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Heather McCreery-Choi swallowed her daily dose of Vioxx, an arthritis medication, on Thursday morning, then flipped on the morning news to learn the drug was being pulled from the market because it doubles the risk of heart attacks and strokes after 18 months.
“At first, I didn’t quite understand it,” the 33-year-old Tucson resident said. “Then I went online and understood a lot more.”
By Thursday afternoon, she was headed to the pharmacy to fill a prescription for Bextra, another COX-2 inhibitor used to control symptoms of rheumatoid arthritis. advertisement
McCreery-Choi is among about 2 million people who take Vioxx, which hit the market in 1999 and quickly became controversial after problems were noticed.
Initially marketed as a pain reliever that would not cause gastrointestinal problems, Vioxx raised some concerns about cardiovascular risks as early as 2000.
“Now you have the question with Vioxx: Do you want to trade an ulcer for a heart attack?” said Dr. Jeffrey Lisse, acting section chief of rheumatology for the University of Arizona.
Early reports of side effects related to 50 milligram doses and their tendency to trigger edema, high blood pressure and other problems.
But most recent studies show that even lower doses of the drug can cause problems after 18 months of use.
Dr. David Yocum, director of the Arizona Arthritis Center in Tucson, was on the Food and Drug Administration advisory panel that recommended its approval.
“I was concerned about the 50 milligram (dosage even then),” he said.
The higher dosage generally is used for arthritis sufferers with acute pain and for no more than five days at a time. Yocum became alarmed when he learned that McCreery-Choi had been taking the higher dose for a month after getting free samples from a relative who is a doctor.
Relatively young for the disease, McCreery-Choi said she developed rheumatoid arthritis after the birth of her son 13 months ago.
Yocum immediately changed her prescription to the 25mg dose, which she has been taking since to control symptoms that were so bad initially she couldn’t lift anything, including her baby.
Most of Yocum’s patients are taking the 25mg dosage. After the news broke that Merck & Co. was pulling Vioxx from the market, Yocum and the seven other rheumatologists in his practice were sending letters to patients telling them to stop taking the drug and schedule an appointment to receive a new prescription or other alternative treatment.
For McCreery-Choi, that meant switching to Bextra. But she is unsure whether it will help relieve the stiffness and pain in her joints. Her first COX-2 inhibitor, Celebrex, didn’t work.
“So I’m a little concerned that the Bextra might not work, too,” she said. “Vioxx has really worked so well.”
Not that McCreery-Choi is considering taking Vioxx anymore.
risk for heart disease
With rheumatoid arthritis comes an increased risk for heart disease “so it’s a little ironic that the medicine to treat my arthritis can cause heart attacks and strokes,” she said.
The irony isn’t lost on Bob Swinehart, a 75-year-old Sun City resident who has been taking the drug since April 30, 2003, to treat his arthritis but also has a heart condition.
Oct. 30, he noted, will mark 18 months since he began taking the drug.
“I’m sort of disgusted, but I have a vendetta against pharmaceutical companies,” he said, referring to the high price of prescription drugs.
Swinehart was trying to determine Thursday whether Merck would refund him $70 for the 47 pills he has left.
The company said it offers refunds for unused prescriptions.
But even if he winds up losing money, Swinehart said, he will pitch the leftover pills.
“I’m certainly not going to take them since I have a heart condition,” he said. “I have enough problems without all of that.”
Instead, he will take over-the-counter ibuprofen at a fraction of the cost of prescription drugs.