title: Long-term use and tolerability of cyclooxygenase-2 inhibitors in patients with analgesic intolerance.
abstract: BACKGROUND
  Cyclooxygenase-2 (COX-2) inhibitors are reported to be well tolerated in patients with analgesic intolerance (AI). However, limited data are available about the long-term tolerability of these drugs.
  
  
  OBJECTIVE
  To determine the long-term tolerability of COX-2 inhibitors in patients with Al.
  
  
  METHODS
  Patients with AI who previously underwent single-masked, placebo-controlled oral provocation tests and were found to tolerate nimesulide, meloxicam, rofecoxib, or celecoxib were interviewed regarding the long-term use and tolerability of these drugs.
  
  
  RESULTS
  Of 87 patients, 61 (70%) had used the recommended COX-2 inhibitor(s). Of the 61 users, 54 (89%) tolerated the drug(s) well and 7 (11%) reported adverse events. Three patients reporting adverse events were rechallenged with the responsible COX-2 inhibitor, and their results were found to be negative.
  
  
  CONCLUSIONS
  Long-term use of COX-2 inhibitors was tolerated well by most patients with AI, and placebo-controlled oral provocation tests, as a single test, seemed to predict tolerability. Furthermore, self-reported positive reactions in the long-term should also be confirmed with rechallenge tests for definite diagnosis.
authors.affiliation: Division of Allergic Diseases, Department of Chest Diseases, Ankara University School of Medicine, Cebeci Hospital, Ankara, Turkey. gcelik@medicine.ankara.edu.tr
authors.forename: Gülfem
authors.initials: G
authors.lastname: Celik
authors.forename: Ferda Oner
authors.initials: FO
authors.lastname: Erkekol
authors.forename: Sevim
authors.initials: S
authors.lastname: Bavbek
authors.forename: Berna
authors.initials: B
authors.lastname: Dursun
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Misirligil
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D018849:Controlled Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism*
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases