Comments on: Evolution of thought processes http://onthepharm.net/2007/12/evolution-of-thought-processes.html Life on the pharm Mon, 26 Jul 2010 18:29:42 +0000 hourly 1 http://wordpress.org/?v=3.0 By: RJS http://onthepharm.net/2007/12/evolution-of-thought-processes.html/comment-page-1#comment-178416 RJS Sun, 02 Dec 2007 05:39:50 +0000 http://onthepharm.net/2007/12/evolution-of-thought-processes.html#comment-178416 I've got no personal beef with naproxen. I think it's a fine drug for most of the world. I take it myself, from time to time. :) It is, however, considered unacceptable in the geriatric population due mostly to its long half-life. Unacceptable being defined as primary literature indicating greater prevalence or severity of adverse reactions with a particular agent and when there are equally effective agents within the same class. Personally, I like diclofenac quite a lot. Way cheaper than celecoxib, and while its renal and CV effects aren't as nice, I don't know that celecoxib is ~$150 a month better. Naproxen probably won't cause GI bleeds, hypertension, renal and heart failure in an average geriatric patient, but if n is large enough, the probability of an adverse reaction occurring approaches 1 -- diclofenac, ibuprofen, Relafen, and Lodine are all safer choices. And then there are the DMARDs, many of which are also considered off-limits. Citations available for all of the above if you are really interested. <strong>Edit:</strong> Forgot to mention that I added your blog to my feed reader. :) I've got no personal beef with naproxen. I think it's a fine drug for most of the world. I take it myself, from time to time. :) It is, however, considered unacceptable in the geriatric population due mostly to its long half-life. Unacceptable being defined as primary literature indicating greater prevalence or severity of adverse reactions with a particular agent and when there are equally effective agents within the same class.

Personally, I like diclofenac quite a lot. Way cheaper than celecoxib, and while its renal and CV effects aren't as nice, I don't know that celecoxib is ~$150 a month better. Naproxen probably won't cause GI bleeds, hypertension, renal and heart failure in an average geriatric patient, but if n is large enough, the probability of an adverse reaction occurring approaches 1 — diclofenac, ibuprofen, Relafen, and Lodine are all safer choices.

And then there are the DMARDs, many of which are also considered off-limits.

Citations available for all of the above if you are really interested.

Edit: Forgot to mention that I added your blog to my feed reader. :)

]]> By: 3+speckled http://onthepharm.net/2007/12/evolution-of-thought-processes.html/comment-page-1#comment-178415 3+speckled Sun, 02 Dec 2007 04:44:00 +0000 http://onthepharm.net/2007/12/evolution-of-thought-processes.html#comment-178415 As a rheumatologist I'm not quite sure what your beef is with naproxen. No NSAIDS are really safe in the elderly, but if they are needed, naproxen is as good as any, maybe the best. Celecoxib is easier on the stomach but if there is any angina, naproxen at low dose with a proton pump inhibitor would probably be my next choice. Hope your grandmother is doing well. Maybe I'm the one treating her. As a rheumatologist I'm not quite sure what your beef is with naproxen. No NSAIDS are really safe in the elderly, but if they are needed, naproxen is as good as any, maybe the best. Celecoxib is easier on the stomach but if there is any angina, naproxen at low dose with a proton pump inhibitor would probably be my next choice. Hope your grandmother is doing well. Maybe I'm the one treating her.

]]>