Warnings need to be strengthened for the anti-inflammatory ibuprofen, and the controversial drug Vioxx should be allowed back on pharmacy shelves, an expert panel advised Health Canada on Thursday.

Ibuprofen carries as much risk of heart attacks and strokes as Vioxx and should therefore be moved behind the counter in pharmacies where patients would need to ask for it, panellists said.

In response, Health Canada said it agreed with the panel's recommendation that all anti-inflammatory pain medications should be relabelled to inform users of the heart disease risks.

COX-2 inhibitors like Vioxx may be no more dangerous than other traditional painkillers. photo)
COX-2 inhibitors like Vioxx may be no more dangerous than other traditional painkillers. photo)

The independent panel was convened to weigh the risks and benefits of three COX-2 inhibitors: Vioxx, Celebrex and Bextra. The medications are prescribed to relieve pain from conditions such as rheumatoid arthritis.

The COX-2 drugs became some of the most commonly prescribed in Canada after they were promoted as causing fewer ulcer problems than traditional arthritis drugs.

Merck withdrew Vioxx from the market last year after clinical trials showed the drug increased the risk of heart attacks and strokes. The move cast doubt on the safety of all COX-2 inhibitors.

About 80 brand-name NSAIDs are sold in Canada.(AP file photo)
About 80 brand-name NSAIDs are sold in Canada.(AP file photo)

In a 12-1 vote, panellists said Vioxx should be brought back on the market in Canada for the majority of healthy people. The risk increases at higher doses, prolonged use and for those already predisposed to cardiovascular problems.

Health Canada said there is no clear reason not to allow Vioxx to return to the market. Merck said it has not yet decided whether to seek approval to resume sales in Canada or elsewhere in the world. In the U.S., the company faces several lawsuits from Vioxx users.

The panel unanimously endorsed keeping Pfizer Inc.'s Celebrex on sale.

They recommended 8-5 against allowing sales of Pfizer's Bextra, arguing there is not enough data on its heart risks, and it may increase the risk of a serious skin disorder.

As with any drug, the decision to take Vioxx should be discussed between a patient and his or her physician, panel chair Dr. Andreas Laupacis told reporters.

The panel also concluded the risks of heavy use of ibuprofen were underestimated.

The non-steroidal anti-inflammatory (NSAID), sold as Advil or Motrin, was approved for short-term relief of pain and fever but is often taken chronically at high doses, they said.

Health Canada doesn't have the power to move older NSAIDs from pharmacy aisles to behind the counter as the panel recommended.

"It is a provincial matter," said Dr. Marc Berthiaume, director of the marketed pharmaceuticals division at Health Canada. "What Health Canada plans to do is to inform provincial authorities of the recommendation."