title: [Clinical use of COX inhibitors--a consensus].
abstract: 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.
authors.affiliation: Institutt for farmakoterapi, Universitetet i Oslo, Postboks 1065 Blindern, 0316 Oslo. asmund.reikvam@medisin.uio.no
authors.forename: Asmund
authors.initials: A
authors.lastname: Reikvam
authors.forename: Sofie
authors.initials: S
authors.lastname: Hexeberg
authors.forename: Tore Kristian
authors.initials: TK
authors.lastname: Kvien
authors.forename: Lars
authors.initials: L
authors.lastname: Slørdal
authors.forename: Lars
authors.initials: L
authors.lastname: Aabakken
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.forename: Berit
authors.initials: B
authors.lastname: Flatø
authors.forename: Njål
authors.initials: N
authors.lastname: Idsø
authors.forename: Villy
authors.initials: V
authors.lastname: Johnsen
authors.forename: Synnøve
authors.initials: S
authors.lastname: Kalstad
authors.forename: Steinar
authors.initials: S
authors.lastname: Madsen
authors.forename: Knut
authors.initials: K
authors.lastname: Mikkelsen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Johan
authors.initials: J
authors.lastname: REder
mesh_terms: 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
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors