She said she learned the news when a friend called her early Thursday morning and told her to turn on the TV and not take her medicine. Lima said she'll be trying another medication when she sees her doctor Monday to get her flu shot.

Merck & Co., which makes the drug, voluntarily pulled it off the market after a new study showed that it doubles the risk of heart attacks and strokes among people taking it for 18 months or more. A Merck spokeswoman said the company did not immediately have a state-by-state breakdown of how many patients were taking the drug.

At HMSA, the state's largest health insurer, Dr. John Berthiaume said at least several thousand of the group's 689,000 members statewide have taken Vioxx in the past.

Berthiaume, an HMSA assistant vice president who oversees pharmacy management, said the drug is popular, but there are similar medications available. "It will make patients look for alternative therapies," he said.

He said the company Pfizer, which manufactures similar drugs Bextra and Celebrex, announced late yesterday that it will offer a coupon on its Web site where Vioxx users can download a seven-day free medication coupon to allow them to try the other drugs.

Berthiaume said HMSA will be notifying pharmacies, physicians and individual patients by letter to make sure that people know about news and take the appropriate action.

Local specialists generally say that other pain relief is readily available. Dr. Denny Nakayama, rheumatologist at the Kuakini Medical Plaza, said he has prescribed Vioxx for younger patients but sees other options.

"It is a popular drug not only in Hawai'i but nationally," Nakayama said. "Will it make a big impact on how we take care of patients? I don't think so. There are other effective medications."

He said he is getting calls from some patients and is working with them to find alternatives but he said he didn't prescribe it much for older patients already at risk for high blood pressure and cardiovascular disease.

Dr. James McKoy, chief of rheumatology and pain management at Kaiser Permanente Hawai'i, said a lot of patients are calling their doctors, who are recommending other medications.

"There's not any panic or fear," McKoy said. "They just want to know, 'Well doc, what's next?' "

McKoy also serves as a board member for the local Arthritis Foundation. He said patients shouldn't worry about any lingering effects or risks as they switch to other medication. "You just stop the medication and get it out of your system in a few weeks," he said.