Tuesday, December 21, 2004

Statins, ACE Inhibitors and Beta-Blockers Are Safe

With all the news about the risks of heart attacks with various pain medications, including Vioxx, Celebrex, Bextra and now Naproxen, one has to wonder which is the next disaster to be announced.

In my book, I aggressively recommend the use of three types of prescription medications, Statins, ACE inhibitors and beta-blockers with great conviction.

I can do this because several medicines within these groups have been formally tested in long-term trials to determine their effects on heart attacks, strokes and premature deaths. The studies are conclusive, these medicines save lives.

The pain medicines were approved based on their ability to reduce pain; only now do we know what their effect is on heart attacks because no study had been performed previously.

Within the classes of medicines I recommend to those at risk of heart attacks, some are proven to reduce risk while others are proven to change a blood pressure reading or cholesterol level. The recent news with these pain medicines teaches an important lesson; you don't know the effects of a drug on long-term risks unless you do a study to find out.

This is why my recommendations in the book are product specific. Some medicines are proven safe, others seem that way. Don't take a chance, ask your doctor for the ones proven to reduce risk of heart attacks, strokes and premature deaths.

posted by jsb @ 11:26 PM  

Sunday, December 19, 2004

Celebrex: As Bad As Vioxx?

This question is the one I expect to hear in my office tomorrow. It's not that I write prescriptions for Celebrex any more than I did for Vioxx, but many of my patients have been treated with one of them. At first glance it seems to be an easy situation to deal with; stop the Celebrex.

In fact, it is far more complex.

Here's why. Many people have terrible pain. Mine isn't so bad, so I stopped taking Vioxx. But if pain is really bad and limits someone's ability to function, it becomes complex. Is the risk worth it? That is the key question and the question that the FDA seems most interested in helping doctors answer.

I say this because I have heard employess of the FDA say publically that a drug that improves quality of life but increases the risk of death may still be a reasonable drug to permit onto the market.
The information to quantify the benefits and risks is necessary and we are starting now to understand the risks of Celebrex or Vioxx.

I don't believe that Celebrex should be withdrawn from the market, but I do think it should become a niche drug, perhaps one that has a specific safety program associated with it. A patient could be given standard literature stating the risks and benefits prior to signing a consent form.

On the other hand, I suppose the lawyers wouldn't like that suggestion; it would prevent them from suing.



posted by jsb @ 7:20 PM