10-06-2004, 20:28
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#2
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Quiet Professional
Join Date: Jan 2004
Location: Phoenix, AZ
Posts: 20,929
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Quote:
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Originally Posted by greg c
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It might be evolving to you but for me it's over.....
Vioxx has been removed from the market.
Team Sergeant
former Poster Boy for Vioxx.....
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Team Sergeant is offline
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10-06-2004, 20:34
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#3
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Quiet Professional
Join Date: Jan 2004
Location: Free Pineland
Posts: 24,822
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Quote:
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Originally Posted by Team Sergeant
It might be evolving to you but for me it's over.....
Vioxx has been removed from the market.
Team Sergeant
former Poster Boy for Vioxx.....
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Yo tambien, and after reading that, I am considering alternatives for the Celebrex they gave me to replace it.
It was nice to take one low dose, low stomach upset pill, once daily, but looks like there are good reasons not to use any of the COX2 inhibitors now.
I may be back to burning holes in my stomach with Ibuprofen and using narcotics when it gets really bad.
Bummer.
TR
__________________
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." - President Theodore Roosevelt, 1910
De Oppresso Liber 01/20/2025
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The Reaper is offline
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10-06-2004, 20:41
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#4
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Quiet Professional
Join Date: Jan 2004
Location: Phoenix, AZ
Posts: 20,929
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celebrex and vioxx have the same basic mechanism of action and it is now being questioned whether the other two cox-2 inhibitors (celebrex and bextra) will have the same side effect if the studies are done to assess for this. Studies necessary to pass FDA approval don't typically have the patient numbers to bear out certain side effects... it was a study looking at vioxx for decreasing the incidence of colonic polyps that began to show an increased incidence in cardiac/cerebral events...
I would be cautious about using the drugs until further testing occurs... if it occurs.
doc t.
TR I asked Doc T to address this when I saw your post... as I saw you're in the same situation I currently in.... and I'm back on motrin....
TS
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Team Sergeant is offline
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10-06-2004, 20:46
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#5
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Consigliere
Join Date: Jan 2004
Location: Free Pineland (at last)
Posts: 8,841
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Doc T:
Isn't it possible to take something to control the impact on the stomach from taking ibuprofen constantly, like prilosec or whatever?
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Roguish Lawyer is offline
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10-06-2004, 20:59
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#6
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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Damn! So much material here I don't know where to start. 
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
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NousDefionsDoc is offline
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10-06-2004, 21:19
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#7
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Gun Pilot
Join Date: Jan 2004
Location: Iowa and New Mexico
Posts: 2,143
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I also was on Celebrex, and was just switched to Etodolac, then to Pyroxicam. I used to be on 800 mg Ibuprofen 4 times per day.
Terry
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E7-CW3-direct commission VN
B model gunship pilot 65-66 Soc Trang, Cobra Pilot 68-69-70 Can Tho Life member 101st Airborne Association
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CPTAUSRET is offline
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10-06-2004, 21:42
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#8
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Consigliere
Join Date: Jan 2004
Location: Free Pineland (at last)
Posts: 8,841
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Quote:
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Originally Posted by CPTAUSRET
I used to be on 800 mg Ibuprofen 4 times per day.
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WOW
[now this post is more than 10 &*^%*&^%*&^% characters]
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Roguish Lawyer is offline
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10-07-2004, 05:24
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#9
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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Gents,
the vioxx issue has been there for over 2 years and finally a second study was done , for another reason, and the same 'bad' effects were noted. The big conference given by Capt. Frank Butler for the Tactical Combat Casualty Care has Vioxx as the preferred in theater oral med for pain control. As a heavy user of Cox-2 drugs, I use Bextra 20-40 mg for the same purpose as Vioxx (I have never prescribed Vioxx due to all thatI had learned about it...sorry TS, it's a dangerous drug, now verified. Bextra, like Celebrex has a significantly reduced incidence of stomach side effects (gastritis, ulcers, bleeding) and does NOT interfere with platelet function so that your blood will clot normally.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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10-07-2004, 09:37
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#10
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Guest
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I am not sure that celebrex has been shown to not increase risks...I need to review the data cited in this article but they say the retrospective review of the year of data rather than 6 months of data does show a trend towards increased cardiovascular risk... not statistically significant from what it implies but certainly could be a concern...
