Bisher AKIL, MD

How much Aleve is safe?

In General Health on April 13, 2009 at 2:37 pm

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed but carry both gastrointestinal (GI) and cardiovascular (CV) risks. Multiple guidelines offer recommendations for mitigating the GI risks associated with NSAIDs (e.g., bleeding), but strategies for simultaneously dealing with the GI and CV risks of these drugs have not been published. To bridge this gap, the Canadian Association of Gastroenterology convened a panel of 21 physician-experts to develop evidence-based recommendations for long-term (>4 weeks) NSAID use.
After considering the strength of relevant evidence in the literature, the panel voted on a series of questions regarding NSAID use. Their answers were used to develop an algorithm to guide the use of NSAIDs in different GI and CV risks. Patients with high CV risk were assumed to be taking low-dose aspirin. The panel’s consensus document included the following recommendations:
1. Patients with low GI and low CV risks should receive a traditional NSAID.
2. Patients with low GI and high CV risks should receive naproxen (Aleve).
3. Patients with high GI and low CV risks should receive a cyclooxygenase-2 inhibitor (Celebrex) plus a proton-pump inhibitor (such as Prilosec, Prevacid, or Protonix).
4. Patients with high GI and high CV risks should receive a careful assessment to prioritize risks.
NSAIDs should be prescribed at the lowest effective dose and for the shortest possible duration. Ref:Rostom A et al. Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: Benefits versus risks. Aliment Pharmacol Ther 2009 Mar 1; 29:481. FROM JOURNAL WATCH.
Comments: Studies are still needed to validate these guidelines that are mainly based on personal experience more than clinical data; but this is a start _BA

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