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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.