Over-the-counter medications (OTCs) are medications that the public can buy without a prescription. Prilosec OTC, Benadryl, aspirin and Tylenol are all OTCs. Although these medications are considered safe for public consumption, they do carry potential side effects. The focus today is on pain relieving OTCs.

Ibuprofen, Motrin, Aleve, Celebrex, Vioxx are medications that belong to a class of medications called "non steroidal anti-inflammatory medications," or NSAIDS. This class has been under scrutiny recently. In early April of this year, the Food and Drug Administration (FDA) put a warning on this class of medications. This was done because some of these medications have been shown to have problems with cardiovascular complications, such as stroke and heart attacks.

Besides potential adverse outcomes related to the heart, these medications have several other potential problems. The first point to consider is these medications should not be used for prolonged periods. In general, they should only be used for up to 14 days. This point is in reference to someone using the medication on their own. Under the care of a physician, at prescription strength, these medications can be used for much longer periods.

The second point is really in regards to all OTCs. Even though you have un-related access to these medications, they can be dangerous. For instance, the side effects from a medication such as Ibuprofen or Naproxen can be kidney or stomach damage. Ulcers which bleed are uncommon, as is kidney damage or failure. But these complications do happen, and the cost to patients and society is very high. Used as directed they are usually safe, but not always. Underlying illness and other medications being taken can make a safe medication unsafe.

I have answered many questions for patients in regards to some of the more notorious medications in this class, specifically Celebrex, Vioxx and Bextra. These types of NSAIDs have the benefit of having fewer "stomach" related problems, such as gastritis or ulcers. Both Vioxx and Bextra have been pulled off the market. Both of these had issues with cardiovascular side effects. Celebrex is still being used. So, is Celebrex, which is similar to Vioxx, and Bextra safe? The current research that has been done sends mixed messages.

It appears at recommended dosages that Celebrex and others within the NSAID class are safe. There are several studies on Celebrex, done at recommended dosages, which show it is a safe and effective medication. There is also some evidence that at very high dosages, there have been cardiovascular complications. The high dosages used were in experiments. These dosages have not been approved for current indications for use by the FDA.

So what do you do if you are on or are prescribed medicines within this class (such as Naproxen Mobic, and Celebrex)? You and your health care provider should talk about the benefits and risks. Many patients would gladly accept the risks to be back on Vioxx.

Their pain is worse than any complication that may or may not happen. Some people with disabling arthritis need pain relief, and will accept potential complications to achieve pain relief along with a better quality of life.

Look at the risks and the benefits with your doctor. This should be explained. The decision then is yours. That decision, either way, carries potential problems. If you start the medication, there are risks. Some known and some unknown or unexpected. On the other hand, if you chose not to be on the particular medication, your pain control may not be adequate and you may have few alternatives.

There you go. Not really a lot of controversy for these types of medications.

Just empower yourself, ask questions, be informed and discuss it with your doctor. I wish you good health and improved health.

Charles H. Keenen, M.D., works in Auburn and can be reached at 282-0525