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What
are Vioxx and Celebrex?
Celebrex
and Vioxx are Cox-2 inhibitors, a class of drugs that
was released on the U.S. market several years ago.
This class of drug was to be the next step in treating
osteoarthritis and other types of pain. Individuals
who had previously taken aspirin or other NSAIDs (nonsteroidal
anti-inflammatory drug such as aspirin or ibuprofen),
but were bothered by gastrointestinal problems commonly
associated with them.
Celebrex
and Vioxx were touted as great medical developments
in the many ads that promoted their benefits. Principal
among these was the claim that Vioxx and Celebrex
relieved pain without causing stomach problems Unfotunately,
Vioxx and Celebrex pose troubling effects for some
users.
What
is the controversy surrounding the two drugs?
A
recent study out of the Cleveland Clinic noted an
increase in the development of myocardial infarctions,
or heart attacks, in people treated with Vioxx, when
compared with those treated with naproxen (a standard
NSAID). As well, several years ago when Celebrex came
to market, The Wall Street Journal ran a story linking
Celebrex to 10 deaths during its first three months.
In addition, there were eleven other cases of gastrointestinal
hemorrhage associated with the drug. Celebrex has
also made news for the complications and mistakes
made due to the similarities between its name and
other drugs. Over 50 reports of errors have been recorded
that Celebrex was mistaken for either Cerebyx and
Celexa. Cerebyx is an intravenous drug used to treat
epilepsy, while Celexa is a medication used to treat
depression.
What
are Cox-2 inhibitors?
Cox-2
inhibitors inhibit the enzyme involved in inflammation
of body tissue. Traditional NSAIDs inhibit both the
Cox-1 and Cox-2 enzymes. The problem with this is
that they stop the "good" Cox-1 enzyme that
helps protect the lining of the stomach. Cox-2 inhibitors,
in theory at least, do not impair the good Cox-1 enzyme,
only the Cox-2 enzyme that is responsible for inflammation.
Cox-2 inhibitors therefore cause less gastrointestinal
problem.
However,
Cox-2 inhibitors are not without their problems. They
increase the risk of heart attack. The reason for
this may be a simple difference between what enzymes
are inhibited in the platelets by these drugs. One
theory for this holds that the Cox-1 enzyme plays
a role in preventing clot formation that leads to
heart problems.
So
aspirin and other nonsteroidal drugs that inhibit
the Cox-1 enzyme probably protect people from developing
heart attacks, whereas, Cox-2 inhibitors don't protect
people from developing heart attacks.
Are
Vioxx and Celebrex more effective than aspirin and
other NSAIDS?
Many
experts in the field are not convinced that Celebrex
or Vioxx are more effective for pain relief than traditional
nonsteroidal drugs (NSAIDS). There does seem to be
substantial evidence that both drugs are safer in
regards to gastrointestinal side effects, like ulcer,
gastrointestinal bleeding or obstructions. However,
there is significant concern about the risks they
posed to consumers with regards to cardiovascular
problems.
Clinical
trials that led to the approval of Celebrex and Vioxx
suggested that the drugs were safer on the stomach.
But the manufacturers had to conduct bigger and longer-term
studies to drop a warning about serious ulcers that
all NSAIDs carry. The conclusion of FDA medical officer
Maria Lourdes Villalba was that Vioxx should continue
to carry the same warning as other NSAIDs regarding
gastrointestinal (GI) problems like ulcers, bleeding
and perforation. Villalba also noted that the risk
of heart attack and stroke should be added to the
label.
Who
shouldn't take Vioxx and Celebrex?
Be
very cautious about taking Vioxx and Celebrex if you:
•
Have had ulcers or stomach bleeding
• Have had asthma, hives or allergic-type reactions
after taking aspirin or other NSAIDs
• Have severe kidney problems
• Have severe liver problems
• Are pregnant
What
should I do if I'm currently taking Vioxx or Celebrex?
The
most important step for patients currently taking
Vioxx or Celebrex is to discuss their health and history
with their physician. Your doctor is hopefully aware
of the potential health risks associated with these
Cox-2 inhibitors and may advise using low-dose aspirin
or some other alternative in order to minimize the
risk of heart disease from these drugs. Patients must
educate themselves on the potential risks, and, if
they experience any side effects associated with Cox-2
inhibitors, must immediately contact their doctor.
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