Drug treatment - COX-2 inhibitors
St. Luke's Hospital
Located in Chesterfield, MO
Main Number: 314-434-1500
Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Find a Physician Payment Options Locations & Directions
Follow us on: facebook twitter Mobile Email Page Email Page Print Page Print Page Increase Font Size Decrease Font Size Font Size
Meet the Doctor
Spirit of Women
Community Health Needs Assessment
Home > Health Information

Senior's Center

Drug treatment - COX-2 inhibitors

There are at least two cyclooxygenase ("COX") enzymes within the body:

  • The COX-1 enzyme releases prostaglandins (fatty acid molecules) that help to form a protective coating within the digestive tract, and
  • The COX-2 enzyme releases prostaglandins responsible for pain and inflammation.

Traditional NSAIDs inhibit both enzymes. They provide both pain relief and anti-inflammatory benefit. However, because inhibition of COX-1 leaves the stomach lining vulnerable to injury, such NSAIDs may promote side effects such as stomach ulcers and bleeding. If you do take one of these medicines, your doctor may also want you to take a stomach acid blocker, such as a proton pump inhibitor, to lower the risk. By contrast, inhibition of only COX-2 provides pain relief but is less likely to cause stomach ulcers or bleeding.

COX-2 inhibitors are a relatively new class of medications that were developed to manage the pain and inflammation of arthritis without the negative side effects of NSAIDs. These medicines have been very controversial since 2004, when rofecoxib (Vioxx), once presumed safe, was withdrawn from the market because of increased danger of heart attack and stroke. Similar concerns were then raised about valdecoxib (Bextra), celecoxib (Celebrex), and now even ibuprofen and other traditional NSAIDs (except for aspirin). Bextra has also been removed from the market. Just one of the COX-2 inhibitors, Celebrex , is approved by the U.S. Food and Drug Administration (FDA) and is available by prescription. COX-2 inhibitors may also impair kidney function, particularly in the elderly. They also may increase blood pressure. For these reasons, anyone with a history of heart disease, high blood pressure, stroke, or transient ischemic attack (TIA) should not take COX-2 inhibitors without specific instruction from their health care provider. You also should not take COX-2 inhibitors if you are pregnant or trying to become pregnant.

A growing body of evidence suggests that the heart risks are real and important to consider, making it wise to weigh the risks versus the benefits when taking NSAIDs, especially if you are at risk for heart disease. COX-2 inhibitors may elevate heart and stroke risks at any dose. The non-selective NSAIDs (except for aspirin) appear to increase risk, but only at higher doses. If someone at risk for cardiovascular disease uses these traditional NSAIDs, the medicines should be used at the lowest effective dose, for the shortest necessary time, and perhaps along with low-dose aspirin and a proton pump inhibitor to reduce side effects.


Review Date: 12/24/2012
Reviewed By: Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, Division of Rheumatology, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Back  |  Top
About Us
Contact Us
Locations & Directions
Quality Reports
Annual Reports
Honors & Awards
Community Health Needs

Brain & Spine
Sleep Medicine
Urgent Care
Women's Services
All Services
Patients & Visitors
Locations & Directions
Find a Physician
Tour St. Luke's
Patient & Visitor Information
Contact Us
Payment Options
Financial Assistance
Send a Card
Mammogram Appointments
Health Tools
My Personal Health
Spirit of Women
Health Information & Tools
Clinical Trials
Employer Programs -
Passport to Wellness

Classes & Events
Classes & Events
Spirit of Women
Donate & Volunteer
Giving Opportunities
Physicians & Employees
For Physicians
Remote Access
Medical Residency Information
Pharmacy Residency Information
Physician CPOE Training
St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Copyright © St. Luke's Hospital Website Terms and Conditions  |  Privacy Policy  |  Notice of Privacy Practices PDF  |  Patient Rights PDF Sitemap St. Luke's Mobile