Sue - COX-2s, ulcers, etc.

[Guest guest]

Sue,

I've sent several posts on NSAIDs and COX-2s, and they should clear up

some of the confusion. Since I know you prefer that I keep my answers

short, I'll try to accommodate you in this post, LOL.

As Cary said, there is a rationale for prescribing COX-2s (they are

meant for people who are at higher risk than average for GI adverse

reactions; I sent a few posts with the risk factors), but, in practice,

they are dispensed rather indiscriminately.

When compared to older nonselective NSAIDS, COX-2s are very expensive,

no more effective, and relatively new - an inherent risk since the

side-effect profile is still developing. Even though they were designed

to be safer in terms of GI adverse events, we are not sure that COX-2s

truly are. In addition, they may introduce other risks that the

conventional NSAIDs don't.

The idea behind the development of the COX-2 inhibitors is that the

older NSAIDs countered both the COX-1 and COX-2 enzymes, but research

implicates COX-2 as the major offender in most conditions for which

NSAIDs are taken. COX-1 is thought to be primarily a " good guy " -

necessary to protect the stomach lining and the rest of the GI tract,

for example. So, drugs like Celebrex (celecoxib), Vioxx (rofecoxib), and

Bextra (valdecoxib) go after COX-2, but leave COX-1 pretty much alone.

Researchers thought if COX-1 were still available to the body, that the

rate and severity of GI adverse reactions would be reduced.

The truth is, we really don't know if the COX-2s are doing what we

thought they would do. We don't understand enough about these drugs

(or even the older NSAIDs), the precise roles of COX-1 and COX-2, and

the exact effects of removing one or both. The trials done to date seem

to indicate that COX-2s are associated with a lower risk and less severe

GI events, particularly with Vioxx, but some researchers and physicians

dispute the conclusions drawn from the studies. The design of the

clinical trials and the objectivity of the pharmaceutical companies have

been called into question.

All NSAIDs, nonselective (like ibuprofen, naproxen) and selective

(COX-2s), have varying degrees of associated GI, cardiovascular, and

renal risks. Vioxx (rofecoxib) has had some very bad press lately since

some studies seem to indicate that it is associated with a greater risk

of cardiovascular events. Bextra has also been linked to data that

suggests that it may be associated with a higher risk for cardiovascular

events than Celebrex or nonselective NSAIDs. Unfortunately, it's too

early to tell what's going on in this regard.

COX-2 inhibitors were developed to be safer for the GI tract, but

pharmaceutical companies cleverly marketed them so that many doctors and

patients believe that they are not only safer than the older NSAIDS, but

that they eliminate GI risks and are more effective than nonselective

NSAIDs. This just isn't true! COX-2s are not more effective than the

older NSAIDs. COX-2s also produce GI adverse events. We don't know if

they are in fact safer than the old stand-bys like ibuprofen and

naproxen. Also, it may be just as effective and safe yet cheaper to

stick with a nonselective NSAID and add either a proton pump inhibitor

(PPI) or misoprostol to it. Only time and more research will tell.

In the meanwhile, a " poor girl " like you might inquire about adding a

medication to protect your gut to your Bextra (pricey, but it may be

safer). This is your doctor's call, but, if you've had a prior GI bleed

and you are older than 60, there are recommendations by some that either

a PPI or misoprostol be used in addition to whatever NSAID or

COX-2 you're on. If you are worried about the cardiovascular risk of

the coxibs, switching to a nonselective NSAID plus a gastroprotectant is

another option. Depending on the nature and source of your pain,

switching from an NSAID or coxib to acetaminophen also may be something

to consider.

Sorry, this wasn't close to being brief.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] Methionine supplement (SAMe) equivalent

tocelecoxib in OA

Isn't it just Vioxx that is associated with the cardiac implications? I

wouldn't want to take that, but I do take Bextra. Glucosamine raises my

blood sugar, and since I have diabetes, that's not a good thing. Aleve

gave me a bleeding ulcer, so I'm afraid that the regular NSAIDs might,

also. What's a poor girl to do?

Sue