I would stay tuned and avoid them unless you have known GI intolerance with bleeding or very low CV risk...my two cents. Team Sergeant is back on motrin....
t.
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10-07-2004, 16:04
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#11
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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motrin....... put him on Bextra, actually don't, I love operating on bleeding stomachs !!!!!!!
JUST KIDDING TS!! Doc T would kill me if anything happened to him!!
Agree with the need for further studies across the class but so far in any study I've read, no statistical significant increase in CV problems.
T-2
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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10-07-2004, 21:01
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#12
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Guerrilla
Join Date: Mar 2004
Location: Event Horizon...
Posts: 383
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Quote:
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Originally Posted by Roguish Lawyer
Isn't it possible to take something to control the impact on the stomach from taking ibuprofen constantly, like prilosec or whatever?
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Nonsteroidal anti-inflammatory drugs (NSAID) are prostaglandin inhibitors. Prostaglandin is formed when cells are damaged. An enzyme breaks down lipids in the cell wall and converts them to an acid. This is further broken down by the enzyme cylcooxygenase forming prostaglandin.
Prostaglandin lowers the threshold of nociceptive fibers so that stimuli is painful. NSAIDS prevent prostaglandin production by blocking cyclooxygenase.
Its more complicated than that but thats the gist of it.
Prostaglandin is also responsible for maintenance of the gastric mucosa. Blocking the actions of prostaglandin can lead to GI bleed, decreased platelet aggregation etc etc.
I havent personaly heard of any way to prevent it from MD's I know. One can take NSAIDs with food but that decreases absorption. I know in the ICU we put everyone on zantac right away d/t stress etc. I would bet someone has done studies of chronic NSAID use concurrent with a proton pump inhibitor (prilosec) or
H2 histamine receptor antagonist (zantac).
Sorry that isnt of any help-
Last edited by ccrn; 10-07-2004 at 21:03.
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ccrn is offline
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10-16-2004, 14:24
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#13
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Guerrilla
Join Date: Mar 2004
Location: Event Horizon...
Posts: 383
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Misoprostol
I found this med while floating over to a step down unit today.
Misoprostol(Cytotec):
Indication: To prevent NSAID-induced gastric ulcer in elderly or debiltated patients at high risk for complications from gastric ulcer and in patients wtih hx of NSAID induced ulcer.
Dose: 100-200microgram
Action: A synthetic prostaglandin E analogue that replaces gastric prostaglandins depleted by NSAID therapy. Also decreases basal and stimulated gastric secretion and may increase gastric mucus and bicarbonate production.
I dont know much about this drug other than it was part of a combination drug (Arthrotec) that incuded a Cox1-2 inhibitor. Also the pt it was prescribed to is 17 yrs old.
From what Ive read it is available as a stand alone med.
The Docs will have something to say about this Im sure-
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ccrn is offline
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10-18-2004, 13:06
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#14
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Asset
Join Date: Feb 2004
Location: Dallas TX
Posts: 16
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Well CCRN, glad they floated you. I was in a pain mangment meeting, we have a pt. with chronic hip pain, but is also a major narcotic drug seeker. So... we implemented a round the clock NSAID, COX ll inhibiters, and Cytotec. No one had used Cytotec, but all attending felt it would be very appropriate for the case. Thanks for a good tip.
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rogerabn is offline
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10-18-2004, 15:42
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#15
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Guerrilla
Join Date: Mar 2004
Location: Event Horizon...
Posts: 383
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YVW Sir,
From what Ive read the med has been controversial as an abortion pill and misused to induce labor-
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ccrn is offline
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