Alternatives To Celebrex ??

[Eloquent pilgrim]

ALTERNATIVES TO CELEBREX  ??

 

I have recently taken advantage of the 50% discount at Bangkok Hospital, Hua Hin, and underwent an “Executive Check Up” You probably know the kind of deal, blood tests for sugar, liver & kidney function, PSA, cholesterol; chest x-ray, full abdominal ultrasound, etc, etc.

 

All my results were thankfully as good as I could hope for. However, when talking to the doctor afterwards for my summarisation, I told him that I have been taking one Celebrex 200mg tablet per day for the last year, to help ease arthritic discomfort in my knee. He said this was not a good long term option because of possible stomach problems as a side effect.

 

He did not offer any alternatives, and so I am wondering if anyone has any views / suggestions / experiences. I don’t want the expense of replacement surgery yet, and it is not bad enough to justify it.

 

I am far from overweight at 175 cm tall and 68 kilos. I have been taking daily supplements of Turmeric capsules, omega 3 fish oil capsules and Glucosamine sulphate for the last 2 years.

 

I have for the last week reduced the Celebrex from daily to every other day, but I do notice a difference ………… Thanks in advance  ???? ????

Edited September 29, 2022 by metisdead
ALL CAPS removed from topic title.

[bolt]

I believe they're are several creams-lotion-GEL available now, which cause less side effects to oral medication 

 

however these creams-lotion-GEL should also be used for short period of time 10-14 days, and then take a break

 

they key ingredient is DICLOFENAC, but of course take professional advice for any recommendation 

 

I was using a GEL which had Diclofenac I can't remember the exact name, it worked very well 

[KannikaP]

8 minutes ago, bolt said:

I believe they're are several creams-lotion-GEL available now, which cause less side effects to oral medication 

 

however these creams-lotion-GEL should also be used for short period of time 10-14 days, and then take a break

 

they key ingredient is DICLOFENAC, but of course take professional advice for any recommendation 

 

I was using a GEL which had Diclofenac I can't remember the exact name, it worked very well 

Voltarol?

[bolt]

3 minutes ago, KannikaP said:

Voltarol?

No it wasn't that, it had an Asian brand on it, but i think they same sort of Gel 

[huangnon]

I used to get Gout, and after a couple of years replaced Celebrex with the much better Voltaren (50 or 75 mg tabs). The Celebrex gave me stomach problems among other side effects.

Voltaren is very effective as an anti-inflammatory with no side effects (for me).

 

(I got rid of gout for good, by using baking soda and other alkaline foods to bring down Uric acid levels).

Edited September 29, 2022 by huangnon

[Sheryl]

Actually your biggest risk is not stomach issues (which are less common with Celebrex than with other NSAIDs like ibuprofen, diclofenac, and the risk of which can be reduced by taking PPI if necessary.)

 

The big risk with long term use is a significant increase in risk of cardiovascular disease - heart attacks and strokes. . The US FDA has added a "black box" warning to this effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC549650/

 

Indeed in most Western countries it is prescription only and doctors will rarely prescribe it to anyone over age 65 (and certainly not for long term use).

 

For some reason few Thai doctors seem aware of these recent findings and continue to give the drug pretty indiscriminantly.

 

As for your options:

 

1- Consider HA injections.

https://www.mayoclinic.org/drugs-supplements/hyaluronic-acid-injection-route/description/drg-20074557

Relief usually  lasts about 6 motns, so most people inject twice a year. Injection must be done by a qualified orthopedic surgeon but is a simple outpatent procedure.  I don't know if available in Hua Hin, but if not you can certainly get it in Bangkok, several good hospitals on the Thonburi side of the river and not far from the Southern bus terminal.

 

2. NSAID gels, like diclofenac (voltaren and local brand names) may give some relief with less stomach upset than if taken orally.  Applying heat (hot bath or hot compress/hot pad) before application will increase  absorption. 

 

If I were you I would definitely look into HA injections.

 

Physical therapy can also be helpful, and you can find exercise videos online. Strengthen some of the leg/thigh muscles can take pressure off the knee.

[setbkk]

I agree that topical diclofenac works well for my arthritic ankle, plus tiger balm. I would avoid Cerebrex, US FDA does not like it.

