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What should Celebrex and Bextra patients do?
Pain relief drug guide
for patients after Vioxx recall

Summary:  After the recall of Vioxx by Merck, many patients have switched to either Celebrex and Bextra.  A few have started to take over the counter drugs, such as Aleve.  None of these drugs are without adverse side effects.  This article provides guidelines on what you should do now.  We have already discussed the background of drug recalls and complications.  This part provides a pain medication guide.

Choose the box that corresponds to your particular heart (left column) and gut (top row) situation.   Important note: ALL patients should talk to their clinicians about these general guidelines to decide what drugs are right for them and what dose to take! 

  If you have pain...   ...and if you are under 60, have never had ulcers or gastrointestinal bleeding, and aren't taking a blood thinner or oral steroid...   ...and if you are over 60, have ever had ulcers or gastrointestinal bleeding, or take a blood thinner or an oral steroid..
...and your heart risk is low and you don't need to take aspirin regularly.. ...Consider a traditional NSAID such as ibuprofen or naproxen. These are available as prescription drugs or over the counter as brand name drugs (Advil, Aleve, Motrin, Nuprin) or as less-expensive store brands that contain the same drug and are just as effective. Acetaminophen (Tylenol or store brand) might also work. ...Consider a non-NSAID such as acetaminophen (Tylenol). Or, if necessary, you could take a traditional NSAID (such as ibuprofen or naproxen, prescription or over-the-counter), together with a proton pump inhibitor drug (Nexium, Prevacid or Prilosec) to protect your stomach.
...and if you have risk factors for heart disease (history of heart attack, stroke or chest pain, or smoking, high blood pressure, high cholesterol or family history of heart disease) ...Consider a non-NSAID such as acetaminophen (Tylenol) or try a traditional NSAID, such as ibuprofen or naproxen (prescription or over-the-counter). If you're taking aspirin to protect your heart, you may want to add a proton pump inhibitor drug (Nexium, Prevacid or Prilosec) because of the added gastrointestinal risk that comes from taking aspirin and another NSAID. If you're not on aspirin, ask your doctor if you should be. ... Ask your doctor if you should take acetaminophen or a low-dose non-NSAID painkiller. If an NSAID is necessary, you must combine with a proton pump inhibitor drug (Nexium, Prevacid or Prilosec) to protect your stomach. If you're not on aspirin, ask your doctor if you should be.

Written by Kara Gavin at University of Michigan Health System

More up-to-date information in available at the Vioxx recall blog.

Related articles:  Natural alternatives to Cox-2 inhibitor drugs (Vioxx, Celebrex, Bextra, Arcoxia, Prexige, etc.) for pain relief

Safe pain killer guide after Vioxx recall and controversy about Celebrex and Bextra   Pain relief without painkillers     

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