A Bitter Pill for Inflammation? What can you tell me about the new anti-inflammatory drug Vioxx? I occasionally need anti-inflammatories for tendonitis. Also, how can I treat inflammations naturally? Vioxx (or rofecoxib) has been approved by the Food and Drug Administration for the treatment of menstrual and osteoarthritis pain, and is available only by prescription. Unlike other nonsteroidal anti-inflammatories (NSAIDS), this new drug is supposed to cause fewer gastrointestinal side effects, such as ulcers. Older anti-inflammatories inhibit two enzymes: cyclo-oxygenase-2 (Cox-2), which triggers pain and inflammation; and cyclo-oxygenase-1 (Cox-1), which prevents blood platelets from clumping together and forming clots, but also helps maintain the stomach lining. Vioxx inhibits only Cox-2 and leaves Cox-1, so it shouldn't interfere with the stomach lining. On the plus side, people taking Vioxx seem to suffer fewer ulcers and other gastrointestinal problems than those taking older NSAIDS. In fact, Merck & Co. (the pharmaceutical company that developed Vioxx) recently reported the results of an 8,000-patient study. They compared Vioxx to the anti-inflammatory naproxen and found that the new drug reduced the risk of ulcers and other gastrointestinal side effects by 54 percent among patients with rheumatoid arthritis. The not-so-good news is that patients taking Vioxx had a significantly higher rate of heart attacks -- 0.4 percent compared to 0.1 percent -- than those who were taking naproxen. This difference is troublesome because most people with osteoarthritis are in the age range where heart attacks are a risk. (We should note that the naproxen group may have had a lower rate of heart attacks because that drug helps prevents blood clots from forming.) Because of this worry, I'd like to suggest some other natural remedies for inflammation: Eliminate polyunsaturated vegetable oils and partially hydrogenated oils from your diet -- they encourage the synthesis of prostaglandins, hormones that intensify the inflammatory response after an injury. Rely on olive oil, and make sure to increase your intake of omega-3 fatty acids by eating salmon, sardines, walnuts, flax seeds or oil, and soy foods. Take two 500 mg capsules of powdered ginger once or twice a day with food. Take curcumin in 400 to 600 mg capsules three times a day, and/or bromelain at 250 mg three times a day on an empty stomach. Take 500 mg of citrus bioflavonoids or other flavonoids, such as quercetin, anthocyanidins, or proanthocyanidins three times a day. Try acupuncture (look for a practitioner who has experience treating tendonitis). Put ice on the affected area as soon as possible when you feel pain. A bag of frozen peas wrapped in a towel works well. Consult a physical therapist who can show you exercises to strengthen the affected muscle and the area around it.