Since the September 30, 2004 recall of Vioxx, a popular COX-2 inhibitor, many questions have arisen regarding the potential side effects and health risks of COX-2 inhibitors and other types of NSAIDs: Non-Steroidal Anti-Inflammatory Drugs). COX-2 inhibitors (such as Celebrex and Bextra) are a type of NSAID and are the most commonly prescribed drugs for arthritis. COX-2 inhibitors are also prescribed for many forms of back pain. This article answers common questions about the side effects of COX-2 inhibitors and naproxen, another type of NSAID that has been called into question. The article also examines recent research and explains the recommendations given by the U.S. Food and Drug Administration (FDA).

See Potential Risks and Complications of Celecoxib

Following the voluntary recall of Vioxx by Merck (the drug's manufacturer), attention has been called to recent studies on COX-2 inhibitors and other NSAIDs. The studies tested new uses of the drugs and have shown an increased risk for cardiovascular problems among certain groups of patients. The study results are still inconclusive at the time of this article, and the FDA has called for additional research on a variety of NSAIDs. More studies on the side effects of NSAIDs are currently underway.


Recommendations for Using COX-2 Inhibitors and Other NSAIDs

There is no single answer for whether individual patients should use NSAID medications such as Celebrex, Bextra, or naproxen. For example, elderly patients and those who take the drugs for long periods of time tend to be more susceptible to known side effects (such as gastrointestinal, kidney, and liver problems). Prolonged use of NSAIDs should also be avoided. The most important thing to remember is that each patient should meet with his or her physician to determine the best course of action based on individual risk factors, treatment needs, and previous experience with NSAIDs.

What are NSAIDs (e.g. COX-2 Inhibitors, Naproxen)?

NSAIDs (non-steroidal anti-inflammatory drugs) are the most frequently prescribed class of drugs for rheumatoid arthritis and osteoarthritis. Patients with arthritis experience inflammation in the joints that causes stiffness, limited range of motion, and often debilitating pain. NSAIDs are used to inhibit the cyclooxygenase enzyme that controls inflammation. In addition to performing the anti-inflammatory function, NSAIDs also serve as an analgesic (painkiller). NSAIDs are also frequently taken for many types of back pain. One benefit is that NSAIDs tend to have fewer gastrointestinal side effects than aspirin and can be taken with acetaminophen (e.g. Tylenol) for additional pain relief.


What are COX-2 Inhibitors (e.g. Vioxx, Celebrex and Bextra)?

The main brands of COX-2 inhibitor drugs currently on the market are Celebrex and Bextra (since the Vioxx recall). COX-2 inhibitors are a newer type of NSAID that block the COX-2 enzyme at the site of inflammation. The benefit of COX-2 inhibitors is that they do not inhibit COX-1, an enzyme that helps with the production of the protective stomach lining. (Other types of NSAIDs block both COX-2 and COX-1, which can lead to gastrointestinal side effects). For more information about the nature of COX-2 inhibitors and known side effects, please see COX-2 Inhibitors: Celebrex.

Types of NSAIDs

The following list shows different types of NSAIDs, including traditional (non-selective) NSAIDs and COX-2 inhibitors (selective) NSAIDs.

COX-2 inhibitors

Types of NSAIDs
Generic name Brand Name(s)
Salycylic acids
Aspirin (acetylsalicylic acid) Ascriptin, Bayer, Ecotrin
Choline magnesium trisalicylate Trilisate
Diflunisal Dolobid
Salsalate Disalcid, Salflex
Propionic acids
Fenoprofen Nalfon
Flurbiprofen Ansaid
Ibuprofen Advil, Motrin, Nuprin
Ketoprofen Actron, Orudis, Oruvail
Naproxen Aleve, Anaprox, Naprelan, Naprosyn
Oxaprozin Daypro
Acetic acids
Diclofenac Cataflam, Voltaren
Indomethacin Indocin
Sulindac Clinoril
Tolmetin Tolectin
Enolic acids
Meloxicam Mobic
Piroxicam Feldene, Fexicam
Fenamic acids
Meclofenamate Meclomen
Mefenamic acid Ponstel
Nabumetone Relafen
Pyranocarboxylic acids
Etodalac Lodine
Ketorolac Toradol
Celecoxib Celebrex
Valdecoxib Bextra
Rofecoxib Vioxx (recalled in 2004)



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