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drug adverse effects of COX-2-specific inhibitors

Adverse effects: 1) hypertension (especially systolic hypertension) 2) diminished renal function 3) peripheral edema 4) heart failure 5) cardiovascular disease [5] a) myocardial infarction, stroke, vascular death b) RR = 1.42 relative to placebo [5] c) may be due to inhibition of COX-2 mediated prostacylin formation 6) GI complications less frequent than with non-selective NSAIDs [6] - GI bleed, gastritis, peptic ulcer - combining COX-2 inhibitor with proton pump inhibitor is the most effective strategy to reduce the risk of peptic ulcer complications with NSAID therapy [8] * safe in patients with aspirin-exacerbated respiratory disease [7]

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DRUGS: cyclooxygenase-2 inhibitor FORM: drug adverse effects cyclooxygenase 2 specific inhibitor

References

  1. Prescriber's Letter 7(10):55 2000
  2. Prescriber's Letter 8(6):31-32 2001
  3. Journal Watch 23(13):103, 2003 Spiegel BMR et al, Ann Intern Med 138:795, 2003
  4. Prescriber's Letter 11(11): 2004 Safety of COX-2 Inhibitors and Their Place in Therapy Detail-Document#: 201102 (subscription needed) http://www.prescribersletter.com
  5. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006 Jun 3;332(7553):1302-8. PMID: 16740558
  6. Cryer B et al. GI-REASONS: A novel 6-month, prospective, randomized, open-label, blinded endpoint (PROBE) trial. Am J Gastroenterol 2013 Mar; 108:392. PMID: 23399552
  7. Morales DR et al. Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials. J Allergy Clin Immunol 2014 Jul; 134:40 PMID: 24388008
  8. Yuan JQ et al. Systematic review with network meta-analysis: Comparative effectiveness and safety of strategies for preventing NSAID- associated gastrointestinal toxicity. Aliment Pharmacol Ther 2016 Jun; 43:1262 PMID: 27121479