The prescription pain relievers Vioxx and Celebrex surged onto the scene two years ago with an unprecedented marketing effort by their makers and an avalanche of sales. But now there are troubling questions about whether Vioxx may have an unexpected side effect - a very slight increase in the risk of heart attack.
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October 10, 2001
By Howard LeWine, M.D.
Harvard Medical School
How does this article relate to me?
Aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs) are the most commonly used medications in the United States. Most people use occasional doses to treat headaches, and joint and muscle pains. Some people need to take them more regularly to control inflammation, or as part of a chronic pain-treatment program. Until now, the newest NSAIDs, which are more selective in their action (selective COX-2 inhibitors), have been considered to be at least as safe as the older agents. For patients at risk of ulcers and bleeding from the stomach or upper intestinal tract, they are safer.
Now a question has been raised about whether drugs like Vioxx and Celebrex might result in higher risk of heart attack. The study that raised this question was not designed to look at this issue. Therefore interpretation is only speculative at this time.
What changes do I need to make?
If you are taking one of the new selective COX-2 inhibitors, like Vioxx or Celebrex, you may want to talk with your doctor about changing to a non-selective inhibitor, like ibuprofen or naproxen. The slight increased risk of heart attack is by no means proven. But for people with coronary heart disease or multiple risk factors for heart disease, then there may be an equal and less expensive choice.
Selective COX-2 inhibitors cause less irritation to the stomach and upper intestine. So there is less chance of bleeding and ulcers compared to non-selective inhibitors. If you have ulcer disease or a history of stomach or upper intestinal bleeding, then stick with Vioxx and Celebrex, even if you have heart disease.
What can I expect in the future?
You can expect that a well-designed study will be reported in the future to address this important question. Even if the risk is only slight, the number of people who take NSAIDs is so large that a small increase is very meaningful.
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