Alternatives to Ibuprofen?

Pill Box: Options for pain relief

click to enlarge John R. White chairs WSU-Spokane's Department of Pharmacotherapy.
John R. White chairs WSU-Spokane's Department of Pharmacotherapy.

I saw a story on the news that said Celebrex (celecoxib) was safer than either ibuprofen or naproxen. I take over-the-counter ibuprofen once or twice a week for headaches. Should I talk to my doctor about a prescription for Celebrex?

There are a multitude of nonsteroidal anti-inflammatory drugs (NSAIDs) on the market. The three that you mention above are included in this category. One of the problems with most NSAIDs is that they can facilitate stomach upset, bleeding and ulcerations. Because of this, a new category of NSAIDs was developed that does not cause this effect. They are called COX-2 inhibitors. Unfortunately, one of the COX-2 inhibitors (Vioxx) was found to increase the incidence of heart attack and was removed from the market. This left concerns regarding the other COX-2 inhibitor, Celebrex.

The study that was recently published in the New England Journal of Medicine and presented at the American Heart Association meeting compared the safety of Celebrex (prescription only), ibuprofen (prescription and OTC) and naproxen (prescription and OTC). Prior to this study, most had assumed that Celebrex was the most dangerous and naproxen was the safest. This study evaluated people who were at high risk for, or already had, heart disease and who were also taking one these meds every day for months or years. More people taking ibuprofen showed worsened kidney function than in the other two groups. An increased risk of hospitalization for high blood pressure or the development of gastrointestinal bleeding or ulcers was reported in those taking naproxen or ibuprofen. Celebrex was not found to be riskier for heart health than the other two medications.

While it appears that Celebrex may be "safer," this is only one study, and it was done in people who were at risk for heart disease who were chronically taking daily doses of NSAIDs. For someone who only occasionally uses ibuprofen, you should not be concerned about the findings of this study (as long as you do not have contraindications to the use of ibuprofen). If you are not sure, please consult with your pharmacist or medical care provider.

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