Wednesday, April 19, 2006

FDA warning on naproxen, ibuprofen, other NSAIDs

In case you haven't seen it elsewhere, the US Food and Drug Administration has just issued a warning that naproxen may be implicated in the same sort of heart problems as have just caused them to pull Vioxx and Celebrex. Since many women have used this for postop pain control after a hyst, thanks to its 12-hour duration of action, it's something that we should all be aware of. That doesn't mean you can't use it, but you should definitely discuss the matter with your doctor before doing so. I don't know if this will ultimately include other non-steroidal anti-inflammatories or even aspirin, so keep an eye on the news. This link may not be good for long, but you can read more on the story here.


The above link, originally published in 12/04, is indeed dead now. But the FDA has finally and officially strengthened the warnings on naproxen, ibuprofen and a whole host of other non-steroidal anti-inflammatory drugs (NSAIDs). You can read the story in greater detail here, with all of the new precautions.

The main import for us is the addition of the cardiovascular risk warning, especially that of heightened clot risk. Since our surgery makes us more susceptible to clots (any abdominal surgery does; it's not specific to a hyst) and initiation of hrt can also raise our clot risk, these things all coming together do pose an interesting quandary in pain management and our ability to discontinue narcotics (which contribute to the dreaded postop constipation) as soon as possible. There are no firm answers here, but certainly a need to discuss this with your surgeon preoperatively, when you are still (relatively) lucid—not when you are at home clutching your generic discharge instruction sheet that was actually composed four years ago and never updated, and having second thoughts about what was really said in the uproar of checking out of the hospital.

Another update

As of 9/06, the latest thinking seems to be that naproxen may provide a lesser risk than some of the more high-powered NSAIDs. Still, because this is an issue that is still in flux and so many individual risk factors may come into play, it looks like the best policy remains "ask first."