More prudent use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) commonly sold over the counter, such as Advil (ibuprofen) and Aleve (naproxen), and used to treat pain and fever, is needed due to the risk of cardiovascular events associated with this drug class, according to a group of European medical experts.
The working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology recently published a review and position paper on non-aspirin NSAIDs. Among their key findings: The drugs should not be used in people who either have cardiovascular disease or are at high risk for it.
Another important recommendation the group made is that non-aspirin NSAIDs should only be sold over-the-counter once appropriate warnings of their cardiovascular risks are put on labeling.
“Whether or not the patient accepts the predicted risks in return for relief of their symptoms should be a major consideration when initiating NSAID therapy,” the team noted. They added that in patients with gastrointestinal risks, a proton pump inhibitor drug (e.g. Nexium) should be taken due to an NSAID’s potential in causing gastrointestinal bleeding.
Non-aspirin NSAIDs are not limited to over-the-counter remedies. Celebrex (celecoxib) and Voltaren (diclofenac), for example, require prescriptions. Celebrex is also in a class of pain relievers known as COX-2 inhibitors, the same class that Vioxx (rofecoxib) was in. Vioxx was pulled from the market in 2004 amid concerns over an increased risk of stroke and heart attack associated with long-term use of the drug at high doses.
The researchers conclude that when it comes to prescribing non-aspirin NSAIDs, each case requires “a careful evaluation of the risk of cardiovascular complications and bleeding.”