Using a cox2 inhibitor - should I?


The cox2 inhibitor choice has been widely promoted as people become more aware of the problems with traditional NSAIDs (nonsteroidal anti-inflammatory drugs). One cox2 inhibitor, Vioxx, came on the market in North America in 1999 (and was pulled off the market in 2004 - more on that below), and others followed, such as Celebrex (celecoxib) Bextra (valdecoxib), and Arcoxia (etoricoxib). Often used for osteoarthritic and nonarthritic joint pain, these drugs, particularly Vioxx, have been used for migraine as well.

So what's the problem with the NSAIDs that we're more familiar with, such as ibuprofen (ie Advil)? The problem is the coenzymes that they affect. Coenzymes are important to the body because they help allow certain biochemical functions that keep the inner workings of your body running smoothly. These coenzymes include cox-1 and cox-2, or cyclo-oxygenase-1 or cyclo-oxygenase-2. A cox2 inhibitor such as Vioxx doesn't interfere with cox1, but other NSAIDs do.

Cox1 is very important to the developing of the protective lining in your stomach, which is why taking ibuprofen and other NSAIDs, especially if you take a lot of them over your lifetime, can cause stomach problems, ulcers, even liver failure. Read more about ibuprofen here.

New concerns about the Cox2 Inhibitor drugs

But recently, Vioxx (rofecoxib) and its cousins have been under fire. Even if these drugs cause less gastrointestinal problems than other anti-inflammatory drugs, there is concern that there is a risk of heart problems, even heart failure, for some patients when taking Vioxx. In September 2004, Vioxx was pulled from the market, due to heart and stroke risks. In April 2005, Bextra was also withdrawn.

Recently, a large Canadian study pointed to a risk of heart failure in patients taking Vioxx, though no problems when taking Celebrex. Other studies have followed. Recently, the US National Cancer Institute released a study that indicated heart problems from patients taking higher doses of Celebrex. Anne Dooley, Vice President of CAPA, gives this helpful warning:

"The safety of Celebrex for arthritis patients should not be based onthe results of one clinical trial focused on cancer treatment. Conclusions about safety should be drawn from the best evidence that is out there. We need to have more studies and monitoring of new drugs that are on the market."


Bextra is also under attack. On the 10th of December, 2004, the makers of Bextra (Pfizer) issued a warning about the drug. They emphasized that patients with stroke and heart problems should be cautious about taking the drug, and that there could be serious skin reactions as a side effect (usually occurring within the first two weeks on the drug).

Read the full warming about the Cox2 Inhibitor Bextra here.


Web MD has an excellent current overview of cox-2 inhibitors



As studies come out on either side of the debate, many doctors are calling for more research to be done. But for those of us with pain right now, what should be done?

Be sure your doctor is aware of two things. First, be sure she knows about the emerging concerns about cox-2 inhibitor drugs. Second, make sure she is well aware of your medical history, and the other drugs you take regularly or when you get a headache. Are you taking aspirin? Drugs such as Advil? Do you have any heart, liver or kidney problems, risk or history of stroke, or any stomach problems? If your doctor is aware of these things, she should be able to help you make an informed decision about a cox2 inhibitor or other NSAID. If any symptoms develop, tell your doctor right away. There are a lot of alternatives – take the time to choose the one that's right for you.



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Looking for alternatives to Cox2 Inhibitors? Use the index to the left to check out home remedies, abortive and preventative meds. There are a lot of options today - don't give up!