Arthritis is an inflammation of the joints.  Doctors combat inflammation in several ways, most commonly with the use of  non-steroidal inflammatory drugs (NSAIDS) or steroids such as prednisone. 

For extreme flare-ups your doctor may give you a shot of prednisone directly into your joint, but this has many side effects. 

Non-steroidal anti inflammatory agents also have many side effects, particularly gastrointestinal ones but they are easier to take and are generally well tolerated as long as the patient takes them with food.

What is a Nonsteroidal Anti-Inflammatory Drug  (NSAID) ?

As their name implies, nonsteroidal anti-inflammatory drugs (or NSAIDs, as they are commonly called) are medicines that block or inhibit the body's inflammation process without the use of cortisone or other steroid drugs.  The most commonly used NSAID's are aspirin, ibuprofen and naproxen. 

Nonsteroidal Anti-Inflammatory Drug Precautions

All NSAID drugs (even Celebrex) have the potential to cause irritation, ulceration, bleeding and perforation of the lining of the stomach. 

For this reason, it is important that you never take any NSAID drug on an empty stomach.  NSAID's should be taken with food, preferably after a meal.

Mixing Coumadin (Warfarin Sodium) with NSAID drugs such as aspirin or ibuprofen can cause serious complications.

Do not mix any NSAID drug ( such as aspirin) with blood-thinners such as Coumadin (Warfarin Sodium) unless your doctor gives you specific instructions on how to do so. 

Some NSAID drugs have been known to cause drowsiness.   Ask your doctor or pharmacist for their opinion and recommendations regarding this matter.

What about Drug Interactions?

NSAID drugs are known to have few clinically significant drug interactions. 

Some researchers feel that  NSAIDS can weaken the effect of certain blood-pressure medications, but this data needs more extensive corroboration.  Ask your doctor or pharmacist for their opinion and recommendations regarding this matter.

This database is arranged alphabetically by brand-name since that is how most doctors and pharmacists know them.


Anaprox (Naproxen Sodium) Generic Available
Drug Family = Arylacetic Acid; Roche

Naproxen is the active ingredient of many drugs including Anaprox.  It is common for the drug companies to have several products with different names but the same active ingredient.

The active ingredient in Anaprox is naproxen sodium or naproxen.  At one time, Anaprox (naproxen) was one of the most popular prescription drugs in the United States. 

It was used for all types of inflammation and pain including arthritic pain and menstrual cramps. 

These days naproxen is available over the counter.  The over the counter version is available in a 200mg tablet. 

Alleve is the same thing as naproxen 200mg.

Prescribing Information
General Information including a pictures of Anaprox pills.
Medline


Anaprox DS (Naproxen Sodium) Generic Available
Drug Family = Arylacetic Acid; Roche
Naproxen is the active ingredient of many drugs including Anaprox DS.  It is common for the drug companies to have several products with different names but the same active ingredient.

The active ingredient in Anaprox is naproxen sodium or naproxen.  At one time, Anaprox (naproxen) was one of the most popular prescription drugs in the United States. 

It was used for all types of inflammation and pain including arthritic pain and menstrual cramps. 

These days naproxen is available over the counter.  The over the counter version is available in a 200mg tablet. 

Alleve is the same thing as naproxen 200mg.
Anaprox (Naproxen) information:
Prescribing Information
General Information including a pictures of Anaprox DS pills.
Medline

Ansaid (Flurbiprofen) Generic Available
Drug Family = Phenylalkanoic Acid Derivative; Pharmacia
Prescribing Information
General Information
Medline

Arcoxia (etoricoxib; Experimental COX II inhibitor; Merck)
Not available in the USA.  In other countries Arcoxia is available as 60, 90 and 120mg tablets.
Arcoxia Patient Leaflet  ( New Zealand)

Arthrotec (Diclofenac Sodium + Misoprostil)
Drug Family = Benzeneacetic acid Derivative plus Syntheric Prostaglandin E1 Analogue; Searle
Note: Known to cause severe fetal harm; must not be taken by pregnant women.

Arthrotec is an interesting drug.  It is a so-called combination drug.  A combination drug is 2 or more drugs mixed together in the same pill.

In the case of Arthrotec, the two drugs are diclofenac a NSAID and misoprostil, a prostoglandin.  The misoprostil is added as a protective agent to guard against stomach irritation and bleeding.

Misoprostil (and all orally taken prostoglandin products) can cause severe fetal damage including spontaneous abortion.  For this reason, if you are a woman of child bearing age, it is a good idea to take a pregnancy test before you take Arthrotec.  Arthrotec is not a very commonly used drug.

