With so many pain relievers available, choosing the right one
for you can seem very confusing. All medications can have potential
side effects and the risks and benefits must be weighed in each
individual. It is best to speak with your doctor to see which one
is best for you.
What are COX-2 nonsteroidal anti-inflammatory drugs
(NSAIDs)?
The COX-2 inhibitors represent a new class of NSAIDs, which are
designed to reduce pain and inflammation just like traditional
NSAIDs. However, COX-2 inhibitors have an added safety benefit of
being less likely to cause stomach problems such as ulcers,
bleeding, and obstruction. Both COX-2 inhibitors and traditional
NSAIDs have equal ability to control pain and inflammation.
How do COX-2 NSAIDs work?
Traditional NSAIDs such as aspirin, ibuprofen, naproxen, and others
act by blocking the production of a family of chemicals (known as
prostaglandins) that cause inflammation. There are two enzymes that
are important for allowing prostaglandins to cause inflammation,
specifically known as COX-1 and COX-2 enzymes.
Traditional NSAIDs work by blocking both COX-1 and COX-2. The
COX-2 inhibitors work by blocking the COX-2 enzyme only. By
blocking the COX-2 enzyme, these new drugs can help block pain and
inflammation and still allow the COX-1 enzyme to work. This is
important because the COX-1 enzyme is needed to help protect the
stomach lining and decrease your chance of having a stomach ulcer
and/or bleeding. Thus, the new COX-2 inhibitors can help relieve
pain and inflammation with the added benefit of protecting your
stomach
What are the names of the newer COX-2 inhibitors?
There is only one COX-2 inhibitor at the present time, namely
celecoxib (Celebrex).
Both rofecoxib (Vioxx) and valdecoxib (Bextra) have been removed
from the market due to concerns about an excess of heart attacks or
stroke. Similarly, Valdecoxib was suspended by Pfizer when the FDA
found an increased rate of heart problems as well as an increased
rate of rare, serious skin reactions.
How are COX-2 inhibitors safer than traditional NSAIDs?
Over the past two years there have been numerous studies
documenting the enhanced safety profile of COX-2 inhibitors over
traditional NSAIDs. Two recently completed large clinical trials
known as the CLASS study for celecoxib, and the VIGOR study for
rofecoxib, collectively investigated over 10,000 patients. Both of
these studies demonstrated that these drugs are significantly
better than traditional drugs such as naproxen (Naprosyn);
diclofenac (Voltaren); and ibuprofen (Motrin), in reducing the risk
for most stomach problems such as ulcerations, perforations, or
bleeding. These drugs do not eliminate this possibility, but
dramatically and significantly reduce it.