Pain Relievers: Questions & Answers
Arthritis Expert Helps You Understand Risks From Pain Relievers
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Some studies have shown that Cox-2 inhibitors have been overprescribed. To whom should these drugs be prescribed?
In particular, a recent study published in the Archives of Internal Medicine
showed that doctors were using Cox-2 drugs in a wide variety of patients
instead of specifically selecting patients at risk for stomach bleeding as the
ideal candidates. It was suggested that marketing and promotion of the drugs
lead to their use in an unnecessarily large group of patients. Moreover,
patients may have requested them because of perceived benefits.
Drug treatment is always based on a risk vs. benefit analysis. In clinical
practice, Cox-2 inhibitors are considered after weighing the benefits vs. the
risks. As more research clarifies the risks and the groups of patients who are
more prone to these risks, it will become easier for patients and doctors to
choose medications optimally.
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
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
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