COX-2 Inhibitors: Pros and Cons

What do I need to know about Cox-2 inhibitors?

• Cox-2 inhibitors were found to cause an increase in cardiovascular problems for long term users (i.e. heart attacks and strokes), it was reported that the risks for patients using these drugs were 2 to 3 times greater than for those who were given a placebo.
• There remain some very real dilemmas about which medicines may be best for you personally. The best decision can only be found in consultation with your doctor

After valuating the pros and cons of NSAIDs (Non-steroidal anti inflammatory drugs) for the relief of pain and reduction of inflammation lets take a closer look at an alternative type of drugs known as Cox-2 inhibitors. When first introduced they were considered an excellent alternative to NSAIDs since Cox-2 inhibitors did not appear to have the gastrointestinal (stomach) side effects associated with the NSAIDs.

However, in 2005 Cox-2 inhibitors received a serious set-back as reports of considerable risks for long term uses, were announced. The Food and Drug Administration Center (FDA) for Drug Evaluation and Research advised caution whilst prescribing Cox-2 selective agents. Soon after this one of the most popular drugs, Vioxx®, was removed from the market because of its associated health risks, this was followed later by Bextra® which was voluntarily withdrawn. The number of sales of Cox-2 inhibitors decreased by 75% following these announcements, and since then approximately only 7% of doctors continued to prescribe Cox-2 inhibitors for new patients.

Why were Vioxx® and Bextra® removed from the market?

The main reasons for the removal of these Cox-2 inhibitors from the market was that they were found to cause an increase in cardiovascular problems for long term users (i.e. heart attacks and strokes), it was reported that the risks for patients using these drugs were 2 to 3 times greater than for those who were given a placebo. The reason for the delay in identifying the risks with these drugs was that effects only became noticeable after 18 months use.

Are the remaining Cox-2 inhibitors safe?

The FDA decided that Celebrex®, another Cox-2 inhibitor, would be allowed to remain on the market with the proviso that it contained a “black box” warning about cardiovascular risks. However it is worth noting that at much the same time the FDA also recommended that all NSAIDs, (with the exception of aspirin), should carry the same warning to raise awareness of associated cardiovascular risks.

What should I consider when making my decision?

There remain some very real dilemmas about which medicines may be best for you personally. The best decision can only be found in consultation with your doctor. It could well be that there are some groups of people who may be at less risk with Cox-2 inhibitors than the alternative NSAIDs, for example those who are already taking treatment for cardiovascular diseases. Other important things for you to discuss with your doctor should be; the level of pain you are experiencing, what has worked for you in the past, and any history of stomach ulcers or heart disease, either personally or in your family.

So should Cox-2 inhibitors remain an option for me?

One medical practitioner on-line suggested that Cox-2 inhibitors should continue to remain an option for doctors, and that for some it could well be a better choice, for example if the patient was already taking aspirin for cardiovascular reasons.

On-going research into these medicines will continue to provide additional information which will help shed more light on this decision making process. In the meantime the Cox-II class of drug could remain an effective treatment for some diseases. It is important to remember, however, that no prescription in this area is without risk. Even ordinary NSAIDs are approximated to be responsible for considerable numbers of hospital admissions, and deaths each year.

The information supplied in this article is not to be considered as medical advice and is for educational purposes only.