A new study confirmed that chronic pain drugs Celebrex (celecoxib), ibuprofen, and naproxen are all related to cardiac disease.

The study was to try and determine if the prescription drug celecoxib was dangerous, mainly because Vioxx, a drug similar to Celebrex, was linked to at least 27,000 heart attacks in 2004. The study focused on arthritis pain relief through the use of Celebrex, ibuprofen, and naproxen. The research was led by Dr. Steve Nissen from the Cleveland Clinic. For studying the effects of the three painkillers, the team recruited 24,000 volunteers suffering from rheumatoid arthritis or osteoarthritis.

Although the results were deemed as satisfactory, more than 50 percent of the participants did not complete the trial. Image credit: http://www.dailymail.co.uk/

Participants were administered naproxen, ibuprofen, and celecoxib, alongside a drug designed to protect the stomach walls. The patients took increased daily doses of each drug, corresponding to 1800mg of ibuprofen, 750mg of naproxen, and 200mg of celecoxib. The usual dose of ibuprofen is 600mg per day.

Only celecoxib caused a lower rate of gastric bleeding, but over 2 percent of all patients, regardless of the prescribed medication, suffered from heart attacks or strokes: 2.3 percent for celecoxib, 2.5 percent for naproxen, and 2.7 percent for ibuprofen.

On the other hand, celecoxib did not affect blood pressure while some patients taking ibuprofen had to be driven to emergencies due to hypertension. The effects of naproxen were classified as “intermediate.”

Why Celebrex?

One of the objectives was to test the link between COX-2 inhibitors and heart damage, seeing that celecoxib is a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). It can be prescribed to treat pain caused by arthritis, menstrual pain, and other chronic ailments. Currently, celecoxib is known to increase the risk of suffering a fatal heart attack or stroke, especially when taken on high dosages.

Back in 2004, the arthritis drug Vioxx was discovered to have caused over 27,000 deaths before being removed from the shelves. A study performed by the FDA found out that from 1999 up to 2004, 27,785 deaths could have been avoided if the patients had ingested Celebrex, manufactured by Pfizer, rather than Vioxx, synthesized by Merck & Co. The company could not comment on the study, apparently because they did not set themselves to read it thoroughly.

After the Vioxx scandal, researchers wondered if Celebrex, which shares the COX-2 inhibitor classification, could be as dangerous. The difference lied in the fact that Vioxx was advertised as a “refined” painkiller, while Celebrex had undergone many studies, all of which exceed in length and importance those concerning Vioxx.

COX-2 is the enzyme that is directly related to pain and inflammation while it helps prevent stomach ulcers. Sometimes COX-2 inhibitors are applied after surgery and even to treat breast cancer, they have also been shown to help deal with mental disorders such as schizophrenia and depressive disorders.

Studies in 2006 and 2007 confirmed that vascular events were much more frequent when the patient took COX-2 inhibitors although the exact cause remains unclear. The most convincing theory is that lesser COX-2 causes a buildup of platelets and contraction of the blood vessels, which are direct causes of clot formation and hypertension.

“People who have cardiovascular disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk for cardiovascular adverse events associated with NSAIDs,” announced the FDA in a 2015 warning.

Risk factors for celecoxib, ibuprofen, and naproxen

The researchers made it clear that celecoxib, ibuprofen, and naproxen can be considered dangerous only when taken in higher doses.

They recommend that, if one were to take these drugs, it should be on the lowest dosage possible for the shortest time possible. If stomach ulcers go unnoticed, the patient could constantly lose blood and may suffer from anemia, which in turn is known to cause heart problems.

When it comes to stomach ulcers, patients that have been taking pain medication for a long time or that have combined them with alcohol are at the highest risk. These ulcers occur when digestive acids eat the inner tissue of the stomach, which leads to bleeding. People who smoke and frequently use steroids are also likely to have these malformations.

Generic ibuprofen. Credit: Wikipedia

The symptoms include a burning sensation in the stomach, weight loss, nausea, bloating, pain when eating or drinking, and acid reflux. Over four million Americans have stomach ulcers, but diagnosis depends on the doctor reviewing the patient’s medical history and any prescribed medication. A bleeding stomach ulcer can be revealed by a blood-red vomit. Contrary to intuition, blood in the stool is mostly due to bleeding in the intestines, anus or esophagus.

When taking prescription NSAIDs, patients are advised to carefully review the labels and to decide if taking the drug as prescribed is the best solution when it comes to exposing oneself to the risk of suffering a heart attack or stroke.

“If you have pain that is sufficiently severe that you need these drugs to function, you should weigh the benefits of relieving pain versus the potential hazards,” stated Dr. Nissen.

Source: NPR