 

Are you aware that you can take paracetamol along with ibuprofen/naproxen as they work in different manners? If really sore, a combination of the two is really effective - no significant risk unlike Cerebrex.

[setbkk]

A friend of mine gets periodic PRP injections in his knees, claims it works. Some constituents from a blood draw are concentrated and reinjected in knee. Somewhat expensive and limited availability of specialists that do it.

 

My vote is topical diclofenac and paracetamol/ibuprofen or naproxen.

[Etaoin Shrdlu]

I've had a couple of HA injections at Bumrungrad, with the last one about five years ago. My knee remains much less painful and with better range of movement than before the first injection. My kneecap also no longer "catches" as it did before. I would say that in my case, at least some of the beneficial effects have been fairly long-lasting.

 

I also take one sachet of Viartril-S every day in.a glass of water. I think Viartril-S is one of the few branded supplements that has actually undergone clinical trials that showed a positive effect on osteoarthritis. 

 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/213562

[Eloquent pilgrim]

1 hour ago, Sheryl said:

Actually your biggest risk is not stomach issues (which are less common with Celebrex than with other NSAIDs like ibuprofen, diclofenac, and the risk of which can be reduced by taking PPI if necessary.)

 

The big risk with long term use is a significant increase in risk of cardiovascular disease - heart attacks and strokes. . The US FDA has added a "black box" warning to this effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC549650/

 

Indeed in most Western countries it is prescription only and doctors will rarely prescribe it to anyone over age 65 (and certainly not for long term use).

 

For some reason few Thai doctors seem aware of these recent findings and continue to give the drug pretty indiscriminantly.

 

As for your options:

 

1- Consider HA injections.

https://www.mayoclinic.org/drugs-supplements/hyaluronic-acid-injection-route/description/drg-20074557

Relief usually  lasts about 6 motns, so most people inject twice a year. Injection must be done by a qualified orthopedic surgeon but is a simple outpatent procedure.  I don't know if available in Hua Hin, but if not you can certainly get it in Bangkok, several good hospitals on the Thonburi side of the river and not far from the Southern bus terminal.

 

2. NSAID gels, like diclofenac (voltaren and local brand names) may give some relief with less stomach upset than if taken orally.  Applying heat (hot bath or hot compress/hot pad) before application will increase  absorption. 

 

If I were you I would definitely look into HA injections.

 

Physical therapy can also be helpful, and you can find exercise videos online. Strengthen some of the leg/thigh muscles can take pressure off the knee.

 

Thanks for a very comprehensive reply Sheryl, as always - your contributions on health matters are priceless, and much appreciated.

 

I looked at both of there articles you linked, and have decided to stop taking the Celebrex completely, and find the best and most convenient way to try the Hyaluronic - acid - injections. I have started swimming again every morning, which I am sure will help to strengthen the quadriceps.

 

Many thanks again

[dhupverg]

1 hour ago, Etaoin Shrdlu said:

I've had a couple of HA injections at Bumrungrad, with the last one about five years ago. My knee remains much less painful and with better range of movement than before the first injection. My kneecap also no longer "catches" as it did before. I would say that in my case, at least some of the beneficial effects have been fairly long-lasting.

 

I also take one sachet of Viartril-S every day in.a glass of water. I think Viartril-S is one of the few branded supplements that has actually undergone clinical trials that showed a positive effect on osteoarthritis. 

 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/213562

How much was the HA series of injections there?  I am looking at possibly getting an HA series of injections if it would help bone on bone.

[carlyai]

Any long term use of anti-inflammatories is bad.

3 or 4 days for all of these poisons is OK, but longer term, you risk problems.

Drugs are a good short term solution, but replacing the worn out part is the only way to go. ????

[Eloquent pilgrim]

Thanks to everyone that has replied; I think I need to get off the Celebrex, and I’m going to take Sheryl’s advice and find out more about the Hyaluronic - acid - injections

[Etaoin Shrdlu]

1 hour ago, dhupverg said:

How much was the HA series of injections there?  I am looking at possibly getting an HA series of injections if it would help bone on bone.

I think each injection was about 25,000 baht. Other hospitals also offer these injections and may be a bit cheaper. 

