COX-2 Inhibitors

A type of nonsteroidal anti-inflammatory drug (NSAID) designed to block pain and inflammation with less risk of peptic ulcers than other types of NSAIDs. In the body, cyclooxygenase (COX) enzymes create prostaglandins, which are hormone-like substances that play a powerful role in inflammation. Prostaglandins are made by two different forms of COX enzymes, COX-1 and COX-2. COX-1 is believed to aid in the production of protective prostaglandins in the gastrointestinal tract, while COX-2 plays a greater role in promoting inflammation throughout the body. COX-2 inhibitors appear to selectively inhibit prostaglandin production by COX-2 without affecting the products of COX-1. Thus, COX-2 inhibitors can alleviate inflammation with fewer negative effects on the gastrointestinal tract.

COX-2 inhibitors are used to treat pain from many different conditions, including ankylosing spondylitis, juvenile rheumatoid arthritis, menstrual cramps, acute injuries (such as sport injuries and surgery), and osteoarthritis. Unfortunately, research has shown an increased rate of cardiovascular events (such as heart attack and stroke) associated with the use of COX-2 inhibitors compared with placebo (an inactive pill). Based on these results, rofecoxib (brand name Vioxx) and some other COX-2 inhibitors have been removed from the market, leaving only the drug celecoxib (Celebrex), which now has a boxed warning about cardiovascular risks on the label.

Want to learn more about medicines for chronic pain? Read “Over-the-Counter and Natural Pain Relievers for Joint Pain,” “Pain Killers: Avoiding Addiction,” and “Taking Your Medicines Safely.”

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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