Danger warning on pain medicine

The Health Ministry has warned that thousands of people using any of five pain-relief medicines should see a doctor about stopping the treatment because of risks to the heart and brain.

The anti-inflammatory "cox-2 inhibitor" drugs, used particularly by arthritis sufferers, have been linked to possible increases in the risk of heart disease or stroke.

Many will now face the dilemma of giving up a useful drug or accepting a possibly increased risk of cardiovascular disease.

Cox-2 drugs have also been promoted as being easier on the stomach than older anti-inflammatories, although an arthritis expert says this risk of the older drugs, such as Voltaren, can be dealt with.

The ministry said it did not yet have enough information to quantify the risk associated with the five cox-2 inhibitors available in New Zealand.

"But our preliminary conclusions are that all cox-2 inhibitors may increase the risk of developing a heart attack or stroke to some degree in some patients," said Dr Stewart Jessamine, the principal medical adviser of the ministry's medicines regulator, Medsafe.

The ministry says people at high risk of these conditions should see their doctor immediately to discuss stopping cox-2 treatment.

Those not at high risk should discuss alternatives at their next GP appointment.

High-risk patients are those who have had a heart attack or stroke, who smoke, have diabetes or high blood pressure, are being treated for high cholesterol, or have a strong family history of heart disease.

In the past year, about 60,000 people have taken a cox-2 drug, a group which includes Vioxx and Celebrex.

Vioxx was used by about 15,000 people until it was suddenly withdrawn from worldwide sale last October after a study linked it to an increased risk of cardiovascular disease.

Only 1.5 per cent of Vioxx patients had cadiovascular problems, but this was double the 0.75 per cent on placebo pills.

Dr Jessamine said that despite uncertainty about the risks posed by each of the medicines, the possible increased cardiovascular risk outweighed the benefits of cox-2 inhibitors for most people.

A final decision would be made on the drugs once further trial data had been obtained.

The ministry said New Zealand had taken a more cautious approach than Australia, partly because none of the drugs was Government-funded in New Zealand so the ministry had only limited information on the types or numbers of patients using them.

In Australia, where the drugs are Government-funded, officials have ordered that warning labels be put on the drug packages.

Mark Crotty, general manager of Pfizer NZ, which supplies Celebrex, said he was mystified by the ministry's announcement.

"It seems a random and rushed decision," he said.

He disputed the ministry's findings, saying that the only evidence of increased cardiovascular risk from Celebrex was from a study in which people were taking four times the recommended dose.

Arthritis sufferer David Bracken, 64, said he would continue taking Bextra despite the publicity and risk of heart problems.

"I'd rather be pain free ... My doctor's brother takes it and if it's good enough for him it's good enough for me."

Mr Bracken, a North Shore fencing contractor, also used Vioxx, which he said was the best for pain relief, and was disappointed when it was withdrawn in October.

Pill danger

Health officials say people taking these drugs should see their doctor about stopping:

Celebrex
Arcoxia
Mobic
Dynastat
Bextra
Vioxx has already been withdrawn from sale