The common perception that is being trotted out as an alternative to Vioxx is switching to Pfizer’s Bextra or Celebrex, the other COX-2 inhibitors out there. However, these medications cannot be taken in those with a sulfa allergy or hypersensitivity. This excludes a large percentage of the population – studies estimate approximately 3.5% have a reaction to a sulfa drug. So, what are your alternatives if you can’t take Celebrex or Bextra?
The first would be going back to an NSAID (i.e. ibuprofen or naproxyn). However, one can presume that a major reason Vioxx was taken in the first place was to avoid the GI side effects that NSAIDs bring. Going back to an NSAID may not be feasible in many cases.
The second would be taking acetaminophen (Tylenol). This may work for some, but this option would lack the anti-inflammatory properties of an NSAID or COX-2.
The third, and least publicized, would be considering COX-2 “preferential” NSAIDs, specifically etodolac (Lodine), nambumetone (Relafen), or meloxicam (Mobic). These medications show some COX-2 selectivity at lower doses (approximately 80 percent COX-2 inhibition in the case of etodolac), and may be a viable Vioxx replacement in those who cannot take Celebrex and Bextra. Also, compare the costs (from drugstore.com):
Vioxx 25mg (30 tabs): $81.99
Celebrex 200mg (30 tabs): $79.99
Bextra 10mg (30 tabs): $83.99
etodolac (Lodine) 400mg (60 tabs): $38.99
Mobic 7.5mg (30 tabs): $82.67
nabumetone (Relafen) 500mg (60 tabs): $39.99
Certainly the option of a COX-2 “preferential” medication should also be discussed a viable alternative to Vioxx, especially in those with a sulfa allergy.