How Safe Are Other Pain Relievers?

Millions of people have taken Vioxx, Celebrex and Bextra for pain. These new COX-2 inhibitor drugs were prescribed for a variety of conditions, including arthritis, muscle strains and bad backs.
Then evidence about heart attacks and strokes led to the removal of Vioxx. Scary headlines also undermined sales of Celebrex and Bextra.
With all the bad news, many physicians started looking for alternatives. Some are prescribing older NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen, naproxen or diclofenac.
Others are turning to newer drugs, such as Mobic, for patients in pain. This anti-inflammatory medication has avoided controversy largely because it was not advertised as heavily as Vioxx or Celebrex. But some scientists have begun to question whether Mobic or even some NSAIDs are much safer than the drugs they are replacing.
Mobic also affects the COX-2 enzyme. Australian drug regulators have classified it as a COX-2 inhibitor and warn against its use by patients with cardiovascular risk factors.
American patients are puzzled. One reader wrote:
“I’ve read that Mobic is a COX-2 inhibitor. I am confused since my doctor told me it isn’t.
“I’m trying to figure out what my risk would be with this drug if it were a COX-2 inhibitor. I’m 43 and not overweight, run 40 miles a week and don’t smoke or drink. My cholesterol and blood pressure are low, and I have no personal or family history of heart disease. Should I be concerned about using Mobic or any other COX-2 inhibitor?”
Most doctors would conclude this patient’s risk is extremely low. But even some people without obvious heart problems may be vulnerable.
One reader shared her tragic story:
“I have read recent reports about the drug Mobic and its possible link to heart attacks. I have been so frustrated trying to find out why my 39-year-old husband suddenly collapsed and died from a fatal heart arrhythmia.
“He was taking Mobic prescribed by his internist after a minor car accident. My vibrant and healthy husband, father of two little girls who were 3 and 7 years old at the time, had excellent blood pressure, no cholesterol problems and was not overweight.
“Please help me get the word out about the dangers of this drug. I am in the process of reporting his death to the FDA. My daughters and I miss their father daily.”
While it is impossible to determine whether Mobic caused this cardiac arrest, some warning flags are flying. FDA safety officer, David Graham, MD, reported preliminary findings that Mobic may also increase the risk of heart attacks.
The manufacturer of Mobic maintains it has not seen problems. Dr. Graham is the first to admit that a single study is not enough to tell whether a drug carries unacceptable hazards. But there is growing concern that many of the new anti-inflammatory drugs may require patients to make difficult decisions.
It can be hard to weigh the chance of stomach ulcers against the possibility of a heart attack.
Until these issues are resolved, Americans might want to follow Australian guidelines for the use of these drugs. They call for heart patients to avoid COX-2 inhibitors and others to take them for the shortest time needed.