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Van Canna · Post by **Van Canna** » Tue Feb 18, 2003 11:34 pm

Bill,

Thanks. But I am told you can take celebrex daily and a small aspirin as well. Is this true?

Gene DeMambro · Post by **Gene DeMambro** » Wed Feb 19, 2003 3:06 am

Hi Van,

Bill's for the most part correct about Celebrex and Vioxx being no better or no worse at relieving aches and pains than the older pain remedies like aspirin, Advil and Aleve, and the cases where they might be preferred over the older remedies, despite their higher cost. After my brotherss spinal fusion, he swore by his Vioxx and he felt it the next day everytime he missed his bedtime dose.

But I am told you can take celebrex daily and a small aspirin as well. Is this true?

I have been trying to get the respective manufacturers of Vioxx and Celebrex to supply data on this question for me, but to no avail. I don't think they have reliable data on this question. If you want, I'll make another round of phone calls to see if there's any recent info.

recent studies have shown that these new wonder drugs put you at higher risk for a cardiac event.

I wonder how much of this increased risk is due to the drugs themselves (i.e. Celebrex and Vioxx) vs. the fact that we tell our patients to NOT take aspirin or ibuprofen, which have proven cardio benefits.

Gene

Gene DeMambro · Post by **Gene DeMambro** » Wed Feb 19, 2003 3:07 am

Oh, one more thing.

A recent study by the makers of Vioxx showed that Vioxx does as good a job on acute pain as a standard Percocet tablet.

Van Canna · Post by **Van Canna** » Wed Feb 19, 2003 3:11 am

Gene,

Thanks for the information. It would be nice to get it straight from the manufacturer.

I think it was Vinny Who also said it was okay to take a daily aspirin with celebrex.

Guest · Post by **Guest** » Wed Feb 19, 2003 3:38 am

Gene DeMambro wrote:Oh, one more thing.

A recent study by the makers of Vioxx showed that Vioxx does as good a job on acute pain as a standard Percocet tablet.

--------------------
Pretty good as chemical All Bran as well.

And you don't need a medicine ball

Laird

Bill Glasheen · Post by **Bill Glasheen** » Wed Feb 19, 2003 4:11 pm

Van

It would be nice to get it straight from the manufacturer.

In this case, Van, I would say 'Buyer beware.' Apparently the manufacturers of these COX II drugs withheld vital information from the FDA when applying for approval. These data showed some of the cardiac problems associated with the use of COX II inhibitors. When it comes to drug manufacturers talking about the safety of their products vs. the chance to make some big buck$, you have a serious conflict of interest.

Last year there were more new drugs pulled off the market than in any other year. These streamlined FDA approval guidelines have their issues.

Nevertheless, it is good to ask. If they say it's a problem, then it most definitely is a problem.

Gene

Here's an abstract from a key publication.

Risk of cardiovascular events associated with selective COX-2 inhibitors.
JAMA. 2001 Aug 22-29;286(8):954-9. Review.
Mukherjee D, Nissen SE, Topol EJ.

Atherosclerosis is a process with inflammatory features and selective cyclooxygenase 2 (COX-2) inhibitors may potentially have antiatherogenic effects by virtue of inhibiting inflammation. However, by decreasing vasodilatory and antiaggregatory prostacyclin production, COX-2 antagonists may lead to increased prothrombotic activity. To define the cardiovascular effects of COX-2 inhibitors when used for arthritis and musculoskeletal pain in patients without coronary artery disease, we performed a MEDLINE search to identify all English-language articles on use of COX-2 inhibitors published between 1998 and February 2001. We also reviewed relevant submissions to the US Food and Drug Administration by pharmaceutical companies. Our search yielded 2 major randomized trials, the Vioxx Gastrointestinal Outcomes Research Study (VIGOR; 8076 patients) and the Celecoxib Long-term Arthritis Safety Study (CLASS; 8059 patients), as well as 2 smaller trials with approximately 1000 patients each. The results from VIGOR showed that the relative risk of developing a confirmed adjudicated thrombotic cardiovascular event (myocardial infarction, unstable angina, cardiac thrombus, resuscitated cardiac arrest, sudden or unexplained death, ischemic stroke, and transient ischemic attacks) with rofecoxib treatment compared with naproxen was 2.38 (95% confidence interval, 1.39-4.00; P =.002). There was no significant difference in cardiovascular event (myocardial infarction, stroke, and death) rates between celecoxib and nonsteroidal anti-inflammatory agents in CLASS. The annualized myocardial infarction rates for COX-2 inhibitors in both VIGOR and CLASS were significantly higher than that in the placebo group of a recent meta-analysis of 23 407 patients in primary prevention trials (0.52%): 0.74% with rofecoxib (P =.04 compared with the placebo group of the meta-analysis) and 0.80% with celecoxib (P =.02 compared with the placebo group of the meta-analysis). The available data raise a cautionary flag about the risk of cardiovascular events with COX-2 inhibitors. Further prospective trial evaluation may characterize and determine the magnitude of the risk.

