Prescribing Of Celebrex In Thailand

[jfchandler]

I was at Phyathai II hospital today to get checked for a minor ailment, and the doctor there suggested to prescribe an anti-inflammatory drug for short-term use. I asked if he meant an NSAID (Non-Steroidal Anti-Inflammatory Drug), and he said yes.

I replied that I recalled there had been some serious health warning problems about NSAIDs in the U.S., and asked about alternatives. He said, don't worry, he wouldn't prescribe any of the NSAID drugs that have been recalled (that's the key word here) in the U.S.

So I later went to the hospital pharmacy, and found he'd prescribed a week of Celebrex. Now at the time, I wasn't sure and couldn't check further, but I thought I remembered Celebrex had been one of the drugs recently found to have significant adverse health risk problems.

So I asked the counter pharmacist about that, and she seemed clueless. So then I asked to speak with the supervisor pharmacist (who also spoke some English), and she likewise seemed clueless about any problems relating to Celebrex. So at that point, I declined the prescription altogether and went home.

Upon checking my trusty computer and Internet after arriving home, I discovered that my vague memory had been correct, and that the FDA (Food and Drug Administration) in the U.S. has issued warnings about Celebrex and recently mandated its relabeling to include warnings about the drug potentially causing serious heart problems and gastrointestinal bleeding, particularly in long term use cases (though it hasn't been pulled from the market).

The whole experience gave me a bit of pause... Just because a drug hasn't been recalled, doesn't mean it's always fine to use. And when there are potentially serious potential side effects (as is the case with Celebrex), shouldn't the doctor or the pharmacist be advising the patient of those???

Not that the U.S. medical system is any better.... but it made me wonder if the doctors here in Thailand are just willy nilly prescribing Celebrex to patients with no warnings of the potential harm it can cause.... or at least, without having a discussion about the risks vs. potential need/benefit of taking it...

Here is the link to the FDA web page with info about NSAID problems....

Edited March 23, 2009 by jfchandler

[dominique355]

As far as I know most, if not all, anti inflammatory drugs are a risk when taken over a long period of time. Take them only together with some food, not on an empty stomach.

I have been taking Celebrex and Voltaren for over 20 years and so far no problems.

[jfchandler]

The issue I was raising was one of "informed consent"...

Glad to hear you've been able to use Celebrex long-term with no problems so far...

Fortunately, you're aware of the risks... But my feeling was doctors who are prescribing the medicine for the first time ought to be discussing those risks with their patients...

[FBN]

As a medico-legal enity "informed consent" does not apply to the prescription of medication, only to surgical procedures and testing for HIV etc.

It should be routine for a physician to advise a patient of any possible serious side effects or precautions to take when taking specific medication.

There is just about no form of medication that has no side effects and these can sometimes run into pages of information and to discuss all of these with a patient would sometimes not be possible.

The pharmacy, however, should include this information with the medication; usually it is done as a printed page.

It is also prudent that the patient would read the inserted package information as well. Alternatively, the internet and your option would then be to return and discuss any concerns with the physician.

[samtam]

I agree that doctors and pharmacies seem to dole out far too many drugs and they don't discuss side-effects etc. Like you, I tend to not take the prescribed drugs before I have read up about them on the internet. I seem to recall I was prescribed Celebrex, and it was the first drug that made me question the lack of information given by pharmacies...after I had been taking it for a few days, and it brought me out in a rash. I then had to take another drug to get rid of the rash. Aargh! My preference is for my own immune system and my body's own defences to take care of problems, if that is all possible, or to alter diet etc. This approach is an anathema to the medical community, because they are under financial incentives to sell drugs - legalised drug pushing, I'm afraid.

[jfchandler]

It should be routine for a physician to advise a patient of any possible serious side effects or precautions to take when taking specific medication.

In almost two years of living here, and a fair number of contacts with different top-flight Thai doctors and hospitals in BKK during that time, I've received only the barest (and simplest) of verbal instructions associated with various prescribed medications. As in, the instructions on the number of times per day and with or without food, and drink lots of fluids, etc. But not once that I can ever recall about any potential health risks where I didn't first directly ask the doctor...

The pharmacy, however, should include this information with the medication; usually it is done as a printed page. It is also prudent that the patient would read the inserted package information as well.

