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Review of the selective COX-2 inhibitors celecoxib and rofecoxib: focus on clinical aspects | Canadian Journal of Emergency MedicinePharmacotherapeutic Specialist, Internal Medicine, Pharmaceutical Sciences Clinical Service Unit, Vancouver Hospital and Health Sciences Centre, Vancouver, BC; Clinical Assistant Professor of Pharmacy, University of British Columbia, Vancouver; Coordinator, Advanced Pharmacotherapeutics, Doctor of Pharmacy Program, UBC Chair, UBC Clinical Research Ethics Board; Publishing Editor, The Journal of Informed PharmacotherapyThe selective cyclooxygenase-2 (COX-2) inhibitors celecoxib and rofecoxib were designed to have similar efficacy but less gastrointestinal toxicity than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Their efficacy has been demonstrated in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, postoperative dental pain and dysmenorrhea. These agents produce fewer endoscopic ulcers, symptomatic ulcers and gastrointestinal bleeds than traditional NSAIDs; although the absolute benefit is small and the gastropreserving effect is negated by concurrent use of low-dose aspirin for cardiovascular risk reduction. Nephrotoxicity and hyptertension remain concerns with COX-2 inhibitors, as they are with traditional NSAIDs. COX-2 inhibitors may be safe alternatives to traditional NSAIDs for patients with aspirin-sensitive asthma.
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