Consumers looking for alternatives to Vioxx have plenty of effective painkillers to choose from, ranging from similar prescription drugs like Celebrex to that old medicine chest standby, aspirin. Vioxx's maker, Merck & Co., pulled it from the market after a study showed that people taking it for 18 months or longer had twice the risk of heart attack, stroke or other cardiovascular problems. About 2 million people currently take Vioxx, mostly for arthritis. The study was testing it for colon cancer prevention.
Here are answers for consumers:
Q. If I've been on Vioxx, do I face a higher risk of heart problems in the future?
A. "The answer to that is almost certainly 'no'. The drug's effects disappear very quickly," so stopping it should reverse risk, said Dr. Alastair J.J. Wood, professor of medicine and pharmacology and associate dean of Vanderbilt University Medical Center.
Q. What about children? Some take it for juvenile arthritis.
A. No safety problems have been seen in children, according to the federal Food and Drug Administration, but Vioxx is being withdrawn from the market for everybody.
Q. Is it safe to stop taking Vioxx suddenly or should people go off the drug slowly?
A. People can and should stop taking the drug immediately. It is only used to treat arthritis pain symptoms, not the underlying disease.
Q. What made Vioxx so good for arthritis?
A. Many pain relievers called non-steroidal anti-inflammatory drugs, or NSAIDS, work against two enzymes, cox-1 and cox-2, that cause inflammation and pain. Cox-1 is found in the stomach, and drugs that attack it often cause upset stomachs and ulcers. Vioxx and other so-called cox-2 inhibitors attack just that enzyme, minimizing stomach side effects.
Q. Are other cox-2 inhibitors safe?
A. All drugs of this type can raise blood pressure, but only Vioxx has been linked to higher risk of heart attack, stroke and other cardiovascular problems, FDA officials say.
Q. What can people take in place of Vioxx?
A. Two other cox-2 inhibitors are sold in the United States - Celebrex and Bextra. Other NSAIDs available by prescription include sulindac, sold as Clinoril, and ketoprofen, sold as Orudis and Oruvail. Non-prescription NSAIDS include aspirin, ibuprofen (Advil), acetaminophen (Tylenol) and naproxen (Aleve).
Q. Besides arthritis, what else is Vioxx used to treat?
A. Other chronic pain conditions, such as carpal tunnel syndrome, and short-term needs like post-operative pain relief.
Q. Can I get a refund on unused Vioxx?
A. Yes. Merck will require patients to mail back the unused drug in the original container, along with a pharmacy receipt, to: NNC Group, Merck Returns, 2670 Executive Dr., Indianapolis, IN 46241. A note with the patient's name, address and phone number should be included. The company will reimburse the cost of the full prescription plus regular shipping. More instructions and information are available through the Internet at www.vioxx.com and www.merck.com or by calling (888) 368-4699. Doctors are being asked to send back samples, and pharmacists will be contacted by Merck representatives on returning unsold inventory.
Q. If Vioxx has been sold since 1999, why did these problems just come to light?
A. Some problems were noticed in a study Merck did in 1999 and 2000, and the FDA required a warning about the risks to be included in the drug's label after that. Isolated reports of problems were reported to the FDA since then, but that evidence was not as good or as strong as what just came from the Merck study.