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Pain Relievers: Questions & Answers

Arthritis Expert Helps You Understand Risks From Pain Relievers

Some studies have shown that Cox-2 inhibitors have been overprescribed. To whom should these drugs be prescribed? continued...

Currently, Cox-2 drugs are most suited for patients who have a history of stomach or intestinal bleeding or who are at risk for bleeding. Persons who are taking the blood-thinning medication Coumadin cannot take traditional anti-inflammatory drugs because of high bleeding risks. When an anti-inflammatory drug is necessary, Cox-2 inhibitors are permissible for this group of patients.

The risks and benefits of taking a medication must be evaluated in an individualized fashion for each patient. The decision to take a medication requires knowledge of the severity of the condition treated, risks of alternatives, underlying medical conditions, past medication experiences, affordability of the drug, and the patient's age to adequately appreciate the risks.

If someone stops taking a Cox-2 drug, is the adverse risk of heart attack or stroke permanent?

No. There is no evidence of a sustained adverse effect. The risk would only be expected to be present while taking the drug, not after it has been discontinued.

It is interesting to note that the heart attack and stroke risk detected in the Vioxx study (which led its manufacturer to pull it from the market) did not present itself in study participants until the drug was taken for at least 18 months. There was no increased risk of heart attack or stroke detected in study participants who took Vioxx for less than 18 months. This suggests the possibility of some metabolism or enzyme change that takes time to occur in the body.

Are Cox-2 inhibitors less likely to irritate the stomach than older anti-inflammatory drugs?

Cox-2 inhibitors (such as Celebrex and Bextra) do not inhibit the Cox-1 enzyme in the stomach and are thus thought to be less toxic to the stomach than traditional anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). These traditional anti-inflammatory drugs, called nonselective Cox-1/Cox-2 inhibitors, inhibit both Cox-1 and Cox-2 enzymes. While inflammation is reduced by blocking Cox-2, the protective mucus lining of the stomach is also reduced when Cox-1 is blocked, which can cause stomach upset, ulcers, and bleeding.

Current evidence suggests that the selective Cox-2 inhibitors are less toxic to the stomach than traditional anti-inflammatory drugs. This effect is especially significant in persons who are at risk of stomach bleeding, such as those with a history of prior stomach bleeding or patients on blood-thinning medications.

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