When Relief Takes Time Cox-2 Update Side Effect Solutions

You most likely have taken a nonsteroidal anti-inflammatory drug (NSAID) – either prescription or over-the-counter (OTC) – perhaps even before you developed arthritis. At low doses, these drugs help a wide range of problems, from muscle aches and headaches to minor pain and fever. At higher prescription doses, NSAIDs help reduce joint inflammation. NSAIDs fall into three basic categories: traditional NSAIDs, COX-2 inhibitors and salicylates. All NSAIDs work by blocking prostaglandins – hormone-like substances that contribute to pain, inflammation, fever and muscle cramps. However, there are subtle differences between the three types.

Traditional NSAIDs
With 20 prescription medications in the group – three of which are available in lower-strength, non-prescription doses – traditional NSAIDs are the largest subset of the NSAID class. Like all medications, even non-prescription versions of NSAIDs carry a risk of side effects, including stomach upset and gastrointestinal bleeding, especially in people over 60. For this reason, consult your doctor before taking any medication you buy without a prescription.

COX-2 Inhibitors
Like traditional NSAIDs, COX-2 inhibitors help reduce pain and inflammation but are designed to be safer for the stomach. (See " Side Effect Solutions")Digestive tract studies have shown less stomach damage from COX-2 inhibitors compared to traditional NSAIDs; however, COX-2s have not been used as long as other NSAIDs.

Studies to determine the incidence of side effects and safety continue. In late 2004 and early 2005, two COX-2s, rofecoxib (Vioxx) and valdecoxib (Bextra), were withdrawn from the market after several large studies showed increased cardiovascular risks and, in the case of Bextra, risk of a serious skin reaction. A long-term study to evaluate the cardiovascular risks of Celebrex is currently underway. In the meantime, the FDA has asked manufacturers of all NSAIDs to highlight warnings on their labels in a black box and to provide consumers with medication guides.(See "COX-2 Update")

Salicylates
The original category of NSAIDs – the salicylates (suh-LIS-uh-lates) – includes aspirin and is still preferred by many patients and doctors. If you plan to take aspirin for more than occasional aches and pains, consult your doctor. Frequent large doses, which can cause some serious side effects, usually are needed to control arthritis pain and inflammation. Your doctor can work with you to determine the best dosage and help you prevent or manage side effects, including kidney problems or gastrointestinal bleeding.

Your doctor may prescribe a chemical variation referred to as a nonacetylated salicylate, which is specially formulated to have fewer side effects, if aspirin is too risky for you. Unfortunately, nonacetylated salicylates lack aspirin’s beneficial protection against cardiovascular disease. Therefore, if you’ve been advised to take low-dose (“baby”) aspirin to prevent a heart attack or stroke and your doctor prescribes a nonacetylated salicylate – or any other NSAID, for that matter – ask about continuing your low-dose aspirin along with it.

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