Prescriber Update Articles

Acute Psychiatric Reactions with COX-2 Inhibitors

Website: June 2002
Prescriber Update 2002;23(2):21

Dr David Coulter, Director, 
Centre for Adverse Reactions Monitoring, Dunedin

Reports received to date for the COX-2 inhibitors in the Intensive Medicines Monitoring Programme (IMMP) include a number of acute psychiatric events, which resolved upon discontinuation of the COX-2 inhibitor.  These reactions occur with conventional non-steroidal anti-inflammatory agents and prescribers are now requested to be aware of similar events occurring with COX-2 inhibitors.

During the first year of monitoring (up to February 2002) of the COX-2 inhibitors in the Intensive Medicines Monitoring Programme (IMMP), 291 reports for celecoxib and 149 for rofecoxib were received.*  Thirteen of these reports (11 and 2, respectively) are of acute psychiatric events.  Some reports gave details of events that were quite dramatic.  Confusion, depression and hallucinations were each reported several times, and anxiety and 'thinking abnormal' were reported once.  Also reported was a patient who suffered an exacerbation of manic depressive psychosis.  Most of the patients were elderly and there were more reports involving women, but more women are prescribed these medicines.  The acute psychiatric events rapidly resolved upon withdrawal of the COX-2 inhibitor in each case.

A few reports^1,2  in the literature suggest that similar reactions occur with the standard non-steroidal anti-inflammatory agents (NSAIAs), but this does not appear to be well known.  Practitioners should be alert to the possibility of psychiatric-type reactions with both the COX-2 inhibitors and other NSAIAs.  Prescribers are encouraged to continue reporting any such events