Q: I am a 62-year-old male. I have had osteoarthritis of my knees and shoulders for several years, and have tried different anti-inflammatory drugs to help the pain and swelling in the joints. The doctor recently gave me Vioxx, and my feet have started to swell and I seem to be retaining fluid. However, my arthritis seems much better. Should I be concerned about the water retention?
A: This is a good question as this is quite a controversial topic at the moment. Vioxx is one of the new families of anti-inflammatory drugs known as cox-2 inhibitors. At first, the drug companies that made this drug and its competitor, Celebrex, touted it as being less harmful to the kidneys than the NSAIDs that were being used previously. NSAIDs are non-steroidal anti-inflammatory drugs such as Voltaren or Motrin. The new drug is also thought to be less likely to cause internal bleeding.
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However, Dr. Mark Perazella, associate professor of Medicine at Yale Medical School, recently published an article suggesting the cox-2 inhibitors could also damage kidneys.
He found that drugs like Vioxx and Celebrex increased the formation of substances known as prostaglandins that have a harmful effect on kidney function. Even in healthy individuals, they changed certain aspects of kidney physiology by altering the blood flow to the organ and affecting the filtration rate. Blood salt levels are reduced and water retention is increased. This can lead to damaged kidneys and raised blood pressure. All this gets worse in high-risk individuals such as those who already have high blood pressure or the elderly, whose kidneys may already be working less than adequately.
In my opinion, cox-2 inhibitors should not be given to anyone over the age of 70 who also has high blood pressure. I think there are a lot of older individuals out there who are taking these medications and are putting themselves at risk.
The good news is that the situation returns to normal within two or three days of discontinuing the medication.
So what is an elderly arthritis sufferer to do? There is no easy answer, but I would suggest you change to extra-strength Tylenol until you have had a chance to discuss this with your doctor, who should check your blood sodium levels and also measure the creatinine to assess the state of your kidneys.
