ss, some excerpts on effects of NSAIDs, one positive - Doc
New Pain Guideline for Older Patients
Avoid NSAIDs, Consider Opioids
Bridget M. Kuehn
JAMA. 2009;302(1):19.
Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.
Physicians treating patients aged 75 years or older for chronic pain should avoid using nonsteroidal anti-inflammatory drugs (NSAIDs), according to an updated guideline issued by the American Geriatrics Society (AGS) in May.
NSAIDs should be "considered rarely, and with extreme caution, in highly selected individuals," the new guideline states, contradicting the AGS's 2002 guideline. The new recommendation reflects evidence about serious cardiovascular and gastrointestinal tract risks associated with this class of drugs that has emerged since 2002, said Bruce Ferrell, MD, chair of the panel that created new guideline and professor of medicine and geriatrics at the University of California, Los Angeles. These drugs also may complicate the treatment of common conditions in this population, such as hypertension and congestive heart failure.
jama.ama-assn.org
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CLINICIAN'S CORNER
Aminotransferase Elevations in Healthy Adults Receiving 4 Grams of Acetaminophen Daily
A Randomized Controlled Trial
Paul B. Watkins, MD; Neil Kaplowitz, MD; John T. Slattery, PhD; Connie R. Colonese, MS; Salvatore V. Colucci, MS; Paul W. Stewart, PhD; Stephen C. Harris, MD
JAMA. 2006;296:87-93.
Context During a clinical trial of a novel hydrocodone/acetaminophen combination, a high incidence of serum alanine aminotransferase (ALT) elevations was observed.
Objective To characterize the incidence and magnitude of ALT elevations in healthy participants receiving 4 g of acetaminophen daily, either alone or in combination with selected opioids, as compared with participants treated with placebo.
Design, Setting, and Participants A randomized, single-blind, placebo-controlled, 5-treatment, parallel-group, inpatient, diet-controlled (meals provided), longitudinal study of 145 healthy adults in 2 US inpatient clinical pharmacology units.
Intervention Each participant received either placebo (n = 39), 1 of 3 acetaminophen/opioid combinations (n = 80), or acetaminophen alone (n = 26). Each active treatment included 4 g of acetaminophen daily, the maximum recommended daily dosage. The intended treatment duration was 14 days.
Main Outcomes Serum liver chemistries and trough acetaminophen concentrations measured daily through 8 days, and at 1- or 2-day intervals thereafter.
Results None of the 39 participants assigned to placebo had a maximum ALT of more than 3 times the upper limit of normal. In contrast, the incidence of maximum ALT of more than 3 times the upper limits of normal was 31% to 44% in the 4 treatment groups receiving acetaminophen, including those participants treated with acetaminophen alone. Compared with placebo, treatment with acetaminophen was associated with a markedly higher median maximum ALT (ratio of medians, 2.78; 95% confidence interval, 1.47-4.09; P<.001). Trough acetaminophen concentrations did not exceed therapeutic limits in any participant and, after active treatment was discontinued, often decreased to undetectable levels before ALT elevations resolved.
Conclusions Initiation of recurrent daily intake of 4 g of acetaminophen in healthy adults is associated with ALT elevations and concomitant treatment with opioids does not seem to increase this effect. History of acetaminophen ingestion should be considered in the differential diagnosis of serum aminotransferase elevations, even in the absence of measurable serum acetaminophen concentrations.
Author Affiliations: Department of Medicine, University of North Carolina, Chapel Hill (Dr Watkins); Keck School of Medicine, Department of Medicine, University of Southern California, Los Angeles (Dr Kaplowitz); Departments of Pharmacology and Medicine, University of Washington, Seattle (Dr Slattery); Boehringer-Ingelheim Pharmaceuticals, Inc, Ridgefield, Conn (Ms Colonese); Department of Clinical Pharmacology and Clinical Pharmacokinetics, Purdue Pharma L.P., Stamford, Conn (Mr Colucci and Dr Harris); Deparment of Biostatistics, University of North Carolina, Chapel Hill (Dr Stewart).
jama.ama-assn.org
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NSAIDs May Lower Prostate Cancer Markers
Study Shows Ibuprofen and Other NSAIDs Reduce PSA Levels
By Salynn Boyles
WebMD Health NewsReviewed by Louise Chang, MD
Sept. 8, 2008 -- Regular use of aspirin, ibuprofen, and other anti-inflammatory pain relievers appears to lower blood levels of the prostate cancer biomarker prostate-specific antigen (PSA).
In a newly reported study, men who used nonsteroidal anti-inflammatory drugs ( NSAIDs) almost every day had average PSA levels that were lower than men who didn't use the pain relievers.
The study is among the first to link NSAID use to lower PSA levels, but the clinical significance of the findings is not clear, researchers say.
The findings may mean that regular NSAID use helps protect against prostate cancer. Or NSAIDs may offer no protection at all, and may simply reduce the sensitivity of PSA as a screening tool for prostate cancer.
"All we can say from this study is that taking these medications regularly resulted in lower PSA values," urologist and study researcher Eric A. Singer, MD, of the University of Rochester Medical Center tells WebMD.
NSAIDS, PSA, and Prostate Cancer
Chronic inflammation is increasingly suspected of playing a role in several cancers, including those of the colon, bladder, and stomach.
There is also some evidence that inflammation plays a role in prostate cancer and that regular NSAID use may help protect against the cancer. But these studies are not conclusive, study co-author Edwin van Wijingaarden, PhD, tells WebMD.
"Several studies have reported a small benefit for NSAID use on prostate cancer, but there is very little information on its impact on PSA, which is the main screening tool for prostate cancer," he says.
In an effort to better understand the impact of NSAID use on PSA levels, the researchers analyzed data collected by the CDC in 2001 and 2002 as part of a nationwide health and nutrition survey. Information about dosage and reason for taking NSAIDs or acetaminophen were not available for analysis.
PSA levels and information on NSAID and acetaminophen use were available for 1,319 men included in the analysis. All the men were 40 or older, but most (72%) were not yet 60.
Men who reported using NSAIDs nearly every day had PSA levels that were about 10% lower than men who reported no current NSAID use.
The study is published in the Oct. 15 issue of the journal Cancer.
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