In the U.S., with all its flaws, I would always receive a printed medication info and side effects/risks/drug interaction precautions sheet for any prescribed medication. In past years, that seems to have been standardized and computerized. So all that info would routinely be printed out for even the most routine of prescriptions in the U.S.

In BKK/Thailand, during the past two years, I've yet to receive or even see anything remotely like that. And many times, even worse, the hospital provided outpatient medications are dispensed in foil blister packs or hospital plastic vials without any of the normal (and highly scientific) product info sheets that come in original boxed medicines coming directly from the manufacturer.

It seems to me...something is missing here....

[bina]

israel matches thailand as far as medical behavior is just about everything it seems-- all the complaints i read here on the forum for thailand match = the complaints i have here in israel: example: i just walked in to the kibbutz clinic, re oredered prescription for daughter for singulair that the doc had given us because i requested it; i was given the prescription and that was that; i had to go to the internet look it up and check out all the potential warnings and whatever; plus other method of use (two type of asthma/allergy use)...

here, u get a prescription, go to the pharmacist, they say: take two hrs before or one hour after eating, and thats about it... no one asks if u take other drugs otc or prescription, and no one tells u about potential side affects.... and if your eyes are like mine, the little pamphlets that sometimes but not always come with the meds are too small to read(sometimes u are given a packet of pills in their blister wrap but in a regualr envelope since the amount is smaller then the amounth that comes in a box, so they are taken out of the box in given in a white envelope with some instructions scribbled on it)

and we are a hypochondriac culture with high levels of drug consumption and a socialist medical system... so maybe its just americans that are used to such specific levels of info? here u go to a doc, they tell u what to do, and u do it.... i am always the crazy american that persists in getting the doc to tell me exactly what, how much, what does it mean, etc.... and they dont like that at all...

guess i'll get on alright in thailand as well then; no expectations.

bina

israel

[Orangutan]

I use to take Clebrex but switched to Artrodar after reading about it..available at several pharmacies in Bangkok.

google obviously will produce some helpful reading about Artrodar.

-O

[JimGant]

He said, don't worry, he wouldn't prescribe any of the NSAID drugs that have been recalled (that's the key word here) in the U.S.

In this case, he's right. Celebrex is still being prescribed in the US; it was the similar product Vioxx that was taken off the market.

[jfchandler]

Jim, I wouldn't say the doctor was "right"....

He wanted to prescribe a fairly powerful drug (Celebrex) to me -- for a very minor ailment -- that has been found to have very serious and potentially fatal side effects in some cases, and he wanted to do so without telling me anything about any of those potential side effects.

[Sheryl]

Anyone who is on a chronic (long term medication) should thoroughly read up on it including its potential interactions with other drugs...even if the doctor and/or pharmacist has already given information but especially if not.

Remember, no one has as much invested in your health as you do. And, while a doctor has many patients, a pharamcist many clients, you have only one patient and thus can be thorough.

[animatic]

I took Viiox in Europe for a year plus for serious neck arthitus after a discectomy,

and then switched to Celebrex for the same amount of time. No issues at all.

I just got Dengue fever diagnosis yesterday, and was told no aspirin or Ibuprofen,

But got Celebrex and Tylenol and codeine.

I am not worried at this time about the Celebrex,

only the codeine induced incoherence and general wooziness.

If I planned high doses for a year or more I might have some pause.

Too many apples can kill you, too much of anything can kill you.

No doubt concentrated sustances can also do that too much too long.

Moderation in most things.

Edited March 23, 2009 by animatic

[jfchandler]

That raises an issue I was trying to figure out today...with no help from the doctor or pharmacist...

Re Celebrex, the bulk of the discussion about harmful side effects appeared to stem from studies tracking patients who used it continuously over the period of several years, such as for osteoarthritis.

But, as best as I could tell (though there wasn't really much clear that I could find on this), there also appear to be risks associated with even short term use. Some of the warnings talked about the potential for sudden and severe gastrointestinal bleeding, even after just beginning taking it.

Would that happen with everyone?? Of course not. But even if there's a small chance of that happening in any case, if I'm taking the medicine, I'd at least want to know that.

In my case, a minor ailment, I decided the risk wasn't worth the benefit.

[PeaceBlondie]

For six years, I have been getting almost all my prescriptions from medical school professors, which are filled at the university medical school pharmacy. Ritalin, aspirin, Mevalotin, Plendil. I cannot remember ever being given instructions, written or oral, other than taking the medicine after eating a meal.