The Cox-2 Controversy: Health Risks of Arthritis Drugs

Millions of Americans live with the pain of arthritis and, until recently, painkillers such as Vioxx and Celebrex have been the modern remedy of choice. But as concerns continue to grow over the health risks of these drugs, many people have begun looking for alternative methods of pain relief.

Pain relievers like Vioxx, Celebrex, and Bextra belong to a class of drugs known as Cox-2 inhibitors, which have been linked to a higher risk of cardiovascular disease, such as congestive heart failure and heart attack. Vioxx is no longer on the market and the FDA is now requiring that a “black box” warning be placed on other Cox-2 inhibitors, such as Bextra and Celebrex.

“There is a risk of cardiovascular disease with these drugs, but it is based on very little data,” says Rudolf Bedford, M.D., a gastrointestinal specialist with Saint John’s Health Center. “Until we know more, the major drug manufacturers are playing it safe by suspending sales of the drugs.”

Drugs such as Vioxx and Celebrex were originally developed to reduce stomach distress and the risk of internal bleeding associated with aspirin. Public perception of these drugs has been that they also pose a decreased risk of developing ulcers and gastrointestinal inflammation as opposed to nonsteroidal, anti-inflammatory drugs (NSAIDs) like Naproxen (sold as Aleve) and Ibuprofen (sold as Motrin).

That perception is misleading, according to Dr. Bedford. “Studies have shown that after taking a drug like Vioxx or Celebrex for more than a year, the risks of developing ulcers and other GI complications are the same as taking painkillers like Aleve and Motrin,” says Dr. Bedford.

“And because people with arthritis commonly take these drugs for years and years, eventually they face the same risks as people using over-the-counter pain relievers like Aleve.”

Dr. Bedford recommends that arthritis sufferers take an acid-lowering drug such as Prilosec when taking a Cox-2 inhibitor or NSAID drug. Prilosec is sold over the counter and is readily available nationwide.

“Cox-2 inhibitors do not offer more pain relief than Ibuprofen does, although many people believe they are better,” he says. “If you take an 800-milligram tablet of Motrin with Prilosec, you will receive the same pain-relieving benefits as taking Vioxx. Most tablets come in a 400-milligram dose, so you simply have to double the dosage. Just make sure you take it with an acid-reducing drug to minimize the risk of gastrointestinal complications.”

One added benefit of taking over-the-counter medication is the lower cost. Drugs like Vioxx and Celebrex typically cost 10 times as much for the same pain relief as Motrin and Aleve, according to Dr. Bedford.

Tylenol is also marketed to consumers for arthritis pain relief. Tylenol, which is an acetaminophen, is a pain reliever but not an anti-inflammatory. While taking acetaminophen may be an option for some, it doesn’t work very well for arthritis pain, according to Dr. Bedford.

Aspirin is also not recommended for arthritis sufferers due to the risk of internal bleeding — particularly in the high doses necessary to relieve severe arthritis pain. To receive the same anti-inflammatory effect as one Celebrex tablet, you would have to take at least a dozen aspirin, medical experts estimate.

“My recommendation to patients is to take Aleve or Motrin with Prilosec, which costs about 71 cents a pill,” Dr. Bedford says. “There is no pain-saving benefit to taking more expensive drugs.”

For more information or to reach a gastrointestinal specialist at Saint John’s, call (310) 829-8990.

For more information, call (310) 829-8909 or visit Saint John’s website at www.stjohns.org.