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The Cox-2 Inhibitors Controversy

Question and Answer with Dr. William Shiel and Dr. Michael Smith

Dr. Shiel is a a practicing rheumatologist, and Chief Medical Editor of MedicineNet.com, and Dr. Smith is Senior Medical Editor, WebMD, Inc.

  1. Question: Dr. Smith
    Are Cox-2 inhibitors less likely to irritate the stomach than older antiinflammatory drugs?


    Answer: Dr. Shiel
    Selective Cox-2 inhibitors (such as Celebrex and Bextra) NOTE: April 7, 2005, Pfizer has agreed to suspend sales and marketing of Bextra in the U.S., pending further discussions with the with the FDA. For more information, please read the FDA press release. , do not inhibit the Cox-1 enzyme in the stomach and are thus felt to be less toxic to the stomach than traditional antiinflammatory drugs (such as aspirin, ibuprofen, or naproxen). These traditional anti-inflammatory drugs, called nonselective Cox-1/Cox-2 inhibitors, inhibit both Cox-1 and Cox-2 enzymes. While inflammation is reduced by blocking Cox-2, the protective mucus lining of the stomach is also reduced when Cox-1 is blocked, which can cause stomach upset, ulcers, and bleeding.

Current evidence suggests that the selective Cox-2 inhibitors are less toxic to the stomach than traditional antiinflammatory drugs. This effect is especially significant in persons who are at risk of stomach bleeding, such as those with a history of prior stomach bleeding or patients on blood thinning medications.

  1. Question: Dr. Smith
    There are studies on Cox-2 inhibitors showing heart risks for elderly people. Is the concern only in elderly people?

    Answer: Dr. Shiel
    Actually, while there have been studies demonstrating a heart risk in persons in the Medicare age group, the issues raised pertain to any patient with underlying risk factors for heart disease or stroke. This means not only the elderly may be at risk, but also those who have underlying known heart disease (either coronary artery disease or congestive heart failure) or known blood vessel disease (atherosclerosis or calcification of blood vessels).