NSAIDs versus COX-2s

Colby Cosh has a fascinating piece from a family physician who explains the difference between regular NSAIDs and COX-2 inhibitors. Which, as it turns out, is not much, other than the stomach issues. And that's the problem.

Remember I said that COX-2, in addition to being involved with inflammation, also works in the kidney and affects blood pressure. What this means is that even though Celebrex and Vioxx are safer on the stomach than older drugs like, oh say, Naprosyn, they were NO SAFER on the blood pressure and kidneys. And even in terms of effect, all the studies showed that Celebrex and Vioxx were just as effective in controlling pain as the older drugs, not MORE effective.

What does this mean practically? Well, before the new drugs came out, it was understood that you didn't give NSAIDs to people over 65, or patients with blood pressure, kidney, or heart problems. Not because of the stomach issues, but because of the other things I mentioned. What got lost in all the marketing was that Celebrex and Vioxx shared those same concerns, and yet they were specifically marketed at that age group. Whether it was the picture of the old lady in the pool, or the geriatric couple jumping on their bed, the message was clear--these drugs are safe for these people.

Useful background information, to be sure. Colby's blog is hand-coded, so his permalinks change over time; check his archives if you're coming to this page later.