Arthrotec Information:
Prescribing Information 
General Information
Medline

Cataflam also Voltaren (Diclofenac Potassium) Generic Available
Drug Family = Benzeneacetic acid Derivative; Novartis
Prescribing Information
General Information including a pictures of  the pills.
Medline

Celebrex (Celecoxib)
Drug Family = COXII Inhibitors; Pfizer

When Celebrex first came out it was wildly successful.  Celebrex was introduced by Pharmacia, a drug company that no longer exists.  Pfizer bought out Pharmacia to get at Celebrex.

Celebrex is an NSAID of the  COX-2 inhibitor class.  It is marketed by Pfizer.  There is a great deal of controversy surrounding the use of Celebrex.

Some studies have shown that Celebrex given at high doses (double or triple the maximum dose) can cause serious side effects such as heart attack

However, the  FDA has not seen fit to withdraw Celebrex from the market.  The FDA considers Bextra to be safe and effective.
Celebrex.com - official website tons of Celebrex information
Prescribing Information
General Information including pictures Celepbrex capsules.
Medline
Compare Prices 

Clinoril (Sulindac) Generic Available
Drug Family = Indene Derivative; Merck
Merck PI - PDF; PDF File - you need Adobe Acrobat to open this file;
  [ Click Here to Download Adobe Acrobat Software for Free]
General Information including pictures Clinirol pills.
Medline

Daypro (Oxaprozin) Generic Available
Drug Family = Propionic Acid Derivative; Pharmacia
Prescribing Information
Medline
General Information

Disalcid (Salsalate) Generic Available
Drug Family = Salicylate; 3M
Prescribing Information
General Information
Medline

Dolobid (Diflunisal) Generic Available
Drug Family = Salicylate; Merck
Prescribing Information
General Information
Medline

EC Naprosyn (Naproxen Sodium) Generic Available
Same active ingredient as Naprosyn; tablet has a special coating
To protect the stomach.
Drug Family = Arylacetic Acid Derivative; Roche
Prescribing Information
General Information (for Naprosyn)
Medline

Feldene (Piroxicam) Generic Available
Very Strong; Never take on empty stomach; take with food.
Drug Family = Oxicam; Pfizer
Prescribing Information
General Information
Medline

Indocin, Indocin SR (Indomethacin) Generic Available
Very Strong; Never take on empty stomach; take with food
Indocin SR is a sustained release version of Indocin.
Drug Family = Indole Derivative; Merck
Prescribing Information
Merck PI - PDF ; PDF File - you need Adobe Acrobat to open this file;
    [ Click Here to Download Adobe Acrobat Software for Free]
General Information
Medline

Lodine , Lodine XL (Etodolac) Generic Available
Lodine XL is a long acting version of Lodine.
Drug Family = Pyranocarboxylic Acid Deriv; Wyeth
Prescribing Information
General Information
Medline

Mobic (Meloxicam)
Drug Family = Oxicam Derivatine; Boehringer Ingelheim

Mobic didn't used to be a very popular drug.  However, when the COX-2 controversy began, many people were afraid to take COX-2 drugs and they switched to Mobic.  For this reason Mobic became very popular, almost overnight.  After it became popular Mobic's price increased.

The nice thing about Mobic is that you only have to take it once a day.

Mobic is a powerful drug; Mobic should never be taken on an empty stomach or it can cause serious stomach irritation, bleeding or ulceration.

Mobic costs between $3.00 and $4.00 per pill.  If you comparison shop, you should be able to get a better price on Mobic.  Click Here to comparison shop for Mobic.

Mobic Tablet.com - official Mobic Website; lots of Mobic information.
Prescribing Information - PDF ; PDF File - you need Adobe Acrobat to open this file;  [ Click Here to Download Adobe Acrobat Software for Free]
General Information including pictures Mobic pills.
Medline
Compare Prices For Mobic

Motrin (Ibuprofen) Generic Available
Drug Family = Propionic Acid Derivative; Pharmacia
Prescribing Information
General Information
Medline
Compare Prices (Source A) |Compare Prices (Source B)

Naprelan (Naproxen) Generic Available
Same active ingredient as Naprosyn; tablet has a special delivery system.
Drug Family = Arylacetic Acid Derivative; Elan
Prescribing Information
General Information
Medline

Naprosyn (Naproxen) Generic Available
Drug Family = Arylacetic Acid Derivative; Roche
Prescribing Information
General Information
Medline

Orudis, (Ketoprofen) Generic Available
Drug Family = Propionic Acid Derivative; Wyeth
Prescribing Information
General Information
Medline 

Oruvail (Ketoprofen) Generic Available
Drug Family = Propionic Acid Derivative; Wyeth
Prescribing Information
General Information
Medline

Relafen (Nabumetone)
Drug Family = Naphthyalkanone; SmithKline
Prescribing Information; PDF File - you need Adobe Acrobat to open this file;   [ Click Here to Download Adobe Acrobat Software for Free
General Information
Medline

