- What are Cox-2 inhibitors?
- For which conditions are Cox-2 inhibitors prescribed?
- Which COX-2 inhibitors are available in the United States?
- What are NSAIDs (nonsteroidal anti-inflammatory drugs)?
- NSAIDs vs. COX-2 inhibitors, which are better?
- What are the side effects of COX-2 inhibitors and/or NSAIDs?
- What drugs interact with COX-2 inhibitors and/or NSAIDs?
What are Cox-2 inhibitors?
Prostaglandins are made by two different enzymes, cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). The prostaglandins made by the two different enzymes have slightly different effects on the body. COX-2 inhibitors are NSAIDs that selectively block the COX-2 enzyme and not the COX-1 enzyme. Blocking this enzyme impedes the production of prostaglandins by the COX-2 which is more often the cause the pain and swelling of inflammation and other painful conditions. Because they selectively block the COX-2 enzyme and not the COX-1 enzyme, these drugs are uniquely different from traditional NSAIDs which usually block both COX-1 and COX-2 enzymes.
For which conditions are Cox-2 inhibitors prescribed?
COX-2 inhibitors are used for treating:
- Ankylosing spondylitis
- Juvenile rheumatoid arthritis
- Menstrual cramps (primary dysmenorrhea)
- Acute pain (for example, sports injuries)
- Rheumatoid arthritis
Which COX-2 inhibitors are available in the United States?
Celecoxib (Celebrex) is the only COX-2 inhibitor available in the United States. It is available as a generic.
What are NSAIDs (nonsteroidal anti-inflammatory drugs)?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that reduce inflammation but are different from steroids, another class of drugs that also reduces inflammation. NSAIDs reduce pain, fever, and swelling and are commonly prescribed for inflammation of the joints (arthritis) and other tissues, such as in tendinitis and bursitis. Examples of NSAIDs include:
- indomethacin (Indocin),
- ibuprofen (Advil, Motrin),
- naproxen (Naprosyn),
- piroxicam (Feldene), and
- nabumetone (Relafen).
NSAIDs are used frequently by millions of individuals for treatment of pain, fever and swelling caused by inflammatory conditions as well as for pain alone. NSAIDs work by blocking the production of prostaglandins, chemical messengers that often are responsible for the pain and swelling of inflammatory conditions.
The side effects of NSAIDs are listed below and are compared and contrasted with those of COX-2 inhibitors.
NSAIDs vs. COX-2 inhibitors, which is better?
COX-2 inhibitors impede prostaglandin production. COX-1 is an enzyme which is normally present in a variety of tissues in the body, including sites of inflammation and the stomach. Some of the prostaglandins made by COX-1 protect the inner lining of the stomach. Common NSAIDs such as aspirin block both COX-1 and COX-2 (see below). When the COX-1 enzyme is blocked, inflammation is reduced, but the protection of the lining of the stomach also is lost. This can cause stomach upset as well as ulceration and bleeding from the stomach and even the intestines.
The other cyclooxygenase, COX-2, also produces prostaglandins, but the COX-2 enzyme is located specifically in areas of the body that commonly are involved in inflammation but not in the stomach. When the COX-2 enzyme is blocked, inflammation is reduced; however, since the COX-2 enzyme does not play a role in protecting the stomach or intestine, COX-2 specific NSAIDs do not have the same risk of injuring the stomach or intestines.
Older NSAIDs (for example, aspirin, ibuprofen, naproxen, etc.) all act by blocking the action of both the COX-1 and COX-2 enzymes. COX-2 inhibitors selectively block the COX-2 enzyme and therefore have a lower risk of causing ulcers of the stomach or intestine.
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