What patients should do if Vioxx, Celebrex or Bextra are banned

So, what if COX-2′s are withdrawn from the market? There are plenty of patients (i.e. those with arthritis) who require an anti-inflammatory in the face of prior ulcers or GI bleeds. That is presumably why they were on Vioxx, Celebrex or Bextra in the first place.

One option would be to use COX-2 preferential medications, such as Relafen, Lodine or Mobic – all discussed previously.

If that cannot be done, then a combination of a non-selective NSAID (i.e. ibuprofen, naprosyn etc.) in combination with a GI-protective agent should be considered. I will consider two scenarios.

Those at high risk for GI bleeding

The FDA has approved two medications for high-risk GI patients who take non-selective NSAIDs: lansoprazole (Prevacid) at 15mg or 30mg daily, and misoprostol at 200ug four times daily. Thus, either of these options should be used in conjunction with the NSAID.

H Pylori should be tested for and treated if present.

Those with a prior history of GI bleeding

In patients with a history of ulcers, studies have shown that treatment with a proton-pump inhibitor (PPIs – either omeprazole at 20mg daily or lansoprazole at 15mg or 30mg daily), in conjunction with continuous NSAID use, demonstrated appropriate healing. PPIs also have been shown to be superior than other medications such as misoprostol and sucralfate in those with a prior ulcer or bleed.

Again, H Pylori should be tested for and treated if present.

Bottom line

If Celebrex and the other COX-2′s are pulled in the near future, here are the options you want to discuss with your physician:

1) Switch to Tylenol.

2) Switch to Lodine, Mobic, or Relafen which are COX-2 preferential; or,

3) Switch to a non-selective NSAID, i) in combination with a PPI or misoprostol if you are at high risk for GI bleeding, or ii) in combination with a PPI if you have a history of GI bleeding.

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  • Anonymous

    This is Douglas at Belief Seeking Understanding. You seem to believe that the COX-2s will be withdrawn from the market. Do you consider that a good thing?

    When reading your post, I saw a picture in my mind’s eye of a tree with “COX-2 user” at the root, and the various branches were the result of various conditions. A computer person would weight the branches of such a tree to see what the distribution of the leaves (final prescriptions) would be.

    Will the COX-2 users be about as well off as they were before? Inquiring minds want to know!

  • Cori

    I’d like the answer to that question myself. I thought the FDA decision — that balancing risk vs. quality of life was a decision for patient and doctor — was actually one that assumed patients could think for themselves. It shocked me; that certainly isn’t what me expect from government agencies these days and it isn’t what the media feeding frenzies push government agencies towards.

    Also, my understanding was that for very long term use the whole pt of switching to the COX-2s was to get patients off Lodine b/c the risk of ultimately developing GI problems was so much higher with Lodine. Are you suggesting it’s comparable?

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