Nonsteroidal anti-inflammatory drugs: cyclooxygenase 2 inhibitors.
OBJECTIVE
To analyze selective COX 2 inhibitor nonsteroidal anti-inflammatory drugs (NSAID) in terms of their mechanism of action, principal indications, posology and most common adverse effects.


METHODS
MEDLINE and LILACS databases and Food and Drug Administration (FDA) and National Agency for Sanitary Vigilance (ANVISA - Agência Nacional de Vigilância Sanitária) websites. The most important articles were selected and preference was given to articles published within the last 5 years.


RESULTS
The principal indications for NSAID are for control of pain and acute and chronic inflammation. There is no overwhelming evidence that demonstrates the superiority of one NSAID over another in terms of effectiveness. To date none of the COX 2 inhibitors has been liberated for use in the pediatric age group. Only meloxicam and etoricoxib can be prescribed for adolescents (13 and 16 years, respectively). Selective COX 2 inhibitors are indicated for patients with adverse effects that have proven to be associated with nonselective NSAID use. Selective COX 2 inhibitors can be prescribed in some cases of allergy to aspirin, but they must be used with care. Principal adverse effects include cardiovascular events and thrombotic phenomena.


CONCLUSIONS
Selective COX 2 inhibitors are medicines that have been used in certain well-defined clinical situations and which may offer certain advantages over nonselective NSAID. Nevertheless, taking into consideration the higher cost involved and the potential for adverse cardiovascular effects, they should be employed only in accordance with strict criteria.
Hilário
Maria Odete Esteves
MO
Departamento de Pediatria, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil. odetehilario@terra.com.br
Terreri
Maria Teresa
MT
Len
Cláudio Arnaldo
CA
D000293:Adolescent; D001241:Aspirin / Q000494:pharmacology; D000068579:Celecoxib; D002648:Child; D051546:Cyclooxygenase 2 / Q000378:metabolism; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology*; D004347:Drug Interactions; D000077613:Etoricoxib; D005334:Fever / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000188:drug therapy; D007249:Inflammation / Q000188:drug therapy / Q000503:physiopathology; D015289:Leukotrienes / Q000096:biosynthesis / Q000494:pharmacology; D000077239:Meloxicam; D009288:Naproxen / Q000494:pharmacology; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D011453:Prostaglandins / Q000096:biosynthesis / Q000494:pharmacology; D011720:Pyrazoles / Q000494:pharmacology; D011725:Pyridines / Q000494:pharmacology; D013449:Sulfonamides / Q000494:pharmacology; D013450:Sulfones / Q000494:pharmacology; D013843:Thiazines / Q000494:pharmacology; D013844:Thiazoles / Q000494:pharmacology; D016896:Treatment Outcome
D052246:Cyclooxygenase 2 Inhibitors; D015289:Leukotrienes; D011453:Prostaglandins; D011720:Pyrazoles; D011725:Pyridines; D013449:Sulfonamides; D013450:Sulfones; D013843:Thiazines; D013844:Thiazoles; D009288:Naproxen; D051546:Cyclooxygenase 2; D000068579:Celecoxib; D001241:Aspirin; D000077239:Meloxicam; D000077613:Etoricoxib