SPOKANE, Wash. — If you are at risk of congestive heart failure, don’t stop taking your pain medications without talking to your doctor — but talk to your doctor about your pain medications. That’s the message from a research study conducted by Washington State University College of Pharmacy faculty at the Spokane and Pullman campuses.

The study examined Spokane-area patients who were admitted to the hospital with congestive heart failure. Results showed that taking non-steroidal anti-inflammatory drugs (NSAIDs) increased the risk of first-time hospitalization for congestive heart failure by 21 percent over those who were not taking NSAIDs. The likelihood of this problem is probably more likely as the amount of medication increases, but some patients may see the effect with small doses. NSAIDS include common pain relievers such as ibuprofen (some brand names include Motrin and Advil) and naproxen (Aleve) as well as several prescription medications.

Dr. Brian Gates, Clinical Assistant Professor of Pharmacotherapy with the WSU College of Pharmacy, and lead investigator in the study, said they examined the question to follow up on previous research done elsewhere into NSAIDs and congestive heart failure. NSAIDS are known to cause fluid retention in some patients, which may make the development of congestive heart failure more likely.

The study also showed that patients who had a history of congestive heart failure and were readmitted to the hospital were 2.7 times less likely to be taking NSAIDs. Gates speculates that this less frequent use in readmitted patients may be a result of the patients having been warned about NSAIDs’ potential effect during a previous hospital admission.

As far as the researchers know, this is the first such study done in the United States. Others have been done in the Netherlands and Australia. Gates’ results showing that NSAIDs can contribute to first-time hospitalization concur with two other studies. A recent study, however, found that NSAIDs only contributed to repeat hospitalizations for congestive heart failure.

“The practical application of these findings is that in addition to those patients who have a known history of congestive heart failure, NSAIDs should also be used carefully in patients who may have risk factors for congestive heart failure,” said Gates. Risk factors include such things as a history of high blood pressure, coronary heart disease, atrial fibrillation, or kidney problems.

“Patients often get frightened by media coverage of research findings like these, and stop taking their medications without consulting with their medical providers,” Gates said. “It’s very important for them to talk with a health care professional first. The conflicting information from our study and the few others that have been done in this area suggests that further research is warranted, and that it is prudent for patients at risk to be careful with these medications. Patients who have been taking these medications safely for a long time should continue to take them.”

Patients who know they have a history of heart or kidney problems should check with their doctor before taking NSAIDs. Gates said this should not be a problem if the patient is regularly seen by a doctor. However, some NSAIDs are available over-the-counter, so patients can buy these without a doctor’s prescription. Acetaminophen (Tylenol) products are not known to contribute to this problem.

Gates conducted the research as part of a post-doctoral fellowship funded by the American College of Clinical Pharmacy, the Merck-ACCP Outcomes and Economics Fellowship. Gates worked with Drs. Stephen Setter, Assistant Professor of Pharmacotherapy, David Sclar, Boeing Distinguished Professor of Health Policy, and Ms. Linda Robison, Research Coordinator. The findings were presented at the annual meeting of the American College of Clinical Pharmacy, held in Albuquerque, N.M., in October 2002.

Related Web sites:
WSU Spokane: www.spokane.wsu.edu
WSU College of Pharmacy: www.pharmacy.wsu.edu
Department of Health Policy & Administration: www.hpa.spokane.wsu.edu
American College of Clinical Pharmacy: www.accp.com