[Clinical use of COX inhibitors--a consensus].
BACKGROUND
Many physicians have been uncertain about treatment options following reports that linked cyclooxygenase (COX) inhibitors to serious cardiovascular events and the subsequent withdrawal of two selective COX-2 inhibitors. Therefore, on June 14, 2005, the Norwegian Medicines Agency and the Department of Pharmacotherapeutics, University of Oslo, held an expert meeting on COX inhibitors.


METHODS
Presentations and discussions based on existing literature and statements from European (EMEA) and American (FDA) medicine authorities. This constitutes the basis for the current recommendations.


CONCLUSIONS
COX inhibitors have solely symptomatic effects, and there are no differences in analgesic and anti-inflammatory efficacy between the various COX-inhibitors. These drugs should, if possible, be used at the lowest effective dose and for as short a time as possible. Some of the COX-2 selective inhibitors show a lower incidence of gastrointestinal side effects than unselective COX inhibitors, but this advantage can be outweighed by increased occurrence of cardiovascular side effects. Generally, the cardiovascular adverse effects are more serious, and more often irreversible, than the gastrointestinal adverse effects. Patients with established or increased risk of cardiovascular disease should not use COX-2-selective inhibitors. In general, COX inhibitors should, if possible, not be administered to individuals with previous peptic ulcer disease, hypertension, heart failure, or kidney disease. There is a need for more data on the effect and safety of COX inhibitors.
Reikvam
Asmund
A
Institutt for farmakoterapi, Universitetet i Oslo, Postboks 1065 Blindern, 0316 Oslo. asmund.reikvam@medisin.uio.no
Hexeberg
Sofie
S
Kvien
Tore Kristian
TK
Slørdal
Lars
L
Aabakken
Lars
L
Engebretsen
Lars
L
Flatø
Berit
B
Idsø
Njål
N
Johnsen
Villy
V
Kalstad
Synnøve
S
Madsen
Steinar
S
Mikkelsen
Knut
K
Os
Ingrid
I
REder
Johan
J
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced; D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D032921:Consensus; D000075202:Contraindications; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D009140:Musculoskeletal Diseases / Q000188:drug therapy; D009664:Norway; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors