Doctors writing in a prominent medical journal recommended that physicians stop prescribing Pfizer Inc.'s Bextra painkiller, just as a large study found the drug maker's sister drug, Celebrex, doubled the risk of heart attacks. Both Bextra and Celebrex are members of the COX-2 inhibitor class of painkillers, the same class as the recalled pain-relieving drug, Vioxx.

A letter by three top doctors published in The New England Journal of Medicine's Dec. 23 edition said that, in light of Vioxx and negative signs on Bextra, Bextra should be avoided.

"To protect the safety of the public, we write to recommend that clinicians stop prescribing valdecoxib (Bextra), except in extraordinary circumstances," editorial writers at The New England Journal of Medicine wrote in the Dec. 23 issue.

Pfizer said a government-sponsored trial of Celebrex was halted after patients taking the medicine had more than twice as many heart attacks as patients taking a placebo. The recent developments with Vioxx, Bextra, and now Celebrex are rekindling the debate over the merits and safety of the entire class of painkiller drugs.

No to COX-2s

Pfizer has aggressively defended Bextra and Celebrex since Vioxx's withdrawal and questions about cox-2 inhibitor safety arose. Officials at Pfizer said they had not seen the medical journal letter and could not comment.

Older cheaper painkillers such as aspirin are as effective as the COX-2s, but can upset some stomachs. Cox-2 inhibitors main advantage is protecting the stomach in patients with gastrointestinal problems. Jonathan Kay, associate clinical professor at Harvard Medical School and a rheumatologist at Massachusetts General Hospital, says regular painkillers can be used with a separate prescription for stomach protection to achieve the same benefits. "This data about Celebrex certainly raises enough concern that all physicians should be very cautious," he said.