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COX2 Selective NSAID
Aka: COX2 Selective NSAID, COX2 Inhibitor, COX-2 Inhibitor
- See Also
- NSAID
- Class
- NSAID in the COX2 selective class
- Agents
- COX-2 Inhibitors
- Celecoxib (Celebrex)
- Rofecoxib (Vioxx) - withdrawn from U.S. market in 2004
- Valdecoxib (Bextra) - withdrawn from U.S. market in 2005
- NSAIDs which favor COX-2 (alternatives to COX-2)
- Etodolac (Lodine)
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- However, higher risk of NSAID Gastrointestinal Adverse Effects
- 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
- (2000) N Engl J Med 343:1520-8 [PubMed]
- 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
- 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- Vioxx voluntarily withdrawn from market October 2004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
- Ruschitzka (2017) Eur Heart J +PMID:29020251 [PubMed]
- Avoid if known vascular disease
- Avoid if significant Cardiac Risk Factors
- Adverse renal effects may occur
- Hypertension (1%)
- Peripheral Edema (2-4%)
- References
- Fitzgerald (2001) N Engl J Med 345:433-42 [PubMed]
- Efficacy
- Similar effect to moderate dose NSAIDs
- NaproxenSodium 550 mg
- Ibuprofen 400 mg
- 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)
- Monitoring
- ProTime if on Coumadin
- Check ProTime weekly for first 4 weeks
- Consider checking labs at 6 months
- Complete Blood Count
- Aspartate Aminotransferase (AST, SGOT)
- References
- (1999) Med Lett Drugs Ther 41(1045): 11-14 [PubMed]
- (2000) Med Lett Drugs Ther 42(1085): 73-78 [PubMed]