21
Volume2 Issue6
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N
ews and
E
vents
HealthCanada Review:
NEWSAFETY INFORMATIONON
PRESCRIPTION-STRENGTH IBUPROFEN
The review showed that prescription-strength
ibuprofen is linked to increased riskof heart attack
and stroke. However, HealthCanada still considers
that “thebenefitsof prescriptionoral ibuprofen
products continue tooutweigh the risks as an
effectivepainand inflammation treatment, but
that additionalmeasures areneeded for these
products to further reduce thecardiovascular risk.”
HealthCanada recommends that healthcare
professionals consider thecardiovascular risks
whenprescribing ibuprofen, and that high
doses (definedas 2400mgormoreper day) not
beprescribed topatientswith ischemicheart
disease, cerebrovascular disease, or congestive
heart failure.
Thisbest practicealsoapplies topatientswith
known risk factors suchas smoking, highblood
pressure, diabetes, highbloodcholesterol, heart
failure, andheart disease. Furthermore, pain
management strategies that donot include the
useof non-steroidal anti-inflammatorydrugs
(NSAIDs) shouldbe sought for patients at high risk
of acardiacevent.
Dr. Gilles Lavigne, deanof theUniversityof
Montreal facultyof dentalmedicineandpresident
of theCanadianPainSociety, recognizes the
riskassociatedwithhighdoses andprolonged
usedof analgesics. “Asdentists,wehave
the responsibility toconsider health risks
(cardiovascular health, kidney function, addiction,
etc.)whenprescribinganymedication, and to
monitor howour patientsuse themedication,” he
says. “In thepresenceof any signof sideeffects
or overuse, rapidcollaborationwithother health
professionals is required.”
Themaximumdoseof ibuprofen recommended
byHealthCanadacanquicklybe reached,
acknowledgesDr. Lavigne, considering that one
may, for example, prescribedosesof 600mg
after anendodontic treatment. “Acombinationof
ibuprofenandacetaminophencanbeprescribed
as analternative tomonotherapy to relieve severe
dental pain,” he suggests, inorder to reduce the
dosesof eachdrugused. “Yet practitioners still
need toconsider the risks associatedwith the
drugsprescribedand their prolongeduse.”
HealthCanadanotes that “noevidenceof an
increasedcardiovascular riskhasbeen found
for over-the-counter ibuprofenwhenusedas
directed.” Themaximumdose recommended for
over-the-counter ibuprofen is 1200mgper day.
Dr. Lavigne,who is alsoCanadaResearchChair in
Pain, SleepandTrauma, stresses the importance
of findingadequatemanagement regimens for
patients inpain. Henotes that according to the
International Association for theStudyof Pain’s
DeclarationofMontreal—whichwas ratified
bychapters andmembers fromclose to200
countries—, “failure tooffer suchmanagement is
abreachof thepatient’shuman rights.”Whilepain
management strategies shouldbedetermined
onacase-by-casebasis, combinationanalgesic
therapymight beanoption toconsider as it limits
thepotential adverseeffectsdue tohighdosesof
drugs and it counters the riskassociatedwith the
useandmisuseof opioids.
HealthCanada is currentlyworkingwith ibuprofen
manufacturers to revise theexisting safety
warnings inproductmonographs. Theupdated
prescribing informationwill recommend that
dosesof 2400mgper daynot beused inpatients
withahistoryof cardiovascular problemsorwith
risk factors for cardiovascular disease.
a
A recentHealthCanada safety review found thathighdosesof ibuprofen increase the risk
of acardiovascular event.
...practitioners still need to consider the risks associatedwith the drugs
prescribedand their prolongeduse.
Dr.GillesLavigne
