II. Class
- NSAID in the COX2 selective class
III. Agents
- COX-2 Inhibitors
-
NSAIDs which favor COX-2 (alternatives to COX-2)
- Etodolac (Lodine)
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- However, higher risk of NSAID Gastrointestinal Adverse Effects
IV. Advantages
- Less gastrointestinal adverse effects than other NSAIDs
- See NSAID Gastrointestinal Adverse Effects
- Cost may not outweigh benefits
- Number Needed to Treat to prevent 1 GI Bleed: 200
- Studies showing decreased GI Bleeds were flawed
- Compared Celebrex to high risk NSAID (Diclofenac)
- Confidence Interval overlaps 1.0
- (2000) JAMA 284:1247-55 [PubMed]
- No inhibition of Platelet aggregation
- No increase in Bleeding Time
- May have pro-thrombotic effect
V. Adverse Effects
- Nonfatal Acute MI risk increased over NSAIDs
- Vioxx voluntarily withdrawn from market October 2004
- Celebrex however appears safer than Ibuprofen in terms of Cardiovascular Risk
- Avoid if known vascular disease
- Avoid if significant Cardiac Risk Factors
- Adverse renal effects may occur
- Hypertension (1%)
- Peripheral Edema (2-4%)
- References
VII. Indications
- Osteoarthritis
- Rheumatoid Arthritis
- Acute pain
- Familial adenoma polyposis
- Arthritic pain relief in NSAID intolerant
- Bleeding risk
- Peptic Ulcer Disease
- Concomitant gastrointestinal symptoms
- Age over 65 years
- Concurrent medication predisposing to Gastritis
- Corticosteroids
- Coumadin (Off-label use of COX2 Inhibitor)