EFFICACY IN POST-SURGICAL DENTAL PAIN

In dental pain, Celebrex (single doses of 200 and 400 mg) is comparable to naproxen sodium 550mg, and ibuprofen 400 mg in terms of duration of analgesia. “Well, that’s odd” you may think, “…if Celebrex is not significantly superior, but merely comparable to conventional NSAIDs, why prescribe Celebrex or Vioxx, both of which are very expensive?” A very good question indeed, my friend! The trick is in selectively inhibiting COX-2, not COX-1. COX-1 inhibition hurts the gut; you increase the risk of GI ulceration and bleeding. So the reason that Vioxx and Celebrex emerged was not for superior analgesic effects, but for GI safety.



When we compare Vioxx and Celebrex, renal and vascular safety with vioxx is compromised due to dose-related peripheral edema and hypertension. As a result of this fact, the FDA took a hard look at chronic Vioxx dose at 50mg. There is more significance of cardiovascular problems with chronic use. As dentists, we’d only prescribe vioxx for 5 days for acute pain. We’re being careful not to promote these drugs too much in the clinic until there are more comparative studies.


“An evaluation of flurbiprofen, aspirin, and placebo in postoperative oral surgery pain”

There are dose related effects related to Flurbiprofen (a Flurinated Ibuprofen) with respects to pain relief. Two aspirin tablets (650 mg) beats the placebo, but is metabolized and its effects are gone in 6-8 hours. Flurbiprofen at 25mg is similar to aspirin, but if you double the dose of flurbiprofen, it jumps way up in effective pain relief. If you double the dose again, it only increases pain relief just a bit. So the lesson here is that if you double a dose it doesn’t necessarily double the effectiveness of a drug,



A salicylate derivative, diflunisal (brandname dolobid= “dolo” as in dolor, which means pain, and “bid” meaning 2x/day… so given 2x/day for pain…clever). We see that aspirin (650 mg) peaks analgesic effects at about 2.5 hours. Diflunisal is clearly superior to aspirin, but rarely prescribed anymore because it is now available generically and hence is not advertised anymore. It’s a case of pharmaco-economics.



This compares acetaminophen (1000mg) and a placebo and naproxen (440mg; known otc as Alleve). Acetaminophen, already at a maximum daily dose, peaks quickly and drops off rapidly. Naproxen has superior analgesic power and lasts longer. So if you tell the patient to take Alleve 2x/day, it beats out acetaminophen. So don’t be a chump and over-prescribe drugs that aren’t as good as some others… use the drugs that are appropriate!

Category: Pharmacology Notes