthritis and cancer or cancer treatment, chronic pain takes a powerful toll on quality of life. Untreated, chronic pain can disrupt sleep and affect mood, restrict mobility and lead to depression, anxiety and isolation, experts say. It can also contribute to falls, which lead to further complications and often death.
“We’ve come out a little strong at this point in time about the risks of NSAIDs in older people,” said the chair of the panel that made the recommendations and a professor of geriatrics at the University of California, Los Angeles. “We hate to throw the baby out with the bathwater — they do work.But it looks like patients would be safer on opioids than on high doses of NSAIDs for long periods of time,” he said, adding “that for most elderly, the risk of addiction appears to be low.”
RISKS OF CHRONIC NSAID USE
The risks from chronic use of NSAIDs are myriad. They can cause life-threatening ulcers and gastrointestinal bleeding, a side effect that occurs more frequently and with greater severity as people age. Some NSAIDs may increase the risk for heart attacks or strokes, and they don’t interact well with drugs used to treat heart failure. NSAIDS can make high blood pressure worse, even uncontrollable, and impair kidney function. And the list of potentially hazardous interactions with other drugs is a long one, experts say. Younger people can use this class of medicine with limited risks. In older persons, it’s a different story. Physical changes make them more sensitive.
These are just a few of the adverse effects listed in Boxed warnings for all ages:
Anaphylactoid reactions; Bleeding/hemostasis: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Cardiovascular events: [U.S. Boxed Warning]: NSAIDs are associated with an increased risk of adverse cardiovascular thrombotic events, including MI, stroke, and new onset or worsening of pre-existing hypertension. Concurrent administration of ibuprofen, and potentially other nonselective NSAIDs, may interfere with aspirin's cardioprotective effect.
Gastrointestinal events: [U.S. Boxed Warning]: NSAIDs may increase risk of gastrointestinal irritation, inflammation, ulceration, bleeding, and perforation. These events may occur at any time during therapy and without warning. Skin reactions: NSAIDs may cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN); discontinue use at first sign of skin rash or hypersensitivity. Visual disturbances: Prolonged use may cause corneal deposits and retinal disturbances; discontinue if visual changes are observed. Elderly: The elderly are at increased risk for adverse effects (especially peptic ulceration, CNS effects, renal toxicity) from NSAIDs even at low doses.
NEW GUIDELINES
The geriatrics society’s new guidelines say NSAIDs should be considered “rarely” in the population of frail elderly people, and used “with extreme caution” and then only in “highly selected individuals.” For those patients with moderate to severe pain that diminishes the quality of life, opiates may be considered, the guidelines suggest, after both the patient and caregiver are screened for prior substance abuse.
In Summary the Geriatrics Society Changes Its Pain Management Guidelines. In its first revision since 2002, the society makes several recommendations, among them- Older patients with moderate-to-severe pain are candidates for opioid therapy and should only "rarely" receive nonselective NSAIDs and COX-2 selective inhibitors.
• Acetaminophen should be the "initial and ongoing" drug treatment for persistent — "particularly musculoskeletal" — pain.
• Nonselective NSAIDs and COX-2 selective inhibitors may be considered "with extreme caution" for patients in whom "other (safer) therapies have failed."
• Patients with fibromyalgia or neuropathic pain are candidates for adjuvant analgesics.
• Breakthrough pain should be treated with short-acting, immediate-release opioids.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
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