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Australian Journal of Pharmacy : April 2005
y education to either reduce the dose or cease the medication if they have increased risks of cardiovascular events. This recommended dose reduction may result in some patients with arthritis having increased symptoms but the review of COX-2 inhibitors clearly indicated there is an increased risk of heart attacks and strokes with high doses of these drugs.7,9 The Australian Drug Evaluation Committee (ADEC) reviewed evidence of six drugs in the COX-2 inhibitor family, all of which were considered to have risks associated with their use. It deter- mined that the exact size of the risk and the exact duration of therapy associated with increased risk are still unknown, and so have recommended that COX-2 inhibitors should be prescribed only when other treatments cannot be tolerated or have caused serious adverse effects. Concerning celecoxib, ADEC took into account the results of a study of celecoxib 800mg a day in low cardiovascular risk patients which showed an increased risk of cardiovascular event. The results of studies of 400mg a day of celecoxib in low cardiovascular risk patients are conflicting with one study at this dose level finding an increased risk. On the other hand, several recently published papers describing observational studies of patients using large linked medical record databases in North America have not reported an increased myocardial infarction risk with celecoxib.9 With meloxicam (Mobic) there are theoretical grounds for regarding the drug as having reduced cardiovascular risks. The drug has less selective COX-2 inhibition than celecoxib or rofe- coxib. Clinical study data are more meagre, with most studies limited to no more than six months’ duration. ADEC recom- mended that further research be conducted regarding safety of the two existing COX-2s and before marketing of other COX-2 inhibitors. For patients with any risk factors in renal function, NSAIDs and COX-2 inhibitors should only be prescribed after careful consid- eration. The combination of diuretics, ACEIs, and NSAIDs is fre- THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 ? 279