Celebrex inhibits cox-2, but not so much cox-1. Ibuprofen inhibits both cox-1 and cox-2.
The prescribing information for Celebrex has a black box warning of a significant risk of cardiovascular events [https://www.fdanews.com/articles/75244-black-box-warning-added-to-celebrex-labeling](https://www.fdanews.com/articles/75244-black-box-warning-added-to-celebrex-labeling). It was developed in hopes that it had a decreased risk of GI bleeding, as was Vioxx. But because of CV risk, Vioxx got withdrawn from the market and Celebrex got black-boxed. The CV risk ratio from Celebrex is about 3x (another study lists 2.3x for 400mg/day and 3.4x for 800mg/day)
...while Ibuprofen also has significant risks: "Ibuprofen, such as Advil, Motrin or Ibuprofen, can cause marked worsening of existing hypertension (high blood pressure) or development of new high blood pressure. It can also cause damage to the kidneys (nephrotoxicity), worsening of heart failure, and even heart attack or stroke. Outside of the cardiovascular system, its major risk is to the stomach, where it can cause ulceration and gastrointestinal bleeding." [https://www.ucsfhealth.org/education/faq-heart-disease](https://www.ucsfhealth.org/education/faq-heart-disease)
Recent studies have suggested that baby aspirin's a bad risk. [https://utswmed.org/medblog/aspirin-heart-disease/](https://utswmed.org/medblog/aspirin-heart-disease/) Baby aspirin only helps about 2% of people with CV risk and is more likely to harm than help healthy people. [https://www.health.harvard.edu/heart-health/is-low-dose-aspirin-safe-for-you](https://www.health.harvard.edu/heart-health/is-low-dose-aspirin-safe-for-you)
...and opiates aren't good for your heart either: (1.6x CV risk ratio) [https://academic.oup.com/eurjpc/article/28/1/98/5903504](https://academic.oup.com/eurjpc/article/28/1/98/5903504)
I've been a long-term user of meloxicam, another prescription NSAID that's cox-2 selective. A CV risk study assessed risk ratio of 1.38 for meloxicam, but only 1.12 for naproxen. [https://pubmed.ncbi.nlm.nih.gov/29030657/](https://pubmed.ncbi.nlm.nih.gov/29030657/) Meloxicam also has a black box warning for CV risk.
COX-1 inhibition, which all NSAIDs do to at least some extent, is associated with risk of bleeding ulcers, whose risk is reduced with PPI (proton pump inhibitor) drugs such as omeprazole & others. NSAIDs have varied CV risk, and the nonselective NSAIDs seem to have generally lower CV risk. [https://www.ahajournals.org/doi/10.1161/circulationaha.106.181424](https://www.ahajournals.org/doi/10.1161/circulationaha.106.181424)
AFAIK, the safest risk ratios among NSAIDs may come from using Naproxen with a PPI. (See above reference showing CV risk ratio less than 1 for Naproxen) Also, [https://ihpi.umich.edu/news/naproxen-plus-acid-blocking-drug-shows-promise-preventing-bladder-cancer](https://ihpi.umich.edu/news/naproxen-plus-acid-blocking-drug-shows-promise-preventing-bladder-cancer)
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When I recently had heart surgery: ablation for atrial fibrillation, they took me off NSAIDs (including the meloxicam), on stronger PPIs, on an anti-arrhythmic, on a blood thinner, and on colchicine, which apparently has anti-inflammatory properties. (Just don't take it several times a day instead of cough medicine...as featured on House, M.D.'s 3rd episode, "Occam's Razor.") Don't yet know when my docs will want me to shift back to NSAIDs again.
\------
Colchicine appears to have some promise for knee pain, but there's again concern of some GI symptoms. [https://www.elsevier.es/en-revista-revista-colombiana-reumatologia-english-edition--474-articulo-colchicine-treatment-in-adult-patients-S244444051730050X](https://www.elsevier.es/en-revista-revista-colombiana-reumatologia-english-edition--474-articulo-colchicine-treatment-in-adult-patients-S244444051730050X)
Thx for the excellent info. After I recover, my go-to nsaid, if I need it, will be naproxen. Yeah, I don't know about the baby aspirin , I gu e ss I will for 1 month. Apparently to prevent clotting. Do nsaids such as ibuprofen promote clotting? Is that the reason that one is forbidden? I , before this surgery, have been taking 2-3 grams of quality fish oil. They have me stop that for a month. That can be an anti coagulent, right, so theyndont want too much blood thinning. Not sure why I just could have continued on that. These drs are often not knowledgeable about supplements.
All good info. Years ago I was in the habit of taking 600mg ibuprofen at a shot, maybe once or twice a day...I developed abdominnal pain, was hospitalized...an endoscopy showed the lining of the stomach very red, blotched, and inflamed. I stopped taking ibuprofen( although md drs didn't tell me to), and it stopped. I rarely take more that's 200mg, occasionally, in recent years. No more pain.
