She had been taking the arthritis and acute pain medication on and off for five years, to treat arthritis and fibromyalgia.
''My husband called me and said, 'Aren't you on that, sweetheart?' '' said Krengel, 53, who works at the Davis County Health Department. ''I took it this morning but am going to stop and call my doctor today. What makes me sad is this has helped so many people to decrease inflammation and stiffness.''
Merck began selling the popular drug in 1999, with sales surging to more than $2.5 billion last year.
"We are taking this action because we believe it best serves the interests of patients," said Raymond Gilmartin, Merck's president and chief executive.
The Whitehouse Station, N.J., pharmaceutical company said it yanked the drug because data from a three-year colon cancer clinical trial showed a heightened risk of cardiovascular complications 18 months after patients started taking Vioxx rather than dummy pills.
"Although we believe it would have been possible to continue to market Vioxx with labeling that would incorporate these new data, given the availability of alternative therapies, and the questions raised by the data, we concluded that a voluntary withdrawal is the responsible course to take," Gilmartin said.
He urged people who take Vioxx to consult their doctors about other medications, and call Merck's hot line at 1-888-36-VIOXX or visit http://www.merck.com or http://www.vioxx.com.
While the news came as a surprise to consumers like Krengel, some doctors expected the withdrawal due to past findings that taking Vioxx increases the risk of blood clots, leading to heart attacks and strokes.
"There's been information unfolding," said Daniel Clegg, division chief of Rheumatology at the University of Utah Health Sciences Center. "I think the relative risk of cardiovascular events such as heart attack and stroke is not high, it just took large numbers of patients to demonstrate that risk. The good news is there are drugs that are chemically equivalent."
Clegg said Vioxx's competitors, Celebrex and Bextra, are possible alternatives. All are COX-2 inhibitors, which impede the production of chemicals that cause pain and swelling.
Also, Merck plans to seek approval from the Food and Drug Administration (FDA) for Arcoxia, a second version of Vioxx already marketed in 47 countries outside the United States.
Arthritis affects nearly one out of three Utah adults - 31 percent - and is a leading cause of disability in the state, according to the Utah Department of Health.
Arthritis generates significant health care costs. For example, hip and knee replacements resulting from arthritis topped $140 million in Utah in 1998. And Medicare paid $18 million for Utahns admitted to hospitals with an arthritis diagnosis in 1999, representing 9 percent of the total Medicare dollars paid for all diagnoses.
Krengel found out she had rheumatoid arthritis, an abnormality in the body's defense or immune system causing inflammation of the joints, when she was 30. She hopes Bextra will work for her because she is allergic to Celebrex.
"I'll get stiff in my hips, knees and hands" until I can see my doctor, she said. However, she commended Merck for taking the drug off the market to safeguard consumers.
Rob Ence, executive director of the American Association of Retired Persons (AARP) Utah chapter, wasn't as forgiving.
"The consumer has a great deal of faith in the pharmaceutical industry's products, and they pay a great deal for those products," Ence said. "The industry should get it right. We will encourage our constituents to talk to their doctors and review their medications."
Victoria Saley, health education coordinator with the Utah/Idaho chapter of the Arthritis Foundation, a support and educational group, said the organization plans to notify members about the recall through its monthly newsletter.
"We've had a couple of calls today, and I'm sure over this week we'll hear from more people wondering what to do," Saley said. "We're urging everyone to talk to their doctors to find out what other treatment plans are available."
Local pharmacies also received calls from people with questions about Vioxx. Smith's Food and Drug Centers Inc. stopped selling Vioxx on Thursday and fielded many calls at its 48 Utah pharmacies, said spokeswoman Marsha Gilford.
Terry Sawchuk, a doctor at the Intermountain Spine Institute at Cottonwood Hospital in Murray, prescribed Vioxx for patients with neck and back injuries.
"We're going to have to look at other anti-inflammatories with a better safety record," Sawchuk said. "There are definitely other options. Anti-inflammatories sometimes lose their efficacy over time and some people react better to one over another. But I don't think there's any reason to panic."
chamilton@sltrib.com
