Jimmy
Papadopoulos, 68, has had arthritis for over eight years.
Three years ago his doctor wrote a script for a drug that
changed his life. On rofecoxib (Vioxx), Mr Papadopoulos
was finally able to spend afternoons gardening without
feeling the debilitating pain caused by arthritis or risk
upsetting his sensitive stomach � a problem he had had
with other meds. He was finally free from his disease
and felt he had his life back.
Four weeks ago all that came crashing
down when Merck announced it was pulling rofecoxib off
pharmacy shelves. On hearing the news, he literally
rushed to his medicine cabinet to count the number of
pills he had left and tried to figure out how he could
stretch them out. For Mr Papadopoulos the increased
risk of heart disease didn't matter � his freedom of
mobility did.
His wife Voula tried to talk some
sense into him. "But Jimmy, these medications can kill
you!" she reasoned. Eventually she convinced her husband
to stop taking the pills and call his doctor for advice.
Many of you may be facing similar
situations in the wake of the rofecoxib announcement.
Patient reactions may vary from utter disbelief to anger
and confusion because you prescribed a dangerous drug.
Here are a few tips on what to tell your patients now
that rofecoxib is off the market.
NEVER
FEAR � OTHER DRUGS ARE HERE
• Just stop period First things first,
if your patient hasn't already stopped using rofecoxib
you need to tell them to discontinue its use now. Address
any concerns the patient may have about discontinuing
a medication that has worked well for them. "There's
no danger in stopping the drug all at once," assures
Dr Michel Zummer, president of the Canadian Rheumatology
Association and chief of rheumatology at the Maisonneuve-Rosemont
Hospital in Montreal. Some patients may be under the
impression that halting the drug will mean the disease
symptoms may come back. Not true, says Dr Zummer. "A
certain amount of patients who get off the drug realize
that they didn't need it as much as they thought," he
says.
• Take a step back
Dr Zummer suggests that you take the time and see if
the patient still needs to be on medication. "The first
thing is to re-evaluate and see if the patient really
needs an anti-inflammatory drug." If an anti-inflammatory
is no longer needed he suggests you tell the patient
to try a local or topical treatment or a simple analgesic.
"For patients who do need an anti-inflammatory you should
evaluate heart and GI risk," he says.
• Try this instead
Reassure your patients that there are other drugs that
will work for them. "There are a lot of alternatives
for treatment of patients with arthritis," explains
Dr Zummer, "and they are very effective alternatives."
He points to some of the older anti-inflammatories:
"These drugs are all of comparative efficacy," he says.
"What made the COX-2 superior is its gastro-protective
property." With that in mind you should tell patients
who are going back to older anti-inflammatories that
they also have to take medication to protect their GI
tract, like a proton pump inhibitor.
• Au natural
Many of your patients may come in with questions about
more natural remedies like glucosamine. Dr Zummer explains
that although some studies have shown that glucosamine
can yield good results, in reality that might not always
be the case. "The problem is that there is no quality
control in Canada," he says. "The quality of the product
is extremely variable." Explain to your patients that
doses can range from 500mg per tablet to 15mg per tablet,
which can lead to ineffective treatment. It's best that
the buyer beware, warns Dr Zummer.
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