Worst Pills, Best Pills

An expert, independent second opinion on more than 1,800 prescription drugs, over-the-counter medications, and supplements



Search results below include E-Alerts where your selected drug is a secondary subject of discussion.


A comprehensive review of the safety and effectiveness of this drug. If the drug is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.
Search results below include Drug and Dietary Supplement Profiles where your selected drug is a secondary subject of discussion.

drospirenone and ethinyl estradiol (GIANVI, YASMIN, YAZ, ZARAH)
  • We list this drug as a Do Not Use drug because it can cause increased blood levels of potassium and is no more effective than other oral contraceptives in preventing pregnancy.
celecoxib (CELEBREX); meloxicam (MOBIC); rofecoxib (VIOXX); valdecoxib (BEXTRA)
  • We list these drugs as Do Not Use drugs because they are no more effective than related drugs, most have not been shown to have a lower rate of ulcers than related drugs and some have been shown to cause heart disease.


Search results below include Worst Pills, Best Pills Newsletter Articles where your selected drug is a secondary subject of discussion.

Critiquing Evidence About the Risky Arthritis and Pain Drug Celecoxib (CELEBREX, CONSENSI)
August 2021
Learn why we have designated celecoxib, a widely used selective COX-2 inhibitor that belongs to a drug class called nonsteroidal anti-inflammatory drugs, as Do Not Use.
Question & Answer
March 2021
In this month’s Question & Answer feature, we respond to a reader’s question about whether the stomach-acid–suppressing drug esomeprazole (NEXIUM, NEXIUM 24HR, VIMOVO) has the same drug interactions as the closely related drug omeprazole (PRILOSEC, PRILOSEC OTC, ZEGERID).
Question & Answer
November 2020
In this month’s Question & Answer feature, we respond to a reader’s question asking about our recommended alternatives to the opioid analgesic tramadol (CONZIP, ULTRACET, ULTRAM), which we have designated as Do Not Use.
Evidence Lacking to Support Use of Compounded Topical Pain Creams
September 2020
In recent years, there has been a surge in the use of compounded topical pain creams as an alternative to oral pain medications, such as non-steroidal anti-inflammatory drugs and opioids. However, a committee of experts convened by the National Academies of Sciences, Engineering, and Medicine recently concluded that there is a lack of evidence to support the safety and effectiveness of these compounded products.
Use of Tramadol for Arthritis Linked to Increased Risk of Death
August 2019
The FDA has approved five medications for treatment of cold sores — sometimes referred to as fever blisters, oral herpes or herpes labialis. Find out which of these drugs offer the most benefit.
Systemic Corticosteroids Ineffective for Low Back Pain
February 2019
Low back pain is a frequent reason for outpatient and emergency room visits among adults. Read why treatment with corticosteroids is a poor choice for treating this common condition.
New Study Supports Link Between Oral Pain Reliever Diclofenac and Cardiovascular Risks
February 2019
This article discusses new research linking use of oral diclofenac, a nonsteroidal anti-inflammatory drug, to an increased risk of heart attacks, strokes and other adverse cardiovascular events.
New Research Shows Aspirin Is Not Beneficial for Older Adults Without Cardiovascular Disease
February 2019
Aspirin is widely used to prevent heart attacks and strokes in the elderly. Read this article to learn whether such use of aspirin is the right choice for you.
Corticosteroid Injections Not Beneficial for Knee Osteoarthritis
November 2017
The injection of corticosteroids into the knee joints of patients with osteoarthritis of the knee is a widespread practice. Find out the results of new research funded by the National Institutes of Health showing that such injections actually may accelerate joint damage.
Further Evidence That CELEBREX Is a Do Not Use Drug; New Designation of Diclofenac (VOLTAREN) as a Do Not Use Drug; and Other Do Not Use NSAIDS
June 2014
Learn about new research that provides further evidence affirming our designation of celecoxib (CE¬LEBREX) as a Do Not Use drug and that has prompted us to reclassify diclofenac (VOLTAREN) from Limited Use to Do Not Use. Also find out which NSAIDs are least likely to cause adverse cardiovascular events, such as heart attacks and strokes.
Steroid Injections and Other Treatments for Lower Back Pain
November 2012
The recent epidemic of life-threatening and fatal infections from contaminated spinal steroid injections is a reminder of the larger issue of their use, even if not contaminated. The article discusses risks that remain even with properly manufactured medications, describing how patients and physicians should know when not to use steroids, consider the risks and benefits of the procedure, and understand other treatment options before using steroids to treat lower back pain.
Liver Toxicity With Topical Diclofenac Sodium (VOLTAREN)
March 2010
Although skin application of drugs usually results in lower blood levels than oral use, cases of liver toxicity have been found with topical diclofenac Sodium (VOLTAREN). The article lists other names of these products and explains the warning signals that may indicate liver toxicity.
Potassium Increases Due to Drug Interactions Can Be Dangerous
November 2008
One of the most common drug interactions occurs when patients take two or more drugs that can each increase blood potassium levels. The resulting condition, hyperkalemia (increased blood potassium levels), can cause nausea, fatigue, muscle weakness or tingling sensations, as well as heart abnormalities, showing up as an abnormal electrocardiogram. In some cases it can be fatal. The article lists 50 drugs which, especially when used in combination, can cause hyperkalemia.
Dangers of Mixing Alcohol with Certain Medications or Diseases
August 2008
The article discusses 273 drugs that can have harmful interactions with alcohol. Also reviewed are several ways in which these harmful interactions can occur: 1/ Medications Can Increase Alcohol Blood Levels 2/ Additive effects of medications and alcohol. One of the best- known drug-alcohol interactions is when alcohol, a depressant, is taken with other sedative medications, and excessive sedation or depression of respiration can occur 3/Alcohol can increase the blood levels of some medications leading to toxicity of these drugs. 4/ Alcohol also can reduce blood levels of some medications causing them to be less effective. Although some of the interactions between alcohol and medications mainly occur in people who drink heavily (three or more drinks on one occasion), many of these interactions may occur with much lower amounts of alcohol use, such as one to two drinks on an occasion. We strongly urge you to tell your physicians and other health care providers how much alcohol you are drinking so they can effectively assess the risks and advise you about the safe use of alcohol and medications.
