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Aspirin, pain relievers can be a risky mix

Many who take Vioxx or Celebrex for arthritis also take aspirin for their hearts, risking gastrointestinal bleeding and ulcers.

June 28, 2004|Jane E. Allen | Times Staff Writer

About half of older patients regularly taking Vioxx or Celebrex for pain also appear to be on aspirin therapy to prevent heart attacks. But that combination could be endangering their health.

Combining the two drugs increases the risk of ulcers and gastrointestinal bleeding.

Even worse, about half the aspirin-takers are further boosting their bleeding risk by using excessive doses of aspirin, a new survey indicates. Doctors recommend 81 milligrams of aspirin a day to protect against heart attack and stroke, but those surveyed frequently used 325-milligram tablets, researchers reported in the June 14 issue of the Archives of Internal Medicine.

Vioxx and Celebrex, members of a class of drugs called COX-2 inhibitors, are relatively expensive pain relievers whose chief advantage over other inflammation-fighters is that they're less likely to cause gastrointestinal bleeding. However, researchers with Express Scripts Inc., a large pharmacy benefit management company in St. Louis, found that many older users of these drugs didn't know that aspirin increased the risk of such bleeding.

In 2001, working from mail-order prescription records, they conducted telephone surveys of 350 long-term adult users of the COX-2 anti-inflammatories. All got their prescription drug coverage through a large employer that had six retirees for every active worker.

Nurses asked how often the Vioxx and Celebrex users also took aspirin, acetaminophen (Tylenol) or two other popular nonsteroidal inflammatory drugs, ibuprofen (Advil) and naproxen sodium (Aleve).

The analysis found that half of those age 56 or older taking Vioxx or Celebrex for arthritis pain also were taking aspirin to prevent heart attacks and strokes. Most used enteric-coated or buffered forms of aspirin, which although designed to be gentler on the stomach may not be gentler in reality, the study authors noted. Half of the aspirin users took excessive doses of up to 325 milligrams, said lead author Emily R. Cox, director of research at Express Scripts.

She suggested that some patients may incorrectly believe that "more is better." Others may opt for higher aspirin doses because they can buy 325-milligrams pills more cheaply than the 81-milligram pills.

Cox said there was a more cost-effective way to relieving arthritis pain while retaining aspirin's cardiovascular benefits. Many patients could replace their COX-2 prescriptions with a lower-cost nonsteroidal anti-inflammatory drug such as Aleve, paired with generic omeprazole (Prilosec) to protect their digestive systems. The Aleve-omeprazole combination costs less than the COX-2 medications alone.

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