Van Canna · Post by **Van Canna** » Wed Feb 19, 2003 4:17 pm

Thanks Bill,

confusing as hell.

RACastanet · Post by **RACastanet** » Wed Feb 19, 2003 5:36 pm

Last week I had a sharp pain in my chest and went to the ER. The attending and the cardiologist ran me though a bunch of tests and could find no problem. However, they suggested I take a week off from Celebrex 'as it is very effective, but not perfect'. That appears to have done the trick. Gastrointestinal problems can mimic a heart problem.

Also, I quized them on the COX2 issue and cardiac problems. Their take is that if you have no problems or risk factors do not worry about it. However, if you have risk factors such as weight, family history, smoke, existing conditions, then consider the risk involved. It is small but real.

Rich

Bill Glasheen · Post by **Bill Glasheen** » Wed Feb 19, 2003 11:42 pm

More answers to questions... I had an impromptu watercooler symposium with two pharmacists in my healthplan. Both are VERY well read. Here's what I gleaned from them.

To Rich...

Percocet contains oxycodone and acetaminophin (Tylenol). Tylenol III has codeine and acetaminophin. Oxycodone is a synthetic derivative of codeine. It is a schedule II narcotic, whereas codeine is schedule III (the lower number being more restricted due to the potential for addiction and abuse.

To Van...

Studies have been done where folks took Celebrex and LDAT (low dose aspirin therapy). The bottom line is that even the very little bit of aspirin used in LDAT will completely negate all the beneficial effects of taking a selective COX II antagonist (a drug that won't bother your stomach). So as the pharmacists put it "What's the point?" You end up in no better shape than if you just took regular aspirin (preferably coated or buffered aspirin) at standard therapy levels. There is one difference though. Celebrex plus LDAT is many orders of magnitude more expensive than standard dose aspirin.

I suspect this is the reason that the manufacturer isn't responding to questions about Celebrex plus LDAT.

- Bill

Gene DeMambro · Post by **Gene DeMambro** » Wed Feb 19, 2003 11:56 pm

It is a schedule II narcotic, whereas codeine is schedule III (the lower number being more restricted due to the potential for addiction and abuse.

Codeine, in tablets or injections by itself, is Schedule II. This is the highest Scheduling for drugs in the US that have a high potential for abuse, but have medically accepted uses. Heroin, for example, has no medically accepted use in the US, and thus is a DEA Schedule I substance.

Codeine, in combination tablets and capsules with other stuff, like Tylenol or aspirin, is a Schedule III. This means it still has a protential for abuse, but not as much as a Schedule II, and prescribing and dispensing restrictions aren't as strict.

Interestingly enough, Cocaine is only Schedule II, b/c it still enjoys wide use as an anesthetic for certain eye, nose and throat procedures.

The bottom line is that even the very little bit of aspirin used in LDAT will completely negate all the beneficial effects of taking a selective COX II antagonist

Bill, would you be so kind as to throw these references my way? This is precisely the information I'm looking for!

Confused yet, Van

Gene

chef · Post by **chef** » Thu Feb 20, 2003 12:05 am

Sorry, this is off subject.
Please check your PM. Need important info.

Thanks,
Vicki

chef · Post by **chef** » Thu Feb 20, 2003 12:06 am

Last message for Bill.
Vicki

RACastanet · Post by **RACastanet** » Thu Feb 20, 2003 12:10 am

Next question: How are morpine and codeine related? Do they originate from the same basic compound?

Rich

Van Canna · Post by **Van Canna** » Thu Feb 20, 2003 3:16 am

Confused?

Well, my doctor today said it is okay to take both celebrex and ldat...#$%*(*)

M. Keller · Post by **M. Keller** » Thu Feb 20, 2003 3:53 am

Rich,

They are both opiates, and both have similar effects on differing scales. The liver can actually interconvert codeine to morphine and hydrocodone, though the percentages differ somewhat by person, as do the effects of the drug

-Mike

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