Ibuprofen Can Reduce Aspirin’s Protective Effect Against Heart Attacks and Strokes
March 2008
This article explains the dangers of using ibuprofen (MOTRIN, ADVIL) because it interferes with the protective effect of low-dose aspirin to prevent blood clots and protect against heart attacks or strokes. Find out how these two widely-used therapies have a harmful interaction and what you should do.
SSRIs Can Have Dangerous Interactions With Other Drugs
January 2008
More than 70 million prescriptions a year are filled for these popular antidepressants, including Prozac, Paxil, Zoloft, Luvox, Celexa and Lexapro. This article gives details about more than 60 other widely prescribed prescription drugs that can have harmful interactions if used with these antidepressants. The two different kinds of interactions are also discussed.
Drug Interactions: Warfarin (COUMADIN)
December 2007
This article explains how to understand the International Normalized Ratio (INR), a test applied to a sample of a patient’s blood to determine how “thin” it is when you are using the blood thinner COUMADIN (warfarin). In addition, the article lists more than 50 drugs or dietary supplements that can interact harmfully with COUMADIN to cause the blood to be too thin (abnormal bleeding) or not thin enough which could result in lessening the effect of COUMADIN in stopping blood clot formation.
New European Warnings and Restrictions on Painkiller Piroxicam (FELDENE): FDA Fails to Issue New Warning
November 2007
The European Medicines Agency (EMEA) has issued new warnings for the painkiller/arthritis drug piroxicam (Feldene). The drug "was singled out for special review because piroxicam-containing medicines are associated with more gastro intestinal side effects and more serious skin reactions than other non-selective NSAIDs." In a series of published studies, in comparison to ibuprofen (ADVIL, MOTRIN), piroxicam was between 2.8 and 7.1 times more likely to be associated with severe gastrointestinal toxicity, defined as bleeding, ulceration or perforation. No other NSAID was as consistently as high in gastrointestinal risk as piroxicam. We continue to recommend that this uniquely dangerous drug be classified as Do Not Use.
Adverse Drug Reactions Cause 1.4 Million Emergency Room Visits in 2004 and 2005
January 2007
An estimated 701,547 patients were treated for adverse drug reactions in emergency rooms each year in 2004 and 2005, totaling 1.4 million visits to the emergency room. Of these, an estimated 117,318 patients were hospitalized each year. According to the study. 18 drugs were each, either independently or in combination with other drugs, implicated in one percent or more of the estimated adverse drug events. These drugs are listed in the table that accompanies this article along with the annual estimates of adverse drug events.
FDA Public Health Advisory - Arthritis Drug Valdecoxib (BEXTRA) Removed From Market; Major New Warnings for Other NSAIDs
June 2005
If you are currently taking celecoxib (CELEBREX)you should contact your physician to consider alternative NSAID treatment.
Cutting Your Drug Bill While Reducing Your Risk Of Avoidable Adverse Drug Reactions: Six Examples
February 2005
This article will look at the potential savings for the individual consumer if the alternative treatments recommended in Worst Pills, Best Pills were used for six DO NOT USE drugs. All six are listed in the Drug Topics Magazine Top 200 selling drugs in U.S. in 2003. The drugs are: celecoxib (CELEBREX) used for arthritis and pain; the Alzheimer’s disease drug donepezil (ARICEPT); drospirenone with ethinyl estradiol (YASMIN 28), an oral contraceptive; esomeprazole (NEXIUM) the “new purple pill” for heartburn; montelukast (SINGULAIR), a drug approved for both asthma and hay fever; and valdecoxib (BEXTRA), an arthritis drug very similar to celecoxib.The combined sales of these six DO NOT USE drugs was $8.1 billion with more that 75 million prescriptions dispensed in 2003.
Blockbuster Arthritis Drug Rofecoxib (VIOXX) Withdrawn From Market
November 2004
Vioxx is the ninth prescription drug to be taken off the market in the past seven years that Worst Pills, Best Pills News readers were previously warned DO NOT USE. The average time between warning readers not to use these drugs and their removal from the market was one year and eight months.
Lawsuit Reveals Serious Safety Problems with the Nonsteroidal Anti-inflammatory Drug Valdecoxib (BEXTRA)
September 2004
Public Citizen filed suit in the District Court for the District of Columbia on February 25, 2004 against the Food and Drug Administration (FDA) asking that they make public complete copies of the agency’s scientific reviews of the nonsteroidal anti-inflammatory drug (NSAID) valdecoxib (BEXTRA).
Overdoses and Lung Toxicity With Methotrexate When Used for Rheumatoid Arthritis and Other Diseases
March 2003
The Institute for Safe Medication Practices (ISMP), with the knowledge of the FDA, issued an alert about methotrexate overdoses that occur when the drug is incorrectly prescribed or used daily rather than weekly.
Do Not Use! New Safety Warning Added to the Arthritis Drug Valdecoxib (BEXTRA)
January 2003
There is an additional similarity (aside from our listing both as DO NOT USE drugs) between valdecoxib and celecoxib, both are sulfa drugs and individuals who are allergic to sulfa drugs should not use them. Although celecoxib came on the market with a warning about sulfa drug allergy, valdecoxib did not. We previously wrote “It may be a dangerous oversight on the part of the FDA not to have required the same warning for valdecoxib.” Unfortunately, because uninformed patients have been needlessly harmed, our prediction has come to pass.
Arthritis Drug Rofecoxib (VIOXX) Linked to Increased Risk of Coronary Heart Disease
December 2002
Investigators from Vanderbilt University in Nashville TN, in a study published in the October 5, 2002 issue of The Lancet, found that patients taking 50 milligrams per day of the arthritis and painkilling drug rofecoxib (VIOXX) for longer than five days are 70 percent more likely to develop coronary heart disease (CHD) than nonusers of the drug.
COX-2 Inhibitors Vioxx and Celebrex: Keep Staying Away--It Gets Worse
March 2001
 In light of the above discussion, we continue to advise the patient-protective five-year-rule for these drugs, as we do for all other new drugs that are not breakthroughs. Do Not Use.


