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Vioxx Off the Market: What Next?

The editors of The Journal of Bone and Joint Surgery wrote this review of the drug Vioxx, which was recently pulled off the market. Vioxx is a fairly new class of nonsteroidal anti-inflammatory drugs (NSAIDs) called Cox-2 inhibitors (coxibs). Coxib drugs are used to treat the painful symptoms of arthritis.

The benefit of the Coxibs is their ability to prevent stomach (GI) problems. They have the added advantage of reducing platelets in the blood. Fewer platelets means less bleeding. This is important during and after any surgery.

Vioxx was withdrawn from use because long-term use can lead to an increased risk of heart attack and stroke. The heart attacks don't happen right away, but they were observed to occur 18 months or more after taking this drug.

There are two other coxibs still available for use: Celebrex and Bextra. Based on studies done so far, it's likely these drugs carry a similar risk. Patients who have Stevens-Johnson syndrome or who have had a coronary artery bypass graft are also at increased risk of heart problems.

What advice do the editors offer doctors? Tylenol should be used as the first choice for chronic muscle or joint pain. Coxibs should be saved for older patients (65 and older) or who already have a history of GI bleeding. Anyone with high blood pressure or a history of heart problems should avoid coxibs.

References: Cardiovascular Risks of Coxibs: The Orthopaedic Perspective (Editorial). In The Journal of Bone and Joint Surgery. February 2005. Vol. 87-A. No. 2. Pp. 245-246.

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