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J R Soc Med. 2005 February; 98(2): 86.
PMCID: PMC1079403

Coxibs and caution

Dr Yoong (December 2004 JRSM1) suggests that, in view of the adverse cardiovascular effects of rofecoxib and the possibility of a class effect of related drugs, there is a case for considering older agents such as diclofenac (together with a proton pump inhibitor). I have taken rofecoxib since it became available in 1999. Very soon I was aware that the benefit from rofecoxib is not proportionate to the dosage, albeit that could be the case in the prevention of colonic polyps. From the outset I was aware of a theoretical cardiovascular risk, which I discounted since I have ingested fish oils daily for many years. I also knew of the possibility of sodium retention causing a rise of blood pressure (for which the mechanism has recently been clarified2) and found myself taking hypotensive agents and trying to adhere to a low sodium diet.

I am devastated by the withdrawal of rofecoxib, which is clearly safe for me, because for other good reasons I have not yet found an adequate substitute. I am thus not now as active as I should be. I have to say also that for years I have been worried by the way many rheumatologists have prescribed coxibs and organized clinical trials of coxibs without monitoring recipients’ blood pressure and fluid status.

References

1. Yoong JKC. Coxibs and serious adverse cardiovascular events: a class-effect? J R Soc Med 2004;97: 609 [PMC free article] [PubMed]
2. Zewde T, Mattson DL. Inhibition of cyclooxygenase 2 in the rat renal medulla leads to sodium-sensitive hypertension. Hypertension 2004;44: 424–8 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press