Selective COX-2 inhibitors

Specific COX-2 inhibitors

Specific COX-2 inhibitory drugs inhibit the inflammatory-induced prostaglandin synthesis, without hindering the constitutive prostaglandin synthesis. (see also the prostaglandin synthesis in the PAIN section for more information).
Etoricoxib and celecoxib belong to the group of specific COX-2 inhibitors.
In theory, these drugs should thus have fewer side effects than non-specific COX inhibitors. However, these drugs recently have been shown to increase the risk of cardiovascular adverse effects. Some COX-2 inhibitors appear to increase the risk of cardiovascular adverse events in a dose-related fashion and have been withdrawn.

Calculating the patient's baseline risk of cardiovascular disease may be wise, and COX-2 inhibitors should not be prescribed to patients with cardiovascular disease or diabetes or those at increased risk of cardiovascular events unless necessary. COX-2 inhibitors should then be used in the lowest effective doses for short periods (weeks) only. A risk–benefit discussion is necessary for those requiring the drug for a longer period.
Meloxicam is not a specific COX-2 inhibitor, because it has at low doses also some COX-1 inhibitory effect. Therefore this drug is preferred as "COX-2 inhibitor".
Check the following publications on cardiovascular risks of COX-2 inhibitors:
Review of the cardiovascular safety of COXIBs compared to NSAIDS (2008)
The COX-2 inhibitors: a reasoned review of the data (2005)


If pain control in older patients with a history of gastrointestinal bleedings with paracetamol is insufficient, COX-2 inhibitors can be prescribed.