Bextra

Bextra is the brand name for valdecoxib, a type of non-steroidal anti-inflammatory drug (NSAID) that is used to treat a variety of painful conditions, some of which include osteoarthritis, rheumatoid arthritis, and painful menstrual cycle. Also referred to as a COX-2 inhibitor, Bextra relieves pain and swelling (inflammation) in the joints. The relief of pain and swelling allow sufferers to perform their daily task.

NSAIDs are commonly used pain relievers, inhibiting part of the chemical cycle responsible for inducing inflammation. Serious side effects can occur in long-term users of NSAID, some of which include stomach irritation, ulcers, and intestinal bleeding. COX-2 inhibitor is an alternative drug to traditional NSAID. It reduces the pain in patients while minimizing the gastrointestinal side effects that are often associated with the use of traditional NSAIDs.

Although Bextra provides pain relief with minimal intestinal side effects, its use, like that of other COX-2 inhibitors, has been linked to cardiovascular and other serious side effects. A public health advisory board issued a report on the concerns of anti-inflammatory pain relievers. The advisory board recommends doctors not prescribe COX-2 inhibitors to patients at high risk of cardiovascular problems. The risk of cardiovascular side effects is greater during long-term treatment and use in high-risk situations, such as immediately after heart surgery.

Bextra was removed from the United States market in 2005 in response to Food and Drug Administration (FDA) report warning patients of the risk of cardiovascular and skin problems associated with the use of Bextra.

Bextra Side Effects

The use of Bextra has been associated with a variety of dangerous side effects, one of which is the development of Stevens Johnson Syndrome (SJS), a debilitating inflammatory disorder of the skin. Although a somewhat rare condition, Stevens Johnson Syndrome is extremely serious, causing widespread skin rash development that can rapidly progress to the formation of boil-like sores on the body. Stevens Johnson Syndrome spreads throughout the body via the skin and/or mucous membranes. Unfortunately, there is no treatment currently able to halt SJS progression. Doctors dealing with a case of Stevens Johnson Syndrome are forced to treat the symptoms rather than the disease itself. The key to symptom management is recognition of the medication causing the reaction and ceasing its use. Bextra is one of a number of notable prescription drugs that have recently been linked with Stevens Johnson Syndrome.

Levels of COX-1 and COX-2 enzymes in the body are naturally in balance. Data suggests that the COX-1 and COX-2 enzymes serve as a “check and balance” to one another. COX-1 enzymes produce platelets that encourage blood clotting and tighten the arteries. Normally, this effect is kept in check by another chemical called prostacyclin. Prostacyclin is produced by COX-2 enzymes with the assistance of COX-1 enzymes. Bextra blocks COX-2 enzymes, upsetting COX enzyme balance. The resulting imbalance leads to decreased levels of prostacyclin while the influence of COX-1 enzymes goes unchecked and the risk of heart attack and stroke increases.

COX Enzymes

Cyclooxygenase or COX is a type of enzyme responsible for triggering changes in the body. COX enzymes produce chemical messengers (prostaglandins) necessary for the promotion of inflammation and pain as the body's defense against infection. By blocking the COX enzymes, NSAIDs stop the body from making prostaglandins, leading to less swelling and pain.

There are two types of COX enzymes, COX-1 and COX-2. Both enzymes promote inflammation and pain. In addition to its inflammatory response, COX-1 protects the stomach lining from digestive acids and helps to maintain kidney functions. COX-2 enzymes are important for maintenance of the cardiovascular system.

COX-1 and COX-2 Selectivity Ratio

Bextra is similar to Celebrex, another COX-2 inhibitor, in relationship to the COX-1/COX-2 enzyme selectivity ratio, which they share at 60. The ratio determines how selective the drug is in blocking the COX-1 vs. COX-2 enzymes. Bextra inhibits COX-2 enzymes 60 more times than COX-1 enzymes. VIOXX has the highest ratio of all COX-2 inhibitors at 272.

Bextra and VIOXX were designed to provide relieve from pain and inflammation without gastrointestinal irritation. This appeared to be a promising development. However, the promise vanished as both drugs were withdrawn from the U.S. market due to studies indicating an increased risk of cardiovascular and other side effects.