Oxaprozin - random question
Sort of a random question, but is there an impact on heart rate (resting and during training) from using NSAIDs? The question is specific to a drug called Oxaprozin but the question is also more general to NSAIDs.
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However, it's important to note:
- most of the data comes from studies generally looking at older/senior populations taking NSAIDs regularly over long period of time, usually to treat chronic pain;
- it's not conclusive since many seniors are already members of a group likely to have other risk factors for heart disease and stroke
- millions of people take NSAIDs with no significant adverse side effects;
- not all NSAIDs are created equal - some have higher / lower risks;
- but a Dutch study found that use of NSAIDs may increase the risk for atrial fibrillation (characterized by a rapid and irregular heartbeat) - in an older population. See relevant quote and reference, below.
Anyway, I haven't seen anything talking about heart rate effects in an athletic population attributed to NSAIDs.
Hope that helps!
"[T]he researchers... analyzed a wide variety of NSAIDs, such as aspirin, ibuprofen, naproxen, Toradol, Aleve and Celebrex. The team studied 8,423 participants who had an average age of 68 at the beginning of the study and did not have atrial fibrillation. The participants were monitored over an average of 13 years...
The researchers found that participants who used NSAIDs were 1.8 times more likely to be diagnosed with atrial fibrillation in comparison to people who did not take the pain relievers. People who were chronic and current users had a 76 percent increased risk of atrial fibrillation."
http://bmjopen.bmj.com/content/4/4/e004059
But ^this^ is very interesting....
Well, I should probably just delete this whole response but I've just been thinking about this for too long. Plus, there are lots of doctors actually practicing current medicine here. Here's a link that discusses the stats of high heart rate with oxaprozin. It is very very very low.
http://factmed.com/study-OXAPROZIN-causing-HEART RATE IRREGULAR.php
BUT
https://my.clevelandclinic.org/health/drugs_devices_supplements/hic_Non-Steroidal_Anti-Inflammatory_Medicines_NSAIDs
Dizziness, lightheaded feeling, mild confusion/distraction, balance problems and a touch of headache are symptoms of all NSAIDS. Aside from the balance problems all of those side effects are also symptoms of cardiovascular problems, particularly in what you'd call the acute setting. Those symptoms of higher heart rate (and possibly weaker individual beats) are listed side effects of oxaprozin (Daypro) but this stuff is a little tricky. Those symptoms can occur for a number of reasons but they are related most immediately to changes in the person's cardiovascular system like a drop in blood pressure. Not directly on the heart rate or force of ventricular contraction - those are usually the consequences of the real problem when the vasomotor components of the brain respond to it. It's often caused by lapses in your total peripheral resistance (TPR), the other half of your overall blood pressure calculus. BP essentially = the integration of your cardiac output (CO) and TPR. You can probably trigger one or more of those 4 symptoms by standing up quickly from a seated or horizontal-ish position. Even a slight reduction in your well-developed cardiovascular reflex will do it and so many things can compromise that response to postural hypotension.
When your arteries are a little more relaxed the resistance to the blood getting pushed out from the heart is decreased. That arterial pressure is something your body has some direct control over such as how adrenalin stimulates Beta2 receptors on arterial smooth muscle and increases blood flow to the major muscle groups you're using during physical exertion. Epinephrine (EPI) and norepinephrine (NorEPI) are the two main cathecholamines (okay, and dopamine) coursing through your bloodstream during exercise and all three of them stimulate the beta1 receptors that increase both the heart rate and force of ventricular contraction. I could bore you to death with more here but it isn't all the story. The other component is the venous system, the vessels that transport the blood back to the heart. And they ain't got any vascular smooth muscle to contract in response to any of the catecholamines. They mostly rely on the combination of your skeletal muscles acting as an external pressure pump and internal one-way valves that stop blood from flowing backwards down the veins.
The discussions of the side effects I listed above say nothing about whether the dizziness & such occured during exertion so it is hard to say whether NSAIDs directly cause those symptoms. Again, reports of those side effects are rare. Plus, you're referring to recent & temporary, not chronic usage, aren't you?
Getting the blood back up to your heart gets very hard during the hours you're running that 70.3 and 140.6 marathon. Remember dehydration, electrolyte imbalances up or down, low blood sugar and exhaustion just because, you know, yer doin' a dang Ironman? And that's without any NSAIDs in your system. Could they contribute peripheral vascular insufficiency to that potential disaster collective? Maybe, but I think the hypervigilant community of professional endurance athletes and coaches and doctors and spouses observing them would have raised the red flag by now if it was a common occurrence.
MANY THANKS AGAIN FOR ALL OF THE INPUT!!!
Now, for the stuff NSAIDs do, or rather prevent from happening in your body. These drugs all inhibit the production of prostaglandins and thromboxanes from arachadonic acid. That group of endogenous compounds does lots of things in your body - and not all of them bad. A couple of them, prostacyclin (PGI2) and PGE2, are definitely our friends in some cases and some of the NSAID adverse effects are due to how they stop you from making them. Angiotensinogen gets converted to angiotensin I and then to angiotensin II (AGII) by the ever-so-cleverly-named Angiotensinogen Converting Enzyme (ACE). Angiotensin II is a potent vasoconstrictor and when you take it out of the vascular management scenario, it can affect your blood pressure at rest or during exercise depending on what other stuff is happening. The changes in our cardiovascular function due to NSAIDs are complex and not exactly predictable from person to person. Add in racing conditions and all bets are off - take that in combination with the lack of reports of NSAIDs causing obvious problems.
http://www.ncbi.nlm.nih.gov/pubmed/7044826 - Mitigating the cardiovascular and renal effects of NSAIDs.This abstract is more concerned with the methods doctors can use to block some of the things NSAIDs do, not anything you could do during a triathlon but it does point to one of the reasons I * don't ever* use them in endurance events. If I have to be taking them to get over something I know I shouldn't be racing on whatever problem it is.
Anyway, the bottom line is they futz with the blood vessels in the kidneys causing reduced perfusion of the renal medulla and alter the way your kidneys work. They do not work as well as they should, even after the first dose of an NSAID, and you are definitely relying on them to be working their best during sustained efforts of more than just 2-3 hours. Who can say how all the conditions on a given day affect a given person so if you're going to use them I suggest you do [I]a few race rehearsals[/I] while taking them to find out how they affect you. Who cares about short term clinical data when it's just you doing your race. Okay, well, you know what I mean.
These effects the kidneys can handle for the short term. The reduced kidney function the NSAIDs cause is reversible once the NSAID washes out of your system. However, over the long term that blood flow not getting to parts of the kidney tends to starve the nephrons, the functional units of the kidney's job. The kidney damage the NSAIDs are proven to cause is primarily going to show up with chronic use or in patients with already compromised kidney function, like a typical elderly person. Like the lungs and liver, the kidneys can often withstand prolonged harm before the person shows clinical symptoms. Thank goodness we've had various blood tests to catch that stuff much earlier nowadays.
And that other reason I don't use them in races? They really enhance the sunburn you can get and I hate that sh*t. Even without taking any NSAIDs and using sunscreen use I still wound up getting some really good ones, even in an olympic.