Position statements

Guidelines for the use of Coxibs

Some recent placebo controlled trials have shown an increase in thrombotic cardiovascular events with the use of COX-2 selective NSAIDs, particularly when used in higher doses.

SARAA recommends the following safety restrictions for COX-2 inhibitor use, as announced by the EMEA (European Medicines Agency) 17 February 2005.

COX-2 inhibitors are contra-indicated in patients with ischaemic heart disease, stroke or peripheral arterial disease.

Caution is advised when prescribing COX-2 inhibitors for patients with risk factors for heart disease, such as hypertension, hyperlipidaemia, diabetes, family history of IHD and smoking.

Doctors are advised to use the lowest dose for the shortest possible duration of treatment in patients with cardiovascular risk factors.

COX-2 inhibitors are recommended for use in: 1. The elderly (>60 years) 2. Patients with previous gastropathy 3. Patients on Warfarin and/or corticosteroids. Providing they do not have contra-indications as outlined above.