New Painkiller Causes Fewer GI Problems

Laine said all cox-2 inhibitors carry a risk of heart attack and stroke. "One wouldn't expect this one (etoricoxib) to be different," he said. "But it could provide another option for patients."

The new trial was done as part of the U.S. Food and Drug Administration's approval process, Laine noted.

Dr. Joost Drenth, of Radboud University Nijmegen Medical Center, the Netherlands, and author of an accompanying editorial in the journal, said there wasn't enough difference between the drugs in terms of gastrointestinal toxicity to show that etoricoxib was better.

"My advice would be to fall back to the good, old, classic NSAIDs with the addition of a proton pump inhibitor. Because we know adding a proton pump inhibitor to NSAIDs will decrease the incidence of dyspepsia," he said.

Another expert thinks etoricoxib and diclofenac are really two similar drugs, because diclofenac acts very much like a cox-2 inhibitor.

"It's not surprising that you don't see much of a difference when you compare Coke and Pepsi," said Dr. James M. Scheiman, a professor of medicine at the University of Michigan Medical Center.

Scheiman thinks the main concern with cox-2 inhibitors is weighing the cardiac risks with the gastrointestinal risks. "Which drug a patient should take is entirely driven by their underlying cardiac and gastrointestinal risk," he said. "Cox-2 inhibitors have a clear advantage on the gastrointestinal side when compared to drugs that aren't cox-2 inhibitors."

Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan School of Medicine, agreed. "If you have cardiovascular concerns and no gastrointestinal risk, I would avoid the cox-2 inhibitors like the plague," he said.

"If you had a prior ulcer and can't tolerate Tylenol, and are lucky enough not to have any cardiovascular risk, then I would lean toward a cox-2 inhibitor or a traditional NSAID and a proton pump inhibitor," Fendrick said. "If you have both risks, then I would use acetaminophen or low-dose narcotics or a more cardiac safe NSAID, like Naproxen, and a proton pump inhibitor."

More information

For more information on cox-2 inhibitors, visit the U.S. Food and Drug Administration.