 

One injection is sufficient to gain relief, but the lubricant gradually wears out or is assimilated by the body and the effect diminishes, usually after about six months. I was fortunate and continue to have better function and less pain than I had before the first injection, although I did have two injections about 18 months apart.

 

Good luck.

 

 

[retiree]

Re gels: drugstores have Neotica gel (piroxicam 0.5%), and Volaren/Emulgel (1% diclofenac), also local brands.  2% Emulgel is available from Thai stores on Lazada or Shopee.   I have found that my mileage varies with all of these.  Note that systemic absorption of the NSAID is very low, hence studies like:

Long-term tolerability of topical diclofenac sodium 1% gel for osteoarthritis in seniors and patients with comorbidities
These results suggest that long-term DSG treatment is safe in patient subpopulations with an elevated risk of NSAID-related adverse events, such as the elderly and those with the comorbidities of hypertension, type 2 diabetes mellitus, and cerebrovascular or cardiovascular disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508560/

 

Re Celebrex (aka celecoxib), the 2005 study was criticized for high dosages (not certain it was this one, but they only consider 400mg / 800mg / day) and found dose-related risk increase:

https://www.nejm.org/doi/full/10.1056/nejmoa050405
Cardiovascular Risk Associated with Celecoxib ...

 

Unlike other Cox-2 inhibitors, Celebrex wasn't banned.  The FDA action prompted a much larger RCT that compared 200mg/day Celebrex to (pain-relief equivalent doses of) ibuprofen and naproxen in an older population (average age 63 +/- about 9.5 years):

"At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety."

Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis (2016)
https://www.nejm.org/doi/full/10.1056/NEJMoa1611593

 

(It was also safer in regard to GI problems, see below; note that all subjects were given the PPI Esomeprazole (20 to 40 mg))   The methodology is interesting to read -- 24,000+ subjects, recruited specifically because they had (or could have) heart conditions to begin with:

   "A key inclusion criterion was established cardiovascular disease or an increased risk of the development of cardiovascular disease"

otherwise the incidence of adverse effects would have been so low that a much larger sample would have been needed to adequately power the test (i.e. make the statistical analysis reliable). 

 

Following the 2016 study a new FDA panel was convened.  See e.g.: 

https://www.npr.org/sections/health-shots/2018/04/25/605226604/fda-panel-affirms-safety-of-painkiller-celebrex

FDA Panel Affirms Safety Of Painkiller Celebrex
"The drug celecoxib, which is sold by Pfizer under the brand name Celebrex, poses no greater risk for causing heart attacks and strokes than two other widely used pain relievers, the committee voted at the end of a two-day hearing. The vote was 15-5. One member abstained.
...
"The study found the risk of dying, suffering a stroke or having a heart attack among patients taking celecoxib was 2.3 percent during a 30-month period, compared with 2.5 percent for naproxen and 2.7 percent for ibuprofen.
"In fact, celecoxib was less likely to cause certain complications, such as gastrointestinal problems like ulcers and bleeding, as well as kidney problems such as kidney failure and the need for dialysis, according to the study. "

While those numbers are high, remember that the 24,000, 63-year-old(-ish) subjects were chosen because they had heart issues to begin with.

 

Interesting topic.

-- Retiree 

 

Edited September 29, 2022 by retiree

[Lorry]

15 hours ago, Eloquent pilgrim said:

Glucosamine sulphate for the last 2 years

Check your intraocular  pressure. 

Discuss with an eye doctor whether you really want to continue it - the benefits are, according to many studies,  not real - the risk for the eyes  is small but real.

Maybe change to Chondroitin

[carlyai]

16 hours ago, Eloquent pilgrim said:

Thanks to everyone that has replied; I think I need to get off the Celebrex, and I’m going to take Sheryl’s advice and find out more about the Hyaluronic - acid - injections

Not sure if they are the same injections, but (before I had my total knee replacement), I had these injections of, dr said the red part on the head, of the rooster's cone.

Started off from specialist in Australia then in Bangkok Bumrangrad. Seemed to work for a while.

I replied before about anti-inflamatory drugs but didn't give much details.

I had a work related back accident when I was 45 years old now nearly 77 and have had 5 back operations in this time. 