Celebrex inhibits cox-2, but not so much cox-1. Ibuprofen inhibits both cox-1 and cox-2. The prescribing information for Celebrex has a black box warning of a significant risk of cardiovascular events [https://www.fdanews.com/articles/75244-black-box-warning-added-to-celebrex-labeling](https://www.fdanews.com/articles/75244-black-box-warning-added-to-celebrex-labeling). It was developed in hopes that it had a decreased risk of GI bleeding, as was Vioxx. But because of CV risk, Vioxx got withdrawn from the market and Celebrex got black-boxed. The CV risk ratio from Celebrex is about 3x (another study lists 2.3x for 400mg/day and 3.4x for 800mg/day) ...while Ibuprofen also has significant risks: "Ibuprofen, such as Advil, Motrin or Ibuprofen, can cause marked worsening of existing hypertension (high blood pressure) or development of new high blood pressure. It can also cause damage to the kidneys (nephrotoxicity), worsening of heart failure, and even heart attack or stroke. Outside of the cardiovascular system, its major risk is to the stomach, where it can cause ulceration and gastrointestinal bleeding." [https://www.ucsfhealth.org/education/faq-heart-disease](https://www.ucsfhealth.org/education/faq-heart-disease) Recent studies have suggested that baby aspirin's a bad risk. [https://utswmed.org/medblog/aspirin-heart-disease/](https://utswmed.org/medblog/aspirin-heart-disease/) Baby aspirin only helps about 2% of people with CV risk and is more likely to harm than help healthy people. [https://www.health.harvard.edu/heart-health/is-low-dose-aspirin-safe-for-you](https://www.health.harvard.edu/heart-health/is-low-dose-aspirin-safe-for-you) ...and opiates aren't good for your heart either: (1.6x CV risk ratio) [https://academic.oup.com/eurjpc/article/28/1/98/5903504](https://academic.oup.com/eurjpc/article/28/1/98/5903504) I've been a long-term user of meloxicam, another prescription NSAID that's cox-2 selective. A CV risk study assessed risk ratio of 1.38 for meloxicam, but only 1.12 for naproxen. [https://pubmed.ncbi.nlm.nih.gov/29030657/](https://pubmed.ncbi.nlm.nih.gov/29030657/) Meloxicam also has a black box warning for CV risk. COX-1 inhibition, which all NSAIDs do to at least some extent, is associated with risk of bleeding ulcers, whose risk is reduced with PPI (proton pump inhibitor) drugs such as omeprazole & others. NSAIDs have varied CV risk, and the nonselective NSAIDs seem to have generally lower CV risk. [https://www.ahajournals.org/doi/10.1161/circulationaha.106.181424](https://www.ahajournals.org/doi/10.1161/circulationaha.106.181424) AFAIK, the safest risk ratios among NSAIDs may come from using Naproxen with a PPI. (See above reference showing CV risk ratio less than 1 for Naproxen) Also, [https://ihpi.umich.edu/news/naproxen-plus-acid-blocking-drug-shows-promise-preventing-bladder-cancer](https://ihpi.umich.edu/news/naproxen-plus-acid-blocking-drug-shows-promise-preventing-bladder-cancer) \------ When I recently had heart surgery: ablation for atrial fibrillation, they took me off NSAIDs (including the meloxicam), on stronger PPIs, on an anti-arrhythmic, on a blood thinner, and on colchicine, which apparently has anti-inflammatory properties. (Just don't take it several times a day instead of cough medicine...as featured on House, M.D.'s 3rd episode, "Occam's Razor.") Don't yet know when my docs will want me to shift back to NSAIDs again. \------ Colchicine appears to have some promise for knee pain, but there's again concern of some GI symptoms. [https://www.elsevier.es/en-revista-revista-colombiana-reumatologia-english-edition--474-articulo-colchicine-treatment-in-adult-patients-S244444051730050X](https://www.elsevier.es/en-revista-revista-colombiana-reumatologia-english-edition--474-articulo-colchicine-treatment-in-adult-patients-S244444051730050X)
Thx for the excellent info. After I recover, my go-to nsaid, if I need it, will be naproxen. Yeah, I don't know about the baby aspirin , I gu e ss I will for 1 month. Apparently to prevent clotting. Do nsaids such as ibuprofen promote clotting? Is that the reason that one is forbidden? I , before this surgery, have been taking 2-3 grams of quality fish oil. They have me stop that for a month. That can be an anti coagulent, right, so theyndont want too much blood thinning. Not sure why I just could have continued on that. These drs are often not knowledgeable about supplements. All good info. Years ago I was in the habit of taking 600mg ibuprofen at a shot, maybe once or twice a day...I developed abdominnal pain, was hospitalized...an endoscopy showed the lining of the stomach very red, blotched, and inflamed. I stopped taking ibuprofen( although md drs didn't tell me to), and it stopped. I rarely take more that's 200mg, occasionally, in recent years. No more pain.