(No subject)

[Guest guest]

Hello Docs,

Good info (and scary) for patients…It reminds me of a

patient of mine who was complaining of fatigue and malaise…turns out she’d

been using IBP for migraines for months, had GI bleeding, and was anemic.

Chuck Simpson, DC

Portland, OR

Review

HAMILTON, Ontario,

Nov. 1 - Taking high doses of Advil or Motrin (ibuprofen) even for a few days

can significantly increase the risk of gastrointestinal bleeding, researchers

reported today.

After three days of

treatment with 800 mg of ibuprofen three times a day, healthy men had evidence

of significant blood loss compared with men randomized to placebo (P<0.001).

The volume of fecal

blood loss was 3.64 mL greater in the ibuprofen group, Hunt, M.D., of McMaster University here and colleagues reported

in the November issue of Clinical Gastroenterology and Hepatology.

Dr. Hunt said the

finding is somewhat surprising because ibuprofen is generally considered the

safest of the non-steroidal anti-inflammatory drugs (NSAIDs) in terms of

bleeding risk.

The authors conducted

a post-hoc analysis of two small, single- center, randomized studies, with 68

participants. They defined fecal blood loss as significant when it was more

than 2 mL daily. Fecal blood loss was measured by radioactive analysis of chromium-51

labeled red cells in stools during baseline and throughout the study for four

weeks of treatment. At baseline fecal blood loss averaged 0.36 mL for all

participants.

During the study,

volunteers randomized to ibuprofen had an average fecal blood loss of more than

2 mL, with a daily mean loss of 2.55 mL versus 0.7 mL in the placebo arm

(P<0.001).

Twenty-six of 31

participants randomized to ibuprofen had between one and seven episodes of

microbleeding with fecal blood loss of more than 3 mL. Nine men in the

ibuprofen arm had a maximum fecal blood loss of more than 10 mL and in two men

the fecal blood loss volume reached 73 mL and 66 mL respectively.

Dr. Hunt noted that

the study dose was significantly higher than the approved over-the-counter dose

of ibuprofen, which is 1,200 mg daily. But he said that people who regularly

use ibuprofen often use it to treat chronic pain, such as arthritis pain. Such

patients " often increase the recommended dose of their painkillers. "

The authors concluded

that " the potential for a serious GI complication should still be

considered when ibuprofen is recommended for self-medication. "

In an editorial that

accompanied the paper, Denis M. McCarthy, M.D., Ph.D, of the University of New Mexico

pointed out that although the authors didn't investigate the development of

anemia, " it is reasonable to assume that blood loss that continues at this

rate in long term NSAID users could lead to significant anemia at least in some

patients. "

Primary

source: Clinical

Gastroenterology and Hepatology

Source reference:

Bowen, B " Time Course and Pattern of Blood Loss with Ibuprofen Treatment

in Healthy Subjects " ClinGastroHep 2005;3:1-5.

Additional source: Clinical

Gastroenterology and Hepatology

Source reference:

McCarthy, DM " Occult GI Bleeding in NSAID Users-The Base of the

Iceberg " ClinGastroHep 2005;3:6-7.