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Ibuprofen May Not Be as Safe as was Thought
- helthanatos 10y agoOne major problem with studying medication effects is that to study humans, not only does the experiment introduce more bias by studying different people, it also leads to results that may contradict the next study. I wish there was a more accurate way of measuring a drug's weaknesses, but it seems that these human studies are here to stay a while.
- SocratesV 10y agoMaybe we should aim to create within the next century a near perfect simulation of us and our world, run it at an incredibly high speed and see if any knowledge regarding this, and many other things, emerges. ;-)
- a_plastic_bag 10y agotl;dr: Celecoxib is safer than previously thought for people with heart problems.
- KaiserPro 10y agocauses the same level of heart problems as ibuprofen, but less kidney and GI problems
- NoGravitas 10y agoThis would have been a much better and less misleading headline.
- steventhedev 10y agoAre those dosages a fair comparison (ibuprofen 600x3, celecoxib 100x2, and naproxen 375x2 daily)? Do they each provide the same level of pain reduction? If not, there is literally no way to compensate for that level of statistical bias. Stomach/kidney/heart damage is not linear, and there's no mention of when people gave up taking the medications. For someone who actually wants to read the study, here's the link: http://www.nejm.org/doi/full/10.1056/NEJMoa1611593#t=article http://www.nejm.org/doi/full/10.1056/NEJMoa1611593#t=article tl;dr - they admit that taking more than 200mg of celecoxib does some damage, and 800mg doses (they apparently were limited by regulations to 200mg/day) showed the same heart damage they expected to see. Time magazine is a horrible source
- surak 10y agoI've done both Ibuprofen 400x3 and naproxen 500x2 daily for knee problems, and would say the pain reduction from Ibuprofen is much greater than Naproxen. So much so, that I would say its not a fair comparison, particularly at 600x3.
- lostcolony 10y agoI've noticed this to be very individual dependent. Ibuprofen does nothing for me for pain relief; Naproxen does.
- taude 10y agoI have to switch between multiple anti-inflammatories as my body seems to adapt to what I take to manage chronic arthritic pain
- rando444 10y agoJust as a suggestion, you might want to try going the other route and working with your body instead of fighting it. Have you looked into prolotherapy before? (sugar water injections) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831229/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831229/
- zymhan 10y agoYes because my body has such a hard time making sugar water \s
- Yxven 10y agoI'm not as skeptical of prolotherapy. The idea is that it acts as an irritant which increases blood flow and other healing responses to that area. Tendons in particular are thought to heal slowly because they don't have great blood flow. This strikes me as similar to the ideas of dry-needling and platelet-rich plasma injections.
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- chmaynard 10y agoThis TIME headline seems totally disconnected from the article, which is about COX-2 inhibitors.
- gcp 10y agoHmm? One of the main results relevant to the wider audience is surely that Ibuprofen no longer looks like the most-recommendable drug because it looks less safe than the alternatives. (Even if some remarks can be made towards the study, that doesn't change the above in terms of presentation and relevance to the audience)
- chmaynard 10y agoFrom the paper: At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety. (Funded by Pfizer; ClinicalTrials.gov number, NCT00346216.) http://www.nejm.org/doi/full/10.1056/NEJMoa1611593 http://www.nejm.org/doi/full/10.1056/NEJMoa1611593 The paper draws no conclusions about the relative safety of ibuprofen. The only claim is that celecoxib is not inferior to the other two NSAIDs. Note that this research study was funded by Pfizer, the company that markets Celebrex.
- gcp 10y agoRight, so this mentions ibuprofen explicitly, and it talks about cyclooxygenase-2 selective inhibitors too. I still don't get what your complaint about TIME's title is? Did you think they should've mentioned celecoxib? That's much less known drug. Mentioning ibuprofen means it's more likely to reach the audience that should care about the study.
- chmaynard 10y agoYes, but we don't know whether Pfizer is hiding other similar studies that came to different conclusions. This is a general problem with big pharma research disclosure, not just Pfizer. FYI, celecoxib is the generic name for Celebrex.
- stinos 10y ago> people were assigned standard doses of 100mg celecoxib twice a day, 600mg ibuprofen three times a day, and naproxen 375mg twice a day > In almost every measure, ibuprofen looks worse, naproxen is intermediate and celecoxib is the best. > the heart concerns led the FDA to require its maker, Pfizer, to pay for additional studies to ensure that celecoxib did not put people at increased risk of heart trouble And afaik Celecoxib is the only one marketed solely by Pfizer, at prices 5 times higher than the other 2. Am I being paranoid thinking this at least deserves more study, not conducted or paid for by pharma?
