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Posted by Joe on November 21, 2000 at 13:52:47:

In Reply to: Re: CELEBREX VS VIOXX:HOW THESE NEW ARTHRITIS MEDS DIFFER. posted by Matt on August 18, 2000 at 13:43:50:

To all who read these words concerning Vioxx and Celebrex. I happened to come upon this website and i have to clarify a few things between these two drugs. I will freely admit that I am a drug rep and I sell Vioxx. First of all, both of these drugs are extremely safe drugs. Neither of them are completely safe though. Both have some incidence of GI complications but they reduce those incidents greatly as compared to even Ibuprofen which most people think is safe. Let's put that into perspective. For Vioxx the GI safety was comparable to placebo and reduced ulcer rates from 46% on Ibuprofen to 14% on Vioxx 50 mg, the highest dosage.
Now the excretion part of the equation is a concern for both drugs and all NSAIDs in general. The reason there are problems in the kidney is because of the mechanism of action of all NSAIDs. Keep that in mind. There is COX-2 in the kidneys as well as other parts of the body. The reason these drugs relieve pain and inflamation is because they do inhibit the COX-2 prostaglandin. Now the question is this, how can you inhibit COX-2 in the joints and stop the pain but not inhibit the COX-2 in the kidneys and cause hypertension and edema? Right now you can't. You inhibit COX-2 then you damage the kidneys atleast temporarily.
So why does Vioxx hurt the kidneys more than Celebrex? At equipotent dosages, it doesn't. That is the key. If you compare 200 mg of Celebrex to 12.5 mg of Vioxx you will always see a similar safety profile as well as a similar efficacy profile. The studies don't lie. Now if you increase to 25 mg or 200 mg BID of Celebrex, you will also see increases in side effects, hypertension and edema. This is a fact.
Now there is one saving grace for both of these drugs and all NSAIDs. The kidneys reset themselves after 7 to 12 days. Searle and Merck have done studies on the renal effects of these drugs and all of the studies have shown that after a week or so of use, depending on the patient, the kidneys reset. When they reset, your kidneys stop holding onto sodium and the hypertension and edema subside. Both drugs have show this.
On the other hand, you have to realize that these drugs never promised to be safer in the kidneys than other NSAIDs. What they did promise is that they would be safer in the GI system which is where the real problem lies. Each year over 16,000 people die from NSAID related GI bleeds. That is a lot! Vioxx and Celebrex just reduced those deaths by a great degree. I am anxious to see how those numbers change over the next few years. You need to remember though that Vioxx and Celebrex are the only Coxib class NSAIDs. They are the only ones. Mobic is not a Coxib and has the same safety profile as traditional NSAIDs. Don't be fooled into thinking it is as safe as either of the two Coxib drugs.
Like I said, I am a Vioxx rep so I know these drugs inside and out. I am not going to sit here and say that Celebrex is a bad drug. It isn't. It is a great drug even if it is my competition. I encourage Doctors everyday that if they aren't going to use Vioxx in a particular patient, they should reach for Celebrex. Again, both are tremendous drugs and they should be used first line in all NSAID patients, not just the high risk. I hope this answered some questions for you. My email is listed if you have any questions I would be willing to do my best to be unbiased. -JOE

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