Vu D, Murty M, McMorran M.
Canadian Adverse Reaction Newsletter 2002;12:1-4

Physicians should exercise caution when prescribing selective COX-2 inhibitors to patients who are at risk for cardiovascular disease. In addition, patients need to be told to report any symptoms of congestive heart failure, chest pain or hypertension. These cautions have been issued as a result of a recent meta-analysis that suggested the use of selective COX-2 inhibitors might lead to an increase in cardiovascular events. It is hypothesized that selective COX-2 inhibitors decrease vasodilatory and anti-aggregatory prostacyclin production and may affect the hemostatic balance in favour of a prothrombic state. This in turn, could lead to increased cardiovascular events. What is unclear is whether these cardiovascular effects are the same for all selective COX-2 inhibitors.

Since rofecoxib (Vioxx®), celecoxib (Celebrex®) and meloxicam (Mobicox®) have been marketed, a number of suspected cardiovascular/cerebrovascular adverse reactions have been reported to Health Canada. A few of them have proven fatal. Several factors need to be taken into account when determining whether the cardiovascular effects are related to COX-2 inhibitors, such as:

• Pre-existing medical conditions
• Prevalence of cardiovascular disease in the population for whom the drugs are indicated
• Concomitant use of drugs that can cause cardiovascular reactions or drug reactions.

Some patients with a cardiovascular condition may use anticoagulant therapy such as warfarin. For these patients caution is needed to prevent hemorrhagic complications that may occur with the concomitant use of COX-2 inhibitors.

Until more conclusive data are available, the benefits of prescribing selective COX-2 inhibitors should be weighted against possible risks.

To read more on this, go to:

http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v12n2_e.html

Content on this site has been reviewed by the arthritisU.com faculty. A listing of the faculty is located in the Faculty Lounge.