Ibuprofen Risky for Heart Patients?
Common Pain Drug May Cut Aspirin Lifeline in People at High Risk for Heart Disease
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Ibuprofen or Naproxen vs. Prexige
The study by Farkouh and colleagues enrolled 18,325 arthritis patients. Nearly 17% of these patients were at high risk of heart attack and stroke.
The trial compared ibuprofen (brand names include Advil, Motrin, and Nuprin) or naproxen (Aleve, Naprosyn) to a new pain drug sold as Prexige in the U.K. and Canada.
Prexige is a member of the stomach-friendly family of pain drugs called Cox-2 inhibitors. Celebrex is the only member of this drug class sold in the U.S. Another Cox-2 drug, Vioxx, was taken off the market after people taking the drug had a suspiciously high number of heart attacks.
All of the high-heart-risk patients in the Farkouh study should have been taking low-dose aspirin. Sixty percent of them did. These patients should have had fewer heart attacks, strokes, and heart deaths than those who did not take aspirin.
But if the patients took aspirin and also took high-dose ibuprofen, they were nine times more likely to have a heart attack than were patients who took aspirin and Prexige. Patients who took ibuprofen without taking aspirin were no more likely to have a heart attack than those who took Prexige.
Farkouh and Nissen say there is strong evidence that ibuprofen blocks the blood-clot-preventing effects of aspirin. Both agree that the drugs do not interact if a person takes aspirin two hours before taking ibuprofen. But Farkouh says this approach will not work in the real world.
“The problem with that is Grandma Jones has to take a statin drug, an ACE inhibitor, and beta-blockers, too. Now you tell her to take a white pill hours before she takes the green pill -- it isn't going to work," he says.
So what is a person who needs low-dose aspirin supposed to do for arthritis pain? For those at low risk of stomach and gut side effects, Farkouh recommends taking naproxen at the lowest helpful dose -- and avoiding ibuprofen.
Nissen says there's far too little evidence to advise anyone to stop taking ibuprofen. However, he recommends that patients take their low-dose aspirin two hours before taking ibuprofen.