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Photo by: Isaac Babcock - Medication always comes with risks, but the balance of that to reward is a tricky call.
Winter Park / Maitland Observer Thursday, Jan. 5, 2017 3 months ago

Is medication risk worth the benefit?

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How to find a balance for better health
by: Dr. Keith Roach Staff Writer

DEAR DR. ROACH: I am a 76-year-old woman with diabetes. My body, as I have been told, is bad with arthritis, for which I have been prescribed Celebrex. I have been taking it for a few months now, and am definitely moving around with a lot less pain. I recently watched a program that devoted the entire hour to Celebrex. It scared me out of my wits upon hearing the side effects of the medicine. I am asking your advice about whether to stop taking the Celebrex. – S.A.

ANSWER: All medicines have risks, and in order to decide whether you should keep taking the medicine, you need to really understand what the risks are and balance them against the benefits you feel in your ability to move around more easily.

In the case of Celebrex, we have a pretty good idea of what the risks are. Like all related drugs (including ibuprofen and naproxen), celecoxib (Celebrex) can damage the kidneys, so it isn't recommended for people with kidney disease. There also can be allergic reactions, which may be related to allergies to sulfa drugs. A few people have had vision changes. However, the most concerning risk is heart disease — both heart attacks and heart failure. These risks definitely are increased among users of celecoxib.

However, the absolute risk is small: There were about two extra cases of all heart events, including heart attack and heart failure, per thousand people taking 400 mg once daily, and six extra events in people taking 400 mg twice daily. Those risks probably are higher if you are at increased risk for heart disease (which you probably are, because of your diabetes), but it still means less than 1 percent of people per year. If the medicine isn't helping, the risk certainly isn't worth it. However, only you can decide if the risk is worth the benefit.

Drug companies get into big trouble when they try to hide the risks of their medications, and honesty demands that we admit that all drugs and supplements have risks. Only you can make that decision, but I think it's up to us as doctors to have a frank discussion, especially about medications intended to be taken long-term.

DEAR DR. ROACH: I am a 72-year-old female. My doctor told me four years ago that I would need a Pap test only every two years, which I have done. She told me recently that I would not need to have any more. My tests have always been negative. I am concerned, as I would rather be proactive and know early if I had cancer. What is your opinion, and what does the American Cancer Society say? – B.L.S.

ANSWER: All of the leading organizations, including the American Cancer Society, have recommended stopping screening at age 65 for women with no history of cancer and who have had adequate screening, meaning three negative Pap smears (or two negative combination Pap and HPV tests) in the past 10 years, with at least one in the past five years. The risk for cancer in this specific group is very low.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.

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