Is naproxen is safer in patients with heart disease than other NSAIDs?

All NSAIDs have a “black box” warning about increased cardiovascular risk. This was added almost a decade ago after the withdrawal of Vioxx. But CV risk isn’t necessarily equal between NSAIDs. Here’s a new report from the experts at Prescriber’s Letter:

Naproxen has a longer half-life than many traditional NSAIDs … which means longer platelet inhibition due to inhibition of the COX-1 enzyme. This might translate to fewer CV events than other NSAIDs that are shorter-acting or more COX-2 selective.

In fact, a recent meta-analysis suggests that naproxen is associated with fewer CV events than diclofenac, ibuprofen, or celecoxib.

But naproxen’s CV risk hasn’t been DIRECTLY compared to other NSAIDs in good randomized trials … so it’s too early to say it’s safer.

This is why FDA isn’t changing naproxen labeling right now. However, the good news is a large randomized controlled trial will evaluate CV, GI, and renal safety of naproxen, ibuprofen, and celecoxib. Unfortunately, the results won’t be available until late 2015.

Prescriber’s Letter says to use doctors, “For now, limit NSAIDs, except low-dose aspirin, if CV risk is high. Even short-term use may be risky in these patients” and “Lean toward naproxen if CV risk is a concern … and celecoxib or low-dose ibuprofen if GI risk is a concern. Try to avoid NSAIDs in patients who are at both high CV and GI risk.”

==========================================

This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

Enter your email to subscribe to Dr. Walt's blogs.

You have successfully subscribed to the newsletter

There was an error while trying to send your request. Please try again.

Dr. Walt Larimore will use the information you provide on this form to be in touch with you and to provide updates and marketing.