Search results below include Additional Information from Public Citizen where your selected drug is a secondary subject of discussion.

Third Class of Drugs Is Bad Idea, Public Citizen Tells FDA (HRG Publication #1828)
Allowing patients to obtain certain drugs on the basis of counseling by a pharmacist but without a doctor’s prescription is a bad idea, Public Citizen told the Food and Drug Administration (FDA) today at a public hearing.
European Drug Regulatory Authority Should Remove Arthritis Drug Etoricoxib and Weight Loss Drug Rimonabant From European Market
The European drug regulatory authority should immediately remove from the European market the arthritis drug etoricoxib (Arcoxia) and the anti-obesity drug rimonabant (Accomplia), according to a letter sent by Public Citizen to the European Medicines Agency (EMEA) today.
Bextra Ban a Good Step, But FDA Should Pull Celebrex Too (HRG Publication #1734)
Statement of Sidney M. Wolfe, M.D., Director, Public Citizen's Health Research Group
Petition to remove the Cox-2 Inhibitors Celecoxcib (CELEBREX) and Valdecoxcib (BEXTRA) From the Market (HRG Publication #1720)
Petition to remove the Cox-2 Inhibitors Celecoxcib (CELEBREX) and Valdecoxcib (BEXTRA) From the Market (HRG Publication #1720)
Vioxx, Other “Super Aspirins” Are Super Disasters – Other Cox-2 Alternatives Have Safety Problems Too (HRG Publication #1707)
Today’s announcement by Merck is the latest evidence that this family of drugs, the Cox-2 inhibitors, once referred to as “super aspirins,” are turning out to be more like super disasters.
Testimony before the FDA Arthritis Drugs Advisory Committee on the Nonsteroidal Anti-Inflammatory Drugs Celecoxib and Rofecoxib (HRG Publication #1555)
A second box warning about cardiovascular toxicity needs to be added. It should warn of the lack of platelet aggregation inhibition of the drugs which protects those at risk from an increased occurrence of heart attacks. In addition, the evidence which is rapidly accumulating about the heart damage caused by these drugs must be mentioned in this cardiovascular box warning.
Statement before the Food and Drug Administration's Arthritis Drugs Advisory Committee on the nonsteroidal anti-inflammatory drug celexocib. (HRG Publication #1465)
There needs to be clear evidence from comparative long-term, higher dose randomized trials in which celecoxib or any other COX-2 type of anti-inflammatory drug is compared to the least dangerous of these older drugs, ibuprofen, that there is a statistically significantly lower amount of serious GI complications such as perforations, ulcers or bleeding with the COX-2 inhibitor drug.