Two articles currently being prepared for publication in The Medical Letter touch on the risks associated with NSAIDs.
One is a brief article reporting that the FDA has approved 2 generic formulations of celecoxib (Celebrex), which is the only COX-2 selective NSAID remaining on the market in the US. The COX-2 selective drugs, also called coxibs, were supposed to provide the analgesic and anti-inflammatory effects of nonselective NSAIDs without their GI toxicity. They did that, but their prothrombotic effects took down first rofecoxib (Vioxx) and then valdecoxib (Bextra). Celecoxib was the least COX-2 selective of the coxibs, and it has not only survived but prospered, ranking among the 25 drugs most prescribed in the US. There is general agreement that celecoxib causes less GI toxicity than ibuprofen or naproxen. Whether it could be a little less heart-healthy than the nonselective NSAIDs is unclear; in any case, the absolute risk is small.
The second article is on Drugs for Osteoarthritis, which many seniors self-medicate effectively with NSAIDs. But we should probably warn them against doing that because even if they take celecoxib and minimize the risk of GI bleeding, they are still susceptible to the renal toxicity of NSAIDs, which is unaffected by COX selectivity and is much worse in the elderly. Renal side effects of NSAIDs include salt and water retention, decreased effectiveness of antihypertensive meds, decreased effectiveness of diuretics, decreased urate excretion, and hyperkalemia. So they develop hypertension or their pre-existing hypertension grows worse, they go into heart failure, they develop gout, and their kidneys fail. Acetaminophen may be a little less effective, but as long as they don’t overdose, it’s probably a lot safer.