Within a few days a patient with previously stable heart failure was lying in an Intensive Care Unit (ICU) clinging to life with severe congestive heart failure (CHF) and acute renal failure. He was a good patient, always took his medication on time and stayed away from salty foods, and he listened to his doctors and took what they prescribed him.
It was his misfortune that he was so obedient to his doctor’s orders. A week before he had visited a pain specialist, a field that is more and more being infiltrated by physicians looking to make easy money by performing procedures and tests that result in huge profits and little improvement in the patient’s pain.
There he was prescribed a drug, Vimovo, a combination of Naproxen and esomeprazole ( a Prilosec-like medication) that is marketed by Horizon Pharmaceuticals. Sadly, a 60 day supply of Vimovo retails for around $137 at Costco while a similar dose of generic Naproxen could be purchased for $10 at the same store. More on that part of the story in a future article.
A few months earlier I cared for another patient was also in heart failure after a podiatrist suggested he take some Advil for his painful toe. While the over-the-counter version of this drug only costs pennies, it was of the same non-steroidal anti-inflammatory drug class (NSAID) and had the same effect. It diminished the blood flow to the kidneys and eventually caused the patient to swell with fluids, the blood pressure to rise, and the kidneys to work less effectively.
NSAIDs, available to anyone at their local pharmacy and under the names like Motrin, Advil, and Alleve, are very unsafe drugs when patients with heart failure, kidney disease, or hypertension take them. The Federal Drug Administration (FDA) is NOT doing a good enough job warning patients about the risk of these drugs. Some doctors, like this specialist in pain management seem naïve to the risk or, as I suspect, are too concerned with assembly line medicine to ask their patient if they have a heart disease, are prescribing medications that appear innocuous, but are very harmful. And other healthcare providers that include dentists, podiatrists, and orthopedists seem to be less knowledgeable about how harmful these medications can be, if given to the wrong patient.
Patients with controlled hypertension who are given an NSAID may find their blood pressure out of control and in their local Emergency Room with a headache or stroke. And patients with coronary disease might be increasing their risk of heart attack by just taking one Advil.
To be fair to manufacturers of NSAIDs, like Horizon Pharmaceuticals, and the FDA, there are warnings on its packaging insert:
- Like all medications that contain non-steroidal anti-inflammatory drugs (NSAIDs), VIMOVO may increase the chance of a heart attack or stroke that can lead to death.
- This increases with a longer use of NSAID medicines in people who have heart disease
- NSAID containing medications, such as VIMOVO, should never be used before or after a type of heart surgery called coronary artery bypass graft (CABG)
- As with all medications that contain NSAIDs, VIMOVO may increase the chance of stomach and intestinal problems, such as bleeding or an ulcer, which can occur without warning and may cause death
- Elderly patients are at greater risk for serious gastrointestinal events
But few patients read the package insert, especially when a physician tells them to take the drug. And too many physicians don’t take the two-seconds to ask: “ Do you have heart disease?”
Twenty-years ago I would never consider writing this, being indoctrinated through my training about the horrors and inappropriateness of malpractice lawsuits, but if physicians are handing out deadly drugs to patients, and if some of those patients are getting very sick because of it, then we need to find a way to prevent this. Unfortunately I continue to witness patients with CHF and renal disease prescribed NSAIDs and it appears that our FDA is not policing big Pharma or enough physicians to stop this. Perhaps a few multi-million dollar lawsuits that make the tabloids might be our only deterrent.
Dr. Evan S. Levine, M.D., F.A.C.C.(Fellow of the American College of Cardiology) is director of The Saint Joseph Cardiovascular Center and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or Can’t) Tell You”. He resides in Connecticut with his wife, two daughters, and two cats, and can be reached by directing e-mail to firstname.lastname@example.org.