Monday, June 08, 2009

Limbrel--new option for osteoarthritis

I wrote some time ago about licofelone, a new analgesic for osteoarthritis (OA) that was then in Phase III clinical trials. Not only does this new agent decrease pain and inflammation from OA without stomach irritation (a la ibuprofen, naproxen, etc.) or cardiovascular complications (a la Vioxx and Bextra), it also demonstrates potential in actually slowing down joint destruction. Alas, while new reports on its dual action efficacy--analgesia AND disease modification--continue to appear, I can find no information on a release date.

I was pleased, therefore, to learn today about a new drug for osteoarthritis--a medical food actually--from a patient. Limbrel is all phytochemicals which should delight the aging hippies in all of us that search for the natural in the drugs we take to keep old body hooked to mellowing soul. It's made from those two lovely plants pictured above: Scutellaria baicalensis and Acacia catechu.

So here's the scoop. Arachidonic acid(AA) is a polyunsaturated fat that's necessary to body functions when it is appropriately converted to chemicals that protect your stomach lining, dilate blood vessels, promote proper blood clotting, and repair tissues. Too much AA in the wrong place at the wrong time is a bad thing whether it's derived from cellular injury or diet (think twisting your ankle as you eat a Big Mac for a double load of AA). Per Dr. Barry Sears: "...if you inject arachidonic acid into... rabbits they are dead within three minutes. "

As you get older, injured, have an inherited predisposition to arthritis, and eat too much fatty red meat or egg yolks, all that piled up AA gets churned along by the COX-1, COX-2, and 5-LOX enzyme systems into a world of inflammatory molecules and reactive oxygen species which set off a process by which your cartilage is destroyed and your bone overgrows into treacherous spurs.

You can inhibit COX-1 by aspirin or NSAIDs or inhibit COX-2 by Celebrex, but unless you turn down your 5-LOX as well, the resultant imbalance creates other problems. Scientists have sorted through more than a thousand plant-derived molecules looking for flavonoids with favorable suppressive action on these inflammatory pathways. Apparently those pretty posies posing above won the competition, proving both safe and efficacious in decreasing the pain of osteoarthritis.

While licofelone has been shown to slow down the cartilage destruction that leads to permanent joint deformities in osteoarthritis, Limbrel makes no such claims. Whether this is due to a lack of research supporting this function, or simply that it doesn't work in that way is not clear. Limbrel, however, is available here and now whereas licofelone is still churning along on the slow train to FDA approval. I've requested samples from the company, and look forward to working with those of you with the gnarly hands and aching knees of osteoarthritis to see what we think about this one.


Ruth said...

I marked this in my Google notebook and will have to see if it is available in Canada anytime soon. I cannot say that other natural preparations (glucosamine, MSM, etc) have made any difference for me in the past 6 months, but I still choke them down. Perhaps it is better just to avoid inflammatory foods instead.

dorsey said...

I'll be a hip guinea pig if samples come in. (I know I'm always hip, but call me anyway)

Carla said...

Thanks for the tip. As an aging hippy with advanced degenerative bone changes I jumped at the chance to try Limbrel. so far, so good! now I'm going to see if it'll work on a PRN basis.

femail doc said...

Hi Ruth: I think avoiding the inflammatory foods is a big part of controlling osteoarthritis.

Dorsey: Still waiting for samples. Perhaps they don't even look at the pleas for samples knowing it's just aging doctors trying to get freebies.

So Carla, the Limbrel worked?

Carla said...

So far the Limbrel seems to work as well as Celebrex and hopefully with less side effects. not cheap, tho, 60 tabs were $127. My primary doc never heard of it, but the orthopedic surgeon knew right away and gave me a script for 500mg bid; I see that it also comes in 250 mg which I probably should have tried first.

Jan said...

After I read your blog entry, I read what I could about Limbrel online. I just saw my primary doc - she did not know about this medication, but looked it up, gave me a script. Pharmacy has had to order it. I cannot tolerate any type of NSAID - have trouble with most medications, period (due to severe GI damage from seatbelt injuries, severe surgical adhesions, etc.). Going to start with one a day to see if my gut will tolerate this. I am SO hoping this might help my 62 aging body. I learn so much from your blog - thanks for writing!

femail doc said...

Hi Jan, Be sure to get back here with update on how the Limbrel worked. And thank YOU for writing!

Claire Melton said...

Dr. I can't find your name so excuse that. I am taking Limbrel 500mg and it is a miracle drug. I could no longer take NSAID'S because of stomach upset. There are no side effects with me other than feeling better. Not just the pain if the osteoarthritis, but an overall sense of well being. I am so much better, I don't think I will get knee replacements. Wow is all I can say!!!!!!!!!!! Enjoyed your blog. Thanks for that.
Claire Melton
Shreveport, Louisiana