Find Information About:

Drugs & Supplements

Get information and reviews on prescription drugs, over-the-counter medications, vitamins, and supplements. Search by name or medical condition.

Pill Identifier

Pill Identifier

Having trouble identifying your pills?

Enter the shape, color, or imprint of your prescription or OTC drug. Our pill identification tool will display pictures that you can compare to your pill.

Get Started
My Medicine

My Medicine

Save your medicine, check interactions, sign up for FDA alerts, create family profiles and more.

Get Started

WebMD Health Experts and Community

Talk to health experts and other people like you in WebMD's Communities. It's a safe forum where you can create or participate in support groups and discussions about health topics that interest you.

  • Second Opinion

    Second Opinion

    Read expert perspectives on popular health topics.

  • Community


    Connect with people like you, and get expert guidance on living a healthy life.

Got a health question? Get answers provided by leading organizations, doctors, and experts.

Get Answers

Sign up to receive WebMD's award-winning content delivered to your inbox.

Sign Up

Pain Management Health Center

Font Size

Cox-2 Use Is Down, but Ulcers Are Up

Patients Turn to Traditional NSAID Painkillers but Skip Drugs That Protect Their Stomachs
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 8, 2007 (Boston) -- The number of bleeding ulcers and other gastrointestinal complications has increased since a class of pain drugs called Cox-2 inhibitors fell out of favor due to their increased risk of heart attack or stroke, according to a new study.

The new research was presented Thursday at the American College of Rheumatology Annual Scientific Meeting in Boston.

Cox-2 inhibitors are a type of nonsteroidal anti-inflammatory drug (NSAID). They were developed to be safer on the stomach than traditional NSAIDs such as ibuprofen and naproxen. But research linking Cox-2 drugs to heart attack and stroke resulted in the withdrawal of some Cox-2 drugs from the market and a decline in the use of these drugs among people with arthritis.

Many people returned to using traditional NSAIDs, which may be safer on the heart but are harsher on the stomach, without taking other drugs known to protect the stomach.

"An increasing number of elderly users of NSAIDs are again being left without appropriate gastroprotection resulting in an impending public health disaster," says researcher Gurkirpal Singh, MD, professor of medicine, immunology, and rheumatology at Stanford University Medical School in Palo Alto, Calif. "Patients need to talk to their doctors to make sure they are protected."

Some people with arthritis who take traditional NSAIDs and are considered to be at risk of GI side effects should take proton pump inhibitors (PPI) to reduce acid production in the stomach, or misoprostol, which protects the stomach lining.

The problem is that not enough people are doing this, says Singh.

"PPI use did triple, but even then the Cox-2 drop was so huge that a lot of people were left unprotected," he tells WebMD.

The new study included arthritis patients older than 65 who were treated with NSAIDs for at least 30 days from 1997 to 2005. The researchers analyzed more than 4 million prescriptions for NSAIDs in the study and tracked the rate of hospitalizations and/or emergency room visits for complicated ulcers of the stomach and small intestine per 100,000 prescriptions.

Increase in Ulcers in 2005

While the gastroprotection gap (the number of people not protecting their stomachs when taking traditional NSAIDs) had been declining steadily over the last decade, it more than doubled in 2005, reaching approximately 35%, the study shows.

Today on WebMD

pain in brain and nerves
Top causes and how to find relief.
knee exercise
8 exercises for less knee pain.
acupuncture needles in woman's back
How it helps arthritis, migraines, and dental pain.
chronic pain
Get personalized tips to reduce discomfort.
illustration of nerves in hand
lumbar spine
Woman opening window
Man holding handful of pills
Woman shopping for vegetables
Sore feet with high heel shoes
acupuncture needles in woman's back
man with a migraine