Stroke ibuprofen

In addition to their beneficial effects, some medications may actually cause cellular injury and disease. An example of this phenomenon involves nonsteroidal anti-inflammatory drugs (NSAIDS). These drugs include aspirin (a derivative of salicylic acid), ibuprofen (arylpropionic acid, Advil ), and acetaminophen (para-aminophenol derivative, Tylenol ). Because of their beneficial pharmacological effects, consumption of these agents has increased significantly in recent years. NSAIDS have the ability to treat fever, pain, acute inflammation, and chronic inflammatory diseases such as arthritis. They are also used prophylactically to prevent heart disease, stroke, and colon cancer. 

The FDA approved this selective cyclooxigenase (COX)-2 inhibitor (Vioxx) for the treatment of pain and inflammation in 1999. This NSAID demonstrated to have a lower risk of side effects such as gastrointestinal ulcers and bleeding than nonse-lective COX inhibitors, for example, ibuprofen. In 2004, a long-term study of Vioxx in patients at increased risk of colon polyps was halted because of an increased cardiovascular risk (heart attack, stroke) in the rofecoxib group. Subsequently, Merck withdrew the drug from the world market at the end of September 2004 [46]. 

Aspirin, 325-650 mg every 4-6 hours Bayer Aspirin, Ecotrin, Bufferin, various generic children who cannot chew or swallow tablets. Do not exceed a total daily acetaminophen dose of 4 g (2 g/d in regular alcohol users). Aspirin should be used cautiously in certain individuals (see text). Use of OTC products containing aspirin, other salicylates, acetaminophen, ibuprofen, or naproxen may increase the risk of hepatotoxicity and gastrointestinal hemorrhage in individuals who consume 3 or more alcoholic drinks daily. Long-term continuous use of NSAIDs may increase the risk of heart attack or stroke. 

Vioxx may no longer be available, but the theory behind its development was scientifically sound and other drugs are coming to take its place, such as Prexige which was launched in January 2006 and which its makers, Novartis, say has been tested on 34,000 patients and shown to be no more likely to cause heart attacks or strokes than the other commonly used painkillers like ibuprofen. 

Patients with osteoarthritis or rheumatoid arthritis are randomized to one of three treatments, celecoxib, ibuprofen, or naproxen, and the primary endpoint is the occurrence of a cardiovascular endpoint a nonfatal myocardial infarction, a nonfatal stroke, or any cardiovascular death. Non-inferiority will be assessed for three different pairwise comparisons celecoxib versus ibuprofen, celecoxib versus naproxen, and ibuprofen versus naproxen. The definition of non-inferiority differs somewhat from the fixed margin approach describe earlier in that there are separate criteria for the confidence interval and the point estimate. The hazard ratio for each comparison will be calculated, and non-inferiority will be concluded if the upper end of the... 

NSAIDs, including ibuprofen, are contraindicated in patients with active bleeding, ulceration, or perforated viscous. NSAIDs are contraindicated in the setting of acute or chronic renal dysfunction. NSAIDs have been shown to increase the risk of cardiovascular thrombotic events, myocardial infarction, and stroke, especially in patients with known cardiovascular disease or with known risk factors for cardiovascular... 

Ibuprofen can increase the risk of life-threatening cardiovascular events, including heart attack or stroke. 

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