Tolectin, (Tolmetin Sodium) Generic Available
Drug Family = Pyrroleacetic Acid; McNeil
McNeil PI- PDF ; PDF File - you need Adobe Acrobat to open this file;
  [ Click Here to Download Adobe Acrobat Software for Free]
General Information
Medline


Trilisate (Choline Magnesium Trisalicylate) Generic Available
Drug Family = Salicylate; Purdue Fredrick
Prescribing Information
General Information
Medline

Vioxx (Rofecoxib) - Recalled from the US market due to safety concerns:
Drug Family = COX II Inhibitors; Merck

Vioxx.com - official website; prescribing info, etc
Prescribing Information
General Information including photograph of Vioxx Tablets
Medline

What is a COX II inhibitor?
Why were 2 of them taken off the market?

Introduced in 1998, COX II inhibitors are a relatively new family of nonsteroidal anti-inflammatory drugs (NSAIDS).  Though not necessarily more effective at reducing inflammation and pain than older, traditional nonsteroidal anti-inflammatory drugs such as aspirin and naproxen, they represented an advance over the older drugs because they were believed to  cause less stomach irritation. 

However, COX-2 inhibitors are still classified as NSAIDS.  Some doctors recommended  that you not take them on an empty stomach. 

They are called COX-2 inhibitors because they block an enzyme called
"Cyclooxygenase".  "Cyclooxygenase" is believed to trigger pain and inflammation in the body.  If you block the COX-2, you block the inflammation.

There was controversy surrounding the use of COX II inhibitors.  Some scientists believed that their use was associated with an increased risk of cardiovascular events such as heart attack. 

Beginning in 1999, researchers reported that this class of drugs also appears to suppress prostacyclin (PGI2), a hormone-like substance that dilates blood vessels and reduces blood clotting.

Prostacyclin is mainly synthesized by vascular endothelium and smooth muscle. Inhibiting the COX-2 enzyme may also inhibit endothelial cell function.  Endothelial cell are the cells that make up the inside of the wall of the blood vessels. 

The endothelial cells produce PGI2 (vasodilators) as well as other anti-coagulants such as T-PA, thrombomodulin, nitrate oxide (NO) and heparin sulfates.  These complex chemicals keep the blood vessels wide open and free of tiny blood clots.

The scientists believed that when a COX 2 inhibitor blocks pain and inflammation caused by  cyclooxygenase, the COX-2 inhibitor also inhibits the back-up defensive mechanisms that the human body has built in to insure that blood clots are kept under control.

You had one group of scientists claiming that by inhibiting prostacyclin and its beneficial effects, many people have had heart attacks and died.

The other group of scientists said that this effect had not been proven conclusively and that COX-2's are safer than aspirin and other NSAIDS because they are gentler on the stomach and cause less bleeding and perforation, and that this stomach safety outweighs the unproven heart attack claims.

In any case, in September of 2004, Merck discovered that its COX-2 inhibitor, Vioxx, was associated with an increased number of heart attacks.

To be on the safe side, Merck voluntarily withdrew Vioxx from the market.  This action caused an avalanche of lawsuits by people claiming that they or their loved ones suffered heart attacks as a result of taking Vioxx.

[ See Also> Interview With A Vioxx Lawyer; famous personal injury attorney presents his case against Merck & Vioxx ]

Then, on April 7th, 2005, Pfizer voluntarily withdrew Bextra from the market at FDA's request. FDA had determined that the risk of taking Bextra outweighed Bextra's benefits.

On that day, Pfizer agreed to work with FDA on a new warning label for Celebrex.  In the near future, Celebrex will get what is called a "Black Box" warning.  This is the strongest warning that a medicine can get on its label.

See Also> FDA Communiqué regarding the withdrawal of Celebrex and the updated warnings on over-the-counter NSAIDs.

Health activist groups such as Public Citizen have been demanding that Celebrex be taken off the market just like Vioxx and Bextra.

People who took these products are scared and confused.  If they have questions they should contact their doctor for reassurance. 

If someone had been taking Bextra or Celebrex (prior to their being taken off the market) and they had no side effects, it is unlikely that they would get side effects after they have stopped taking the drugs.

You may also be interested in:

>>www.arthritissupport.com - resource for arthritis research and treatment news (they also send free weekly email news bulletins).

>>About.com Arthritis Information - Large collection of arthritis information.  Compiled by arthritis expert Carol Eustice.  Excellent starting point if you are interested in arthritis information; free newsletter - Editor's Choice

>>Arthritisinsight.com - Editor's Choice

>>Columbia University Medical Textbook; Arthritis Chapter

>>Arthritis News (Google)

>>Other Drug Information Databases

>>Home Page


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