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Aspirin-Like Drugs for Arthritis Treatment
July 5, 2009 | Leave a Comment
Aspirin-Like Drugs
One of the best arthritis buys in the pharmacy is a frequently overlooked prescription drug called salsalate. It has been around for so long that many physicians have forgotten about it. Because salsalate is available generically, the cost should only be the amount of your co-pay. Even without insurance, the cost shouldn’t be much more than $1 a day.
salsalate is a kissing cousin to aspirin (it is salicylsalicylic acid instead of acetylsalicylic acid). Because it lacks the acetyl group, salsalate behaves differently in the body. Studies done 20 to 30 years ago suggest that it may be a little less irritating to the stomach than aspirin because it is absorbed only from the small intestine. (There are no data on whether it irritates the small intestine the way enteric-coated aspirin does.)
Asalsalate is just as effective as aspirin at relieving joint pain or morning stiffness. Unfortunately, it probably won’t prevent blood clots or heart attacks the way aspirin does. salsalate may also be a little more likely to cause dizziness or ringing in the ears. It does require medical supervision, just as any NSAID does, and probably has similar side effects.
BRANDS OF SALSALATE
• Amigesic • Mono-Gesic
• Artha-G • Salflex
• Disalcid • Salsitab
Another aspirin-like arthritis medicine that is often overlooked is choline magnesium trisalicylate (Tricosal, Trilasate, Trisalicylate). It too requires a prescription and should cost a lot less than $1 a day. Like salsalate, it may be a little less irritating to the stomach than aspirin. Again, it provides no extra protection against heart attacks or strokes.
Ibuprofen and Naproxen
For those who cannot tolerate aspirin or who want a traditional NSAID to get them over a hump, which drugs would we consider using? This is an incredibly difficult call because of the new and alarming data linking these drugs to heart attacks. If forced to recommend something, we would probably fall back on naproxen. For one thing, it is a good deal. When prescribed generically the co-pay should be $10 or less a month. Even when purchased over the counter the cost should be no more than 15 cents per day. That compares to as much as $4 to $7 a day for Celebrex.
One study found that ibuprofen and naproxen are not associated with accelerated progression of hip and knee arthritis the way some other NSAIDs are.82 Another possible plus with these two drugs may be a somewhat safer cardiovascular profile. One epidemiological study demonstrated no increased risk of heart attacks or other cardiovascular complications with these two pain relievers when they were used for short periods of time. 13 Another study, unfortunately, found that NSAIDs like ibuprofen increase the risk of a second heart attack.” A Danish study of nearly 60,000 heart attack survivors showed that NSAIDs such as Celebrex, ibuprofen, and diclofenac were linked to an increased risk of heart attack death. This complication showed up within several weeks of starting on the pain reliever. The researchers concluded that heart attack survivors need to be very cautious about the kind of pain reliever they use.
N a p r o x e
Naproxen is an NSAID available both OTC and by prescription (Anaprox, Naprelan, Naprosyn). it does a reasonable job of relieving arthritis pain and the effect lasts a little longer than that of Ibuprofen. Some researchers believe that it may be less likely to pose cardiovascular risks than other NSAIDs. This is unconfirmed, and naproxen may not be as safe as we would wish.84
Downside: Damage to the stomach lining. Indigestion, gastritis, and ulcers. High blood pressure, kidney problems, liver complications, rash, constipation, diarrhea, dizziness, and ringing in the ears.
Cost: Approximately $4 to $5 per month SIGNS OF TROUBLE!*
• Chest pain
• Shortness of breath or sudden weakness
• Slurred speech or paralysis
• Severe stomach pain or indigestion
• Black, tarry stools
• Sudden weight gain
• Trouble removing a ring
• Skin rash, itching, blisters, fever
• Nausea, fatigue, yellow eyes, flu symptoms
*If any of these symptoms occur, contact your physician immediately or visit urgent care.
Even people who have not had a heart attack need to be wary about NSAIDs. Anyone with high blood pressure, high cholesterol, blockage in a coronary artery, or kidney problems is likely to be at increased risk of a heart attack when taking such pain relievers. Finnish investigators studied more than 33,000 heart attack patients hospitalized between 2000 and 2003. By comparing them to 139,000 control subjects, the researchers found that taking any NSAID increased the chance of a heart attack by approximately 40 percent.
For those who think taking aspirin together with a drug like Advil or Aleve might diminish any risk of a blood clot, think again. There are no clear-cut data to support that notion. There is even some worry that drugs like ibuprofen and naproxen might undo the cardiovascular protective benefits of aspirin.88,89 Be wary of interactions with other medications, especially blood pressure drugs (ACE inhibitors), furosemide (Lasix), lithium (Eskalith, Cibalith, Lithane, Lithobid, Lithotabs), methotrexate, (Rheumatrex, Trexal), and blood thinners like warfarin (Coumadin).
Of course anyone who opts to use an NSAID must treat these drugs with the respect they deserve. Treatment for more than 10 days requires medical supervision and great vigilance. Remember, there may be an increased risk for heart attack, hypertension, heart failure, kidney problems, and ulcers.
To counteract the risk of serious GI toxicity, many gastroenterologists now routinely recommend acid-suppressing drugs called PPIs (proton pump inhibitors) in combination with NSAIDs. Medications such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex) are supposed to diminish the likelihood of NSAID-induced stomach upset and ulcers.’ Despite this belief, there is no guarantee that such drugs can prevent all ulcers or perforations. A review of the use of low-dose aspirin in the New England Journal of Medicine cautions against any sense of complacency. This should apply to all NSAIDs.