Have you ever taken the drug Vioxx or celebrex? In September 2004 the drug manufacturer Merck decided to recall the product after long term data suggested a serious potential side effect.

This drug and others like it such as as 'Celebrex', 'Bextra' and 'Arcoxia' are part of a family of drugs known as "COX2 drugs" or "COX2 inhibitors"

They have been developed with, ironically, patient safety in mind.They are typically used in treatment of arthritis, though high dose vioxx was promoted for short term relief of acute muscular/skeletal pains.They were anti-inflammatory drugs.

The serious side effects were in connection with the heart suggesting risk of heart disease or heart attack.In medical circles it was referred to as "..adverse cardiovascular effects."

There are other drugs used to treat inflammation that have been around for many years.YOu may have heard of products such as Advil or Nurofen which contain the ingredient Ibuprofen.Other older anti-inflammatory drugs include such brands as Voltarol or Naprosyn.

What's the difference between these older drugs and the recent treatments know as "COX2 drugs"?

The newer drugs such as Arcoxia,Celebrex and Vioxx were designed to be much more specific in their mode action than old drugs like Ibuprofen.The idea was to limit the associated problems in long term treatment.

When we get older we all seem to get more sensitive to side effects of drugs.Often this is complicated even more by the fact that we may suffer from more than one problem or disease at the same time.

At this point we take more medication in the last five to ten years of our lives than in all the other years put together! Is it any wonder we might feel under the weather, a little off colour even?

You could have asthma and high blood pressure. Anxiety and lack of sleep every night. Panic attacks and depression.

If you take an anti-inflammatory drug for a given length of time, your doctor/physician will no doubt tell you about one major problem.

Ulceration of the stomach or intestines.....

It was hoped that the newer COX2 drugs would not cause this problem at all.Therefore it would avoid the risk of someone suffering internal bleeding which could become fatal.

The older you become the greater the risk of this occuring. It could be a slow blood loss or a sudden episode of an ulcer bleeding more profusely.

So when people got the signs of ulcers, they got treatment for an ulcer. Some would stop taking medication and others would take a maintenance dose to prevent ulcers coming back while continuing to take the old ibuprofen drugs for their arthritis.

It was hoped drugs like vioxx would stop this, but ulceration still remains a possibility. Doctors routinely consider offering anti ulcer drugs to reduce the probability of this happening.

So what is the all the recent fuss about ? Where did it all suddenly seem to unravel after all that hope and expectation ? A new long term study seemed to indicate some degree of risk to the heart some 18 months or so after starting treatment.

So if you took vioxx for a week or a couple of months, this potential problem did not appear.It has only been spotted after taking the medication for a longer period such as 18 months.

What can you do? Are there ways to reduce risks? This is something you need advice on as only your doctor will have your medical history.There is much to consider and such a problem can in some circumstances be minimised.

Of course if you smoke you increase the risk of stomach or intestinal ulceration if you also take anti-inflammatory drugs such as Ibuprofen.Why not quit instead?

If you take other medication for depression or anxiety then these drugs can increase the risk of bleeding with any anti-inflammatory drug being taken at the same time.

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