title: Prescriptions for chronic high-dose cyclooxygenase-2 inhibitors are often inappropriate and potentially dangerous.
abstract: OBJECTIVE
  To describe the use of coxibs outside of licensed indications and recommended dosing ranges including rofecoxib 50 mg, valdecoxib 20 to 40 mg, and celecoxib 400 mg.
  
  
  METHODS
  Cross-sectional study of coxib utilization in 2002 and 2003 and retrospective cohort analysis of new users.
  
  
  METHODS
  Patients with known age and sex enrolled in Tennessee's Medicaid program.
  
  
  METHODS
  The prevalence of coxib use by dose and duration, and the proportion of persons initially prescribed a high-dose coxib and indications for such use.
  
  
  RESULTS
  The estimated daily prevalence of nonaspirin prescription nonsteroidal anti-inflammatory drugs (NSAIDs) was 8.7% in 2002 to 2003 (45.7% coxibs). NSAID use peaked at age 65 to 74 with a prevalence of 19.8% (56.3% coxibs). Doses above the recommended daily dose for osteoarthritis accounted for 33.2% (95% confidence intervals [CIs] 32.4%, 33.9%) of celecoxib use, 14.9% (95% CI 14.4%, 15.5%) of rofecoxib use, and 52.2% (95% CI 50.6%, 53.8%) of valdecoxib use. Most of these prescriptions were for a month's supply. For new coxib users, 13.5% were given a month's supply for the highest dose category, and 28% refilled their prescriptions within 7 days of the end of the original prescription. Of these new chronic high-dose users, 17.2% had ischemic heart disease and 7.1% had heart failure.
  
  
  CONCLUSIONS
  A substantial portion of coxib prescriptions were for a month's supply at doses above those recommended for most chronic indications. New users were also prescribed high doses despite evidence for cardiovascular comorbidity. These prescribing patterns at doses outside licensed indications are both inappropriate and potentially dangerous.
authors.affiliation: Veterans Administration, Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, Tenn 37212, USA. christianne.roumie@vanderbilt.edu
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Edward F
authors.initials: EF
authors.lastname: Mitchel
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002908:Chronic Disease; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D010003:Osteoarthritis / Q000188:drug therapy; D015203:Reproducibility of Results; D013714:Tennessee; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors