What Are COX-2 Inhibitors?

Also known as selective COX-2 inhibitors, these medications treat inflammatory pain.

Selective COX-2 inhibitors are a type of nonsteroidal anti-inflammatory medication (also known as NSAIDs).

Over-the-counter NSAID medications include aspirin, ibuprofen (Advil, Motrin, and other brand names), and naproxen (Aleve), but selective COX-2 inhibitor NSAIDs are prescription medications that are more specialized in the way they work on inflammation.

All NSAIDs inhibit cyclooxygenase (COX) enzymes, which the body uses to create inflammatory and painful chemicals called prostaglandins.

There are two types of cyclooxygenase enzymes: COX-1 and COX-2. Most NSAID medications target both COX-1 and COX-2, but this can lead to stomach and intestinal problems for some people.

This is because COX-1 seems to serve some “housekeeping” functions in the body, such as helping to protect the gastrointestinal tract.

When they’re used long term, nonselective NSAID medications that target both COX-1 and COX-2 can cause a condition called erosive gastritis, in which parts of the stomach and intestinal lining wear away, because these NSAIDs suppress COX-1.

Gastrointestinal erosions can be uncomfortable (causing abdominal pain), and can also lead to dangerous problems, like gastrointestinal bleeding or even perforation.

If you’re at risk for, or already have, gastrointestinal problems, long-term use of selective COX-2 inhibitors may be safer for you than regularly using nonselective NSAID medication.

What Selective COX-2 Inhibitors Treat

Selective COX-2 inhibitors are often given for inflammatory pain, such as that from:

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis

They’re especially recommended if you have a history of gastrointestinal bleeding or if you’re on an anticoagulant medication (also called a “blood thinner”).

COX-2 inhibitors are occasionally given to help prevent colon cancer in people with an unusual genetic condition called familial adenomatous polyposis.

Examples of Selective COX-2 Inhibitors

Celebrex (celecoxib) is currently the only brand-name selective COX-2 inhibitor available in the United States; there are also generic versions of celecoxib.

Some other COX-2 inhibitors have been taken off of the U.S. market due to safety issues:

Vioxx (rofecoxib) was recalled worldwide in 2004 due to concerns about adverse cardiovascular effects, like heart attacks and strokes.

Bextra (valdecoxib) was withdrawn from U.S. and European Union markets in April 2005 due to cardiovascular risks and life-threatening skin reactions, according to the FDA.

Prexige (lumiracoxib) was withdrawn from much of the world market because of concerns about severe liver damage.

Still other COX-2 inhibitors are available in other countries, but not in the United States:

Arcoxia (etoricoxib) is available in many countries, but not in the United States.

Dynastat (parecoxib) is an injectable medication that’s not available in the United States.

Who Shouldn’t Take Selective COX-2 Inhibitors?

You shouldn’t take selective COX-2 inhibitors if you’ve had any of the following medical conditions:

• Chronic renal insufficiency
• Liver failure
• An asthma attack or other severe allergic reaction from taking aspirin, another NSAID medication, or sulfonamide antibiotics (also called “sulfa” drugs)

You should also avoid all NSAID drugs (including COX-2 inhibitors) if you:

• Plan to have surgery soon, which may increase the risk of severe bleeding.
• Have a history of recent heart surgery, especially a coronary artery bypass graft (CABG, pronounced “cabbage”).

COX-2 Inhibitors During Pregnancy and Breastfeeding

There is still some question about the safety of using selective COX-2 drugs during pregnancy.

Some doctors recommend that you take no NSAID medication except low-dose (81 milligram) aspirin after the 30^th week of your pregnancy, because NSAIDs may affect the developing heart of the fetus.

Most NSAID drugs are considered safe to take while breastfeeding, but you and your doctor should review the drug safety information for any of these medicines before you take them.

Always talk to your doctor before taking any medication, especially while pregnant or breastfeeding.