Posted by ed_uk2010 on December 8, 2013, at 2:38:03
In reply to Re: Thoughts on Ibuprofen for arthritic pain + doses, posted by jono_in_adelaide on December 6, 2013, at 21:52:01
>I just did a bit of googling, and the idea of taking Prilosec or another PPI with your anti-inflammatory is also endorsed by the National Institute of Clinical Excellence in England (equivalent to the US National Institutes of Health) as well as the FDA, so there must be something in it.
Oh yes, it's standard practice, including all >60s. And you're right about the cardiovascular safety of naproxen, but some people do find it causes dyspepsia even with a PPI. Worth a try though. It is no more analgesic than ibuprofen in the short-term, but its anti-inflammatory properties in arthritis are superior.
As for ibuprofen. 200-400mg up to three times a day tends to have a pretty good safety record, both gastric and cardiovascular. Total doses above 1200mg, especially up to 2400mg cause far more adverse effects. Ibuprofen may be less effective for severe arthritis pain than some of the stronger NSAIDs, but is a very useful pain reliever for other types of pain.
Diclofenac is a very effective NSAID but its cardiovascular safety is poor. Very suitable for acute severe rheumatic inflammation eg. acute gout for a week or so.
Celebrex has a considerably better cardiovascular safety profile than Vioxx at its currently licensed dose. The dose should be kept as low as possible. Higher than recommended doses appear to have a poor cardiovascular safety profile. The gastric tolerability of Celebrex is usually quite good, but a PPI is still recommended in the elderly.
Etoricoxib (Arcoxia) is a potent long-acting NSAID sometimes used in Europe, but not in the US. Its cardiovascular safety profile is poor in the long-term, but it provides very good and sustained pain relief in the short-term esp. post-op pain, severe dental pain and gout attacks.
Hope this helps.
poster:ed_uk2010
thread:1055473
URL: http://www.dr-bob.org/babble/20131115/msgs/1055670.html