Drs put me on anti-inflammatries, valium, muscle relaxants, pain killers, massage, stretching machine, everything.

I eventually went cold turkey and gave most pills up but still kept the anti-inflammatries and sometimes slow release pain killers.

Gave those up long time ago, but my stomach is very sensative (from the anti-inflams).

Also pain killers cause constipation, so unless you take laxatives you strain your bowel that can produce pockets that can get infected, called Diverticular Disease.

Now I don't take any Dr medicine.

So long term it's best to try and stop antinflams. pain killers and all that <deleted> Drs prescribe. ????

 

[Eloquent pilgrim]

7 hours ago, Lorry said:

Check your intraocular  pressure. 

Discuss with an eye doctor whether you really want to continue it - the benefits are, according to many studies,  not real - the risk for the eyes  is small but real.

Maybe change to Chondroitin

Thanks for your input. I am nearly out of my supply of Glucosamine sulphate, and have just ordered 60 capsules of Hyaluronic Acid + Chondroitin Sulfate, in a brand name Doctor’s best … I will try them for a couple of months ….. cheers

[Eloquent pilgrim]

11 hours ago, retiree said:

Re gels: drugstores have Neotica gel (piroxicam 0.5%), and Volaren/Emulgel (1% diclofenac), also local brands.  2% Emulgel is available from Thai stores on Lazada or Shopee.   I have found that my mileage varies with all of these.  Note that systemic absorption of the NSAID is very low, hence studies like:

Long-term tolerability of topical diclofenac sodium 1% gel for osteoarthritis in seniors and patients with comorbidities
These results suggest that long-term DSG treatment is safe in patient subpopulations with an elevated risk of NSAID-related adverse events, such as the elderly and those with the comorbidities of hypertension, type 2 diabetes mellitus, and cerebrovascular or cardiovascular disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508560/

 

Re Celebrex (aka celecoxib), the 2005 study was criticized for high dosages (not certain it was this one, but they only consider 400mg / 800mg / day) and found dose-related risk increase:

https://www.nejm.org/doi/full/10.1056/nejmoa050405
Cardiovascular Risk Associated with Celecoxib ...

 

Unlike other Cox-2 inhibitors, Celebrex wasn't banned.  The FDA action prompted a much larger RCT that compared 200mg/day Celebrex to (pain-relief equivalent doses of) ibuprofen and naproxen in an older population (average age 63 +/- about 9.5 years):

"At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety."

Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis (2016)
https://www.nejm.org/doi/full/10.1056/NEJMoa1611593

 

(It was also safer in regard to GI problems, see below; note that all subjects were given the PPI Esomeprazole (20 to 40 mg))   The methodology is interesting to read -- 24,000+ subjects, recruited specifically because they had (or could have) heart conditions to begin with:

   "A key inclusion criterion was established cardiovascular disease or an increased risk of the development of cardiovascular disease"

otherwise the incidence of adverse effects would have been so low that a much larger sample would have been needed to adequately power the test (i.e. make the statistical analysis reliable). 

 

Following the 2016 study a new FDA panel was convened.  See e.g.: 

https://www.npr.org/sections/health-shots/2018/04/25/605226604/fda-panel-affirms-safety-of-painkiller-celebrex

FDA Panel Affirms Safety Of Painkiller Celebrex
"The drug celecoxib, which is sold by Pfizer under the brand name Celebrex, poses no greater risk for causing heart attacks and strokes than two other widely used pain relievers, the committee voted at the end of a two-day hearing. The vote was 15-5. One member abstained.
...
"The study found the risk of dying, suffering a stroke or having a heart attack among patients taking celecoxib was 2.3 percent during a 30-month period, compared with 2.5 percent for naproxen and 2.7 percent for ibuprofen.
"In fact, celecoxib was less likely to cause certain complications, such as gastrointestinal problems like ulcers and bleeding, as well as kidney problems such as kidney failure and the need for dialysis, according to the study. "

While those numbers are high, remember that the 24,000, 63-year-old(-ish) subjects were chosen because they had heart issues to begin with.

 

Interesting topic.

-- Retiree 

 

Thanks for your detailed input. The general consensus of opinion seems to be using anti-inflammatories as little and as infrequently as possible, which is the road I am going to take … cheers