Aleve, Vioxx, Celebrex and Bextra: What You Need To Know About Arthritis Pain MedicationsRecent controversy about
safety of pain medications for arthritis has left patients and health care professionals alike confused about which medications are safe to use. In fact, a recent survey by
Boston-based Rippe Lifestyle Institute indicated that many people with arthritis are suffering unnecessarily because they have stopped or reduced their use of pain relievers due to confusion about which drugs are considered safe.
The survey also showed that now, more than ever, those with arthritis need to understand
benefits and possible side effects associated with all arthritis pain medications. In order to do so, people with arthritis, their caregivers and families must be familiar with recent news about
two types of drugs most commonly used to treat arthritis pain – non-selective, non-steroidal anti-inflammatory drugs (NSAIDs), and another group of NSAIDs known as cyclooxygenase-2 (COX-2) specific inhibitors.
COX-2 specific inhibitors vs. Other NSAIDs
COX-2 specific inhibitors are
newest members of
NSAID class of medications. Available by prescription only, they became widely used in recent years to reduce joint pain and swelling. COX-2 specific inhibitors work by selectively blocking, or inhibiting, one of
two enzymes associated with inflammation. Some experts think that this selective inhibition may be one reason for some of
negative side effects currently associated with COX-2 specific inhibitors.
Non-selective NSAIDs were developed earlier than COX-2 specific inhibitors and have been widely used to relieve arthritis pain and inflammation for many years. Unlike COX-2 specific inhibitors, non-selective NSAIDs inhibit both major enzymes involved in
inflammatory process, COX-1 and COX-2. The non-selective NSAID category includes a number of different medications that are available in both prescription and over-the-counter (OTC) products.
Timeline of Events
To understand
current state of affairs, it is important to understand
sequence of events. The controversy started when a study published in
October 21, 2004, issue of
New England Journal of Medicine cited
COX-2 specific inhibitor, Vioxx as potentially causing “major adverse events,” including heart attack and stroke, among patients taking
drug. As a result, Merck (the drug’s manufacturer) voluntarily withdrew Vioxx from
market. However, in
months following,
safety of
other available COX-2 specific inhibitors such as Celebrex and Bextra, as well as other arthritis pain medications in
non-steroidal anti-inflammatory (NSAID) class, were also called into question.
Consequently, in February 2005,
US Food and Drug Administration (FDA) convened a special Advisory Committee, made up of members of
Arthritis and Drug Safety Advisory Committees, to review
cardiovascular safety of these arthritis pain medications.