A day after a popular arthritis drug is pulled from pharmacy shelves, patients and doctors are trying to decide what to do next.

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Fact Sheet: More On Vioxx

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Vioxx is one of the most popular pain medications in the world -- raking in $2.5 billion in sales last year. About 2 million people worldwide take the drug.

On Thursday, Merck Pharmaceuticals announced new concerns that Vioxx may dramatically increase the risk of heart trouble and stroke in those who take it 18 months or longer.

Merck said that the results were unexpected, but several studies over the past four years have suggested cardiovascular problems. Dr. Dan Solomon, of Brigham and Women's Hospital in Boston, published one of those studies.

"With that original data, there were many people in the cardiovascular community concerned about the safety of this drug," he said.

Even some patients, like Lyle Shelly, had heard news reports questioning its safety. After two years of taking the drug for a sports injury, he stopped taking it just two weeks ago.

"I take care of myself, and I don't want to put anything bad into my body. And yeah, I'm happy I'm not taking it right now, knowing what I know," Shelly said.

Another Vioxx user, AnnaMarie DeCarlo, said she was "stunned" at the recall and that she's taking the information "very, very seriously." She said she's used the drug for about eight months for shoulder pain -- and that it was "absolutely terrific."

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Popular Arthritis Drug Recalled Worldwide

Vioxx is known as a cox-2 inhibitor, as is another leading pain medication, Celebrex. But studies suggest that Celebrex does not have similar effects on the heart. A third cox-2 drug, Bextra, is too new to the market to know if it has long-term cardiac side effects, experts say.

"Unfortunately, these drugs have been marketed very heavily to patients and doctors. The good news today is that the overuse that we've really seen over the last couple of years will really be scaled back," Solomon said.

Dr. William Palmer, a rheumatologist in Omaha, Neb., said Merck did the right thing in recalling Vioxx, but he has a stack of 40 charts of patients wanting to know what to do next.

"Believe it or not, 15 to 20 percent want to keep taking it," Palmer said.

But Palmer is advising patients to stop taking Vioxx.

Patients who are currently taking Vioxx should contact their health care providers to discuss discontinuing use of Vioxx and possible alternative treatments. For more information, visit merck.com, vioxx.com, or the Food and Drug Administration's Vioxx page. Patients and health care professionals with questions can also call (888) 36-VIOXX (1-888-368-4699).

Patients can get a refund on unused Vioxx by mailing back the remaining drug in the original container, along with a pharmacy receipt, to:

NNC Group
Merck Returns
2670 Executive Dr.
Indianapolis, IN 46241

A note with the patient's name, address and phone number should be included. The company will reimburse the cost of the full prescription plus regular shipping.