Wed, Oct 01, 2003 - Page 2 News List

Medical foundation issues painkiller warning


The Foundation for Poison Control yesterday warned that popular painkillers could be dangerous if taken improperly or for long periods of time.

According to National Health Insurance Bureau records from 2000, 3 million prescriptions were made out to 50,000 patients over the course of a year. Sixty-three percent of the prescriptions were for painkillers.

Over 9 percent of the prescriptions required patients to take painkillers for more than one month, and about 4 percent for more than two months.

Approximately NT$1.34 billion was spent on painkillers in 2001.

Lin Hsiao-yi (林孝義), an allergy, immunology and rheumatology physician at the Veterans General Hospital, said that the two primary types of painkillers commonly sold over the counter were simple analgesic painkillers and non-steroidal anti-inflammatory drugs (NSAID).

Acetaminophen is a widely used simple analgesic, while aspirin and ibuprofen are examples of NSAID.

Chiang Shao-ching (姜紹青), Koo Foundation Sun Yat-sen Cancer Center pharmacist, said that while painkillers were unavoidable sometimes, it was important to choose an appropriate type of painkiller.

Chiang said that aspirin was stronger than other NSAID. He warned that people under the age of 18 should not use aspirin when they have chicken pox, common cold or influenza, saying that it could lead to Reye's Syndrome, a rare disorder that can damage the liver, cause fever and induce unconsciousness.

He also said that women taking aspirin to alleviate menstrual cramps should realize that aspirin can prolong periods. Chiang said that pregnant women and those with asthma should avoid aspirin. Furthermore, individuals using walfarin, a drug used to treat irregular heartbeats and gout, as well as drugs to control high blood pressure and seizures, should not take aspirin.

Chiang said that acetaminophen is usually the safest choice, although prolonged use and high dosages can lead to liver and kidney damage.

Lin said that most rheumatologic disorders cannot be treated with aspirin because it would require a dangerously high dosage. He also said that rheumatologic problems are ranked third on a list of the primary reason for taking painkillers.

He said that NSAID inhibit the production of a certain enzyme, cyclo-oxygenase (COX). There are two types of COX. COX-1 protects the stomach lining and intestines and COX-2 controls inflammation. Traditional NSAID inhibit both of the enzymes, thereby harming the digestive tract.

Lin called traditional NSAID "silent killers," saying that often there are no warning signs before episodes of internal bleeding in the stomach.

A newer version of the drug now makes it possible to inhibit only COX-2. Lin stated that COX-2 inhibitors had fewer harmful side effects but were not as widely distributed and usually require a prescription to obtain. He also warned that long-term use could harm one's kidneys. In the US, about US$5 billion is spent on COX-2 inhibitors each year.

"No painkiller is completely safe. Because so many people use these drugs, research in this area is vital," Lin said.

Chiang stressed that there are three questions that patients should answer before taking painkillers: Do I need to take painkillers? What is the appropriate type to take? How should I take these painkillers?

He urged the public to seek a doctor or pharmacists' advice before taking painkillers.

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