What Doctors Don't Tell YouWhich drugs are COX-2 inhibitors? All NSAIDs, even those not classed specifically as COX-2 inhibitors, can act to inhibit COX-2 in the body (J Rheumatol, 1998; 25: 2298-302; FASEB J, 1998; 12: 1063-73). From the most selective (they specifically inhibit prostacyclin, which stops platelets from clumping) to the least (from left to right, top to bottom), currently available COX-2-inhibiting drugs are:
rofecoxib (Vioxx)
etodolac (Ultradol)
meloxicam (Mobicox)
celecoxib (Celebrex)
diclofenac (Voltaren)
piroxicam (Feldene)
ibuprofen (Motrin)
naproxen (Naprosyn)
acetasalicylic acid (aspirin)
nabumetone (Relafen)
indomethacin (Indocid)
ketoprofen (Orudus, Orafin, Oruvail)
ketorolac (Toradol).
The gastrointestinal toxicity of an NSAID also varies according to dose and the drug, although all are associated with some degree of GI damage (Semin Arthritis Rheum, 1977; 26: 210). From the least GI toxic to the most (from left to right, top to bottom), these are the NSAIDs to watch out for:
ibuprofen (Motrin)
acetasalicylic acid (aspirin)
diclofenac (Voltaren)
naproxen (Naprosyn)
indomethacin (Indocid)
piroxicam (Feldene)
ketoprofen (Orudus, Orafin, Oruvail).
Based on data presented in Therapeutics Letter, January/February 2001, published by Therapeutics Initiative, University of British Columbia, Department of Pharmacology and Therapeutics, Vancouver, BC, Canada V6T 1Z3
Daniel Redwood DC
Tom Ferguson MD
