COX-2 selective inhibitor is a form of non-steroidal anti-inflammatory drug (NSAID) that directly targets COX-2, an enzyme responsible for inflammation and pain. Targeting selectivity for COX-2 reduces the risk of peptic ulceration, and is the main feature of celecoxib, rofecoxib and other members of this drug class. After several COX-2 inhibiting drugs were approved for marketing, data from clinical trials revealed that COX-2 inhibitors caused a significant increase in heart attacks and strokes, with some drugs in the class having worse risks than others. Rofecoxib (commonly known as Vioxx) was taken off the market in 2004 because of these concerns and celecoxib and traditional NSAIDs received boxed warnings on their labels.
- Long-term use of NSAIDs can cause bleeding in the stomach. In response to this, the drug industry has produced a class of NSAIDs, the COX-2 Inhibitor.
- Presently, only celecoxib (Celebrex) remains on the market. Valdecoxib (Bextra) and rofecoxib (Vioxx) were voluntarily withdrawn from the market because of an increased risk of heart attack, stroke, and severe skin toxicity (see below).
- Because these medications have been on the market for only a short time, the long-term side effects are just beginning to be understood. These medications have not been proven to be stronger than ibuprofen, acetaminophen, or naproxen. It is also unclear whether these medications cause less significant stomach problems.
- People older than 75 years are at more risk of significant stomach problems, such as ulcers, from NSAIDs, especially if they have had previous ulcers. Elderly individuals also typically have higher risk factors for heart attack and stroke.
- Besides COX-2 inhibitors, other options exist to protect the stomach from ulcers and bleeding associated with NSAIDs. The additional use of misoprostol (Cytotec) or a proton pump inhibitor, such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium), with an older NSAID may decrease ulcer formation and bleeding.