COX-2 inhibitors

Cyclooxygenase-2 (COX-2) inhibitors constitute a new group of non-steroidal anti-inflammatory drugs (NSAIDs) which, at recommended doses, block prosta glandin production by cyclooxygenase-2, but not by cyclooxygenase-1. Two COX-2 inhibitors are currently available in Australia - celecoxib, whic h is taken twice daily, and rofecoxib, which is taken once daily. Both drug s act rapidly in providing pain relief and their antiinflammatory analgesic effect in osteoarthritis and rheumatoid arthritis is equivalent to standar d doses of non-selective NSAIDs. Celecoxib and rofecoxib show significantly lower incidences of gastrotoxici ty (as measured by endoscopic studies and gastrointestinal ulcers and bleed s) than non-selective NSAIDs. There is Level 2 evidence that COX-2 inhibitors: reduce pain in classic pain models - third-molar extraction, dysmenorrhoea and after orthopaedic surgery; reduce pain and disability in osteoarthritis of the hip and knee; and reduce pain and disability in rheumatoid arthritis. Other adverse effects, such as interference with antihypertensive agents an d the potential to produce renal dysfunction in patients with compromised r enal function by COX-2 inhibitors, seem similar to those of non-selective N SAIDs.