[Safety of selective inhibitors of inducible cyclooxygenase-2 taken for a long period].
The serious digestive side effects of the selective inhibitors the inducible cyclooxygenase-2 are reduced by 60% as compared to the nonselective non-steroidal anti-inflammatory drugs. The main risk factors associated with gastro-intestinal ulcers caused by the latter were found also with the selective inhibitors taken for long period (age > 60 years, antecedents of gastro-duodenal ulcers, concomitant aspirin treatment). In contrast, H. pylori infection was not found as risk factor apart from past history of gastro-duodenal ulcers. The complications in the lower digestive tract are twice less frequent with the selective inhibitors than with nonselective anti-inflammatory drugs. Nevertheless, it seems that the risk of exacerbation of inflammatory colitis is not reduced. The cardiovascular complications are discussed. Rofecoxib taken at supra-therapeutic dosage was recognised to increase the incidence of myocardial infarction. A such increase was not found with usual dosage or with celecoxib. The selective inhibitors may reduce the renal sodium excretion and increase the blood pressure, particularly in hypertensive patients whose the blood pressure has to be regularly checked.
Lamarque
Dominique
D
Unité d'hépato-gastroentérologie et service de chirurgie générale, Hôtel-Dieu, 1 place du Parvis de Notre-Dame, 75004 Paris. dominique.lamarque@htd.ap-hop-paris.fr
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000068579:Celecoxib; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007527:Isoenzymes / Q000037:antagonists & inhibitors* / Q000378:metabolism; D007668:Kidney / Q000187:drug effects; D007783:Lactones / Q000009:adverse effects; D008565:Membrane Proteins; D009203:Myocardial Infarction / Q000139:chemically induced; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors* / Q000378:metabolism; D010437:Peptic Ulcer / Q000139:chemically induced; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism; D011720:Pyrazoles; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects; D013450:Sulfones
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D007783:Lactones; D008565:Membrane Proteins; D009363:Neoplasm Proteins; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D000068579:Celecoxib