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Some Pain Medications Have Deadly Side Effects

Feb 22, 2003 | Knight Ridder Newspapers

When arthritis or muscle pain strikes, you might down a couple of over-the-counter pills to take care of the problem without giving it a thought.

But when it comes to using common pain medications, what you don't know can make you very sick.

While popular medications such as aspirin and ibuprofen, known as nonsteroidal anti-inflammatory drugs or NSAIDs, work wonderfully to help reduce pain and inflammation, they also can cause serious side effects. Some 76,000 adverse effects are reported annually, including gastrointestinal bleeding, ulcers and kidney problems. Medical experts estimate that between 12,000 and 16,000 people die each year from bleeding caused by using these medications.

In September the National Consumers League testified before the U.S. Food and Drug Administration's Nonprescription Drug Advisory Committee, urging it to consider requiring that nonsteroidal anti-inflammatory drugs be sold with a warning label and accompanying literature.

Alice Pomidor, chief of geriatrics at Akron General Medical Center in Akron, Ohio, said the typical person in pain takes these drugs with no clue of possible side effects.

Pomidor said patients frequently will combine the nonsteroidal anti-inflammatory drugs with other prescription pain medications, not dreaming that they could put themselves at risk.

"I had one lady just this week come in," Pomidor said, "and she was taking aspirin, Aleve, Advil and Motrin and didn't realize she shouldn't be taking them all at the same time."

The casual use of nonsteroidal anti-inflammatory drugs concerns Deborah Plate, a family practice physician in Akron, Ohio. She has about "20 conversations a week" with patients regarding use of the medications.

A lot of patients don't even remember to include them on a list of current medications they are using, Plate said.

"What's really important is to give them boundaries," she said, "because if they don't have boundaries, they think if one is good, two or three are better."

William Wojno, a rheumatologist with Summa Health System in Akron, said older patients are much more vulnerable to developing problems from nonsteroidal anti-inflammatory drug use, because they tend to have other medical conditions that can increase their risk.

However, younger patients also can develop such problems as ulcers and bleeding, he said.

"I've tried every single one of them," said rheumatoid arthritis patient Mary Lynne Zahler, 42. "Most of them just kill my stomach."

But through trial and error, Zahler and her doctor have settled on one brand of a nonsteroidal anti-inflammatory she can tolerate.

While some side effects may be worth the pain relief, others aren't.

Some of the adverse gastrointestinal reactions are "silent" -- about half the people who develop nonsteroidal anti-inflammatory drug-related ulcers never have any abdominal pain. Instead, they might not feel like eating much and lose weight.

Other signals that a person is developing problems, Plate said, include stomach pain "above the navel," vomiting that looks like it contains coffee grounds, or a change in bowel habits.

Sometimes, physicians can prescribe stomach-protecting medications that can be taken in tandem with an nonsteroidal anti-inflammatory drug, Pomidor said, though she doesn't think these medicines are as effective as doctors first believed.


Other drugs face an insurance hurdle

An option to nonsteroidal anti-inflammatory drugs is to use newer pain-relief medications cyclooxygenases-2 inhibitors, or COX-2 inhibitors said several pain specialists. These include brands such as Celebrex and Vioxx.

While still carrying some risk of gastrointestinal bleeding, COX-2 inhibitors tend to have fewer side effects than nonsteroidal anti-inflammatory drugs. However, the two medications have been linked to a nonbacterial type of meningitis in some patients, according to the Food and Drug Administration.

Roland Moskowitz, a rheumatologist with Case Western Reserve University and University Hospitals, said he often will first prescribe a COX-2 inhibitor for his patients instead of a nonsteroidal anti-inflammatory drug.

But many health care plans balk at first paying for the COX-2s because they are expensive; the plans require that a patient "fail" two traditional NSAIDs before trying COX-2.

Moskowitz said he doesn't think patients should have to fail two different nonsteroidal anti-inflammatory drugs before being eligible for the COX-2 inhibitors.

"That's like saying, `Don't wear a seat belt until you've had an accident,' " Moskowitz said. "Why not use the safer agent?"

He said he will tell an insurance carrier that if the patient develops gastrointestinal bleeding from taking a traditional nonsteroidal anti-inflammatory drug, "I'm going to lead the charge into court."

Often, the COX-2 prescription then will be approved.

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