oa SA Pharmaceutical Journal - The use of cyclo-oxygenase 2 inhibitors in South Africa : evidence-based pharmacy practice
Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase 2 (COX-2) inhibitors are effective anti-inflammatory and analgesic agents that are used to treat a wide range of acute and chronic medical conditions. The focus of this article is specifically on COX-2 inhibitors, namely celecoxib, etoricoxib, lumiracoxib, parecoxib, rofecoxib and valdecoxib. Meloxicam is more COX-2 selective than traditional NSAIDs, but is not regarded as a pure COX-2 selective inhibitor generally. The COX-2 inhibitors have been surrounded by controversy since their introduction to the world market. The findings of well-known clinical trials have resulted in the subsequent withdrawal of some of these products from South African and other worldwide markets. Currently, there are three specific COX-2 inhibitors or coxibs that are available in South Africa, namely celecoxib, etoricoxib and parecoxib. Coxibs are effective analgesics, and compared with other NSAIDs, carry the lowest risk of ulcer formation and gastrointestinal upset. However, some studies suggest that they can be prothrombotic, increasing the risk of myocardial infarction, stroke and claudication. Although they have potentially serious side-effects, there is a place for COX-2 inhibitors. The benefits and risks should be carefully weighed up for each patient.
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