- MichaelBurge 10y ago> Am I being paranoid thinking this at least deserves more study, not conducted or paid for by pharma? Do their rivals have an incentive to check Pfizer's work? If they're publishing bogus studies to get through regulatory checks, it could delay the new drug from being released. Further, if they're publishing bogus studies, it seems like the FDA would be partially responsible. So one might expect the FDA to possibly run trials of their own on a random sample of drugs, and compare with what the drug companies published. Also, Trump has mentioned speeding drugs through the FDA process. There might be less incentive to cheat the results if they don't need to do it to release their drug.
- kqr 10y agoThe FDA has these funny rules where you only need one successful study to be accepted. So as long as you can pay for study after study you can just wait until chance works out in your favor and you're out on the market. This is known. FDA does not care.
- refurb 10y agoAnd afaik Celecoxib is the only one marketed solely by Pfizer, at prices 5 times higher than the other 2. It's generic now. https://www.goodrx.com/celecoxib?drug-name=celecoxib https://www.goodrx.com/celecoxib?drug-name=celecoxib
- KaiserPro 10y agoUrgh, medical reporting is almost as bad as Tech reporting. No critical thinking. this is the gist: "There is a new drug that acts similarly to ibuprofen, but appears to be less aggressive towards kidneys. Equally as bad for the heart." However 70% of the participants failed to complete the study, so its not long term. No percentage risks are quoted. It also doesn't compare how effective celecoxib is compared to the much cheaper and well understood(interaction wise) ibuprofen. It also notes that high doses were not tested: "600mg ibuprofen three times a day" That my friend is a fucking large dose, as in three weeks and you have an ulcer dose.
- Broken_Hippo 10y agoActually, that isn't that large of a dose. The normal tablest in the US are 200mg: Lots of folks take 2 a few times a day: 400mg 3 times a day, as recommended on most of the packaging. Prescription ibuprofen is 800mg tablets (most times). This is a fairly common dosage, 3-4 times a day.
- claudius 10y agoReally?! Is this among the elderly who already have lots of little aches here and there or the general population? When I broke my arm I took 400mg about six or seven times over three days and for a cold I tend to take one or two paracetamol, but taking pain killers regularly sounds very absurd to me and I don’t know of anyone who takes anything stronger than coffee regularly and more than once a month.
- justinhj 10y agoDo you know anyone with long term chronic pain?
- KaiserPro 10y agothats the difference between acute (short term) and chronic (long term) In acute cases paracetamol can have an 8 gram daily limit. long term you're going to see problems. When you have something like arthritis, or and old joint injury, you'll be needing long term anti inflammatories
- zihotki 10y agoI would also like to add that not all Ibuprofen pills are equal. Biological availability should be taken into account too. 400mg pills with 90% of availability will have the same effect for pain as 600mg pills with 60% of availability. But they'd likely have different effects on stomach/kidney.
- e40 10y agoIs this quality listed somewhere? I've never heard of it.
- zentiggr 10y agoThe wikipedia template for these drug descriptions include basic bioavailability / excretory data. Would still need to dig a bit for comparative BA figures for tablets/caplets/liquids/etc, but at least the core number is there.
- zihotki 10y agoUnfortunately not all manufactures test it and mention it in the pill notes. But some of them are, for example Advil liquid capsules, they mention in the note that it has 90-95% availability
- refurb 10y agoIn order to get approved as a generic version of the branded drug, the generic manufacturer has to show data that indicates 80% to 125% bio-equivalence. If there is a version on the market with only 60% bioavailability, somebody screwed up (the FDA).
- pault 10y agoA friend's sister took a few ibuprofen a few days ago on an empty stomach, started throwing up blood for several hours, spent the night in the ER. Now she has an ulcer. Edit: Ulcer, not hernia.
- lightbyte 10y agoThe warning label on every bottle of ibuprofen specifically says to not take it on an empty stomach for exactly that reason. What was she expecting?
- pault 10y agoI know; she's an idiot. I'm not sure many people know how dangerous this can be, though. I'm not sure people take warnings on medication as seriously as they should.
- mark_kalvelage 10y agoI'm looking at a bottle of Advil right now and nowhere does it mention not to take it on an empty stomach.
- pkroll 10y agoLooking at a generic from Wal-mart: the closest warning is "Take with food or milk if stomach upset occurs."
- quietkatalyst 10y agoI am looking at a bottle of right now and do not see it on there.
- Confusion 10y agoDid you know that most people that win the lottery took ibuprofen in the month before winning?
- pault 10y agoThis isn't random chance. Ibuprofen can cause ulcers and blood in the urine if taken on an empty stomach. Not many people know this.
- readhn 10y agohere is input from my pharmacist friend on this article: "Just saw this study come out a few days ago and it kind of is no news. The harm of nsaids has been known and the warnings are out there. I tell patients everyday not to take advil/naproxen if they are older than 40/50 because of the heart and stomach issues. Will be interesting once they release celebrex as over the counter, this latest study will definitely catapult that process exponentially. In the mean time, only take nsaids if u really need to, with food and i tell patients to eat frequently and not too much salt to combat the water retention which causes the heart issues."
