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Related to COX-2 inhibitors: Prostaglandins
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Selective COX-2 inhibitors could induce severe coronary vasospasm through unbalanced COX inhibition.
For seven traditional NSAIDs (diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam) and the COX-2 inhibitors etoricoxib and rofecoxib, the odds ratios for heart failure with current use ranged from 1.
But if you're at risk for a blood clot (thrombosis) in a deep vein, you may want to think twice about a particular painkiller: a COX-2 inhibitor (Celebrex[R]).
Editor's Note: "We found 30-day mortality from stroke increased by around 20% if patients were taking a COX-2 inhibitor before admission," said study co-author Christian Christiansen, PhD, of Aarhus University Hospital.
In addition, conventional COX-2 inhibitors can increase blood pressure, trigger leg swelling, and alter or aggravate kidney function, like their "cousins"--NSAIDs--in certain patients.
Selective COX-2 inhibitors promise better gastrointestinal tolerance, but various studies (6, 7) have shown that selective COX-2 inhibitors do not decrease the frequency of GPAs coprescription.
After the Vioxx recall, other painkillers were prescribed to fill the gap, such as celecoxib (Celebrex), another COX-2 inhibitor, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin or naproxen, and opioid drugs.
This equates to about four extra cases of atrial fibrillation per year per 1,000 new users of NSAIDs and seven extra cases among new users of COX-2 inhibitors.
Compared with non-users, the association was strongest for new users, with around 40 pc increased risk for non-selective NSAIDS and around 70 pc increased risk for COX-2 inhibitors.
All versions of the model are based on estimating the hazard function or the likelihood of a transition (in our case, between nonuse of COX-2 inhibitors and use of COX-2 inhibitors) between states at time [DELTA]t, conditional on the spell (of nonuse) having persisted to time t.
The objective was to determine the impact of PAR for COX-2 inhibitors on prescription expenditures and prescribing patterns in a Medicaid program.
Between 1997 and 2004, the gap between NSAID prescriptions and gastroprotective therapies steadily decreased (from 79% to 14% of patients on NSAIDs who were not getting gastroprotection), aided in large part by the availability and increased usage of COX-2 inhibitors beginning in 1999.