- carlmcqueen 10y agoI have always avoided nsaids if I can, and when I have to take them I always am asked to also take previcid to protect my stomach. I very quickly start to lose hunger and have stomach issues without something else to protect against the nsaid.
- emodendroket 10y agoIsn't aspirin regularly promoted as being good for your heart?
- Herodotus38 10y agoIt is, as well as prevention of stroke and prevention of colon cancer. While in the same general category of NSAIDs, you should think of it as really being a different animal. It has more of an antiplatelet effect than the other NSAIDs these articles are talking about which lead to decreased clotting.
- YCode 10y agoIIRC isn't the number needed to treat on aspirin pretty high, like in the thousands? I'm not sure how that compares with other treatments or the average but offhand it seems pretty high to the point of asking whether it's worth it.
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- dahart 10y agoHonest question, is it possible this article or the study it mentions is a paid ad for Celebrex? It somehow feels more pushy than impartial, and it didn't mention the cost difference between Ibuprofen and Celebrex, which is to put it mildly, enormous. I have taken too much "Vitamin-I" over the years, and it finally caught up with me and started causing stomach and esophagus problems. I've wanted to try Celebrex, but it's way too expensive. Have tried Meloxicam and it's much gentler than Ibuprofen, but let's just say it did come with some side effects on my gastrointestinal system.
- NTripleOne 10y agoI mean, it's literally in the article that pfizer had to pay for the study, so it wasn't exactly impartial from the start.
- bigato 10y agoThe fact they were forced to pay for the study does not imply they had any saying on how it was conducted.
- marricks 10y agoPerhaps, but it does suggest they had influence to make the authors not publish if the results didn't go there way. There's so many ways to distort information. I'm not saying this study is bad, but studies paid for by corporations for their own gains should be the last we see running through news headlines. But of course, that is partly the effect they'd want from them...
- zymhan 10y agoThe FDA mandated that this study be conducted. There was no chance of Pfizer sweeping the results under the rug, as the FDA was watching the whole process.
- beachstartup 10y agothat's not how it works. if you don't toe the line with the result of your study, that'll be the last one you do for the entire industry.
- CiPHPerCoder 10y agoWARNING: Autoplay video. Even if you open it in a new tab and are still viewing the current one (middle click on my computer).
- OldSchoolJohnny 10y agoWho in the world doesn't know that NSAIDS are dangerous drugs at this point? It's not exactly a surprise is it, this info has been around for years. Acetaminophen is obviously much worse but still...
- Broken_Hippo 10y agoThere are folks that don't realize that acetaminophen or ibuprofen are in many cough and cold formulations. But they aren't really dangerous per se. Certain population groups shouldn't take them, some can't tolerate them, and there are consequences to taking them over a long-course (which is what this was comparing). But for most with everyday aches, pains, colds, and so on, they aren't that dangerous. You know, use responsibly and stuff.
- gnicholas 10y agoThe study authors made clear (in another article [1]) that they are not trying to discourage people from infrequent ibuprofen/naproxen use. This study was about prescription doses and daily use. > "I don't want the public to think that if you take an occasional ibuprofen or naproxen that you're going to have kidney failure or you're going to die," Nissen says. "We didn't study that. We studied daily doses in arthritis patients [taking] ... high doses of these drugs." The headline doesn't reflect this, but it probably wouldn't get as many clicks if it said "daily use of prescription-level ibuprofen may not be as safe as was thought". 1: http://www.npr.org/sections/health-shots/2016/11/13/501033431/safety-of-painkiller-celebrex-affirmed-in-new-study http://www.npr.org/sections/health-shots/2016/11/13/50103343...
- deleted 10y ago[deleted]
- mindcrime 10y agoAll I can say about this is the following: I used to take a lot of vitamin I (ibuprofen). I've had some knee issues resulting in chronic pain dating back to my teens, and I always used Ibuprofen. And, yes, to be honest, at times I took more than the recommended (OTC) dose, and took it for longer periods of time than you're supposed to. Then I noticed that they changed the warning labels to point out the increased risk of heart attack from regular use of Ibuprofen. Then I had a heart attack. And all of my doctors (GP, cardiologist, etc.) suggested I quit taking Ibuprofen. Hrrmmm... to be fair, in the case of any individual, they can never really say exactly why you had an MI when and where you did. And I was a little overweight at the time, but I had very few other risk factors. I never smoked, had no family history of early heart attacks, and I was only 41. So did Ibuprofen play a role? We'll never know, but I'm following my doctor's advice and not taking it anymore. I'd recommend anyone who uses Ibuprofen frequently consider having a chat with their doctor and think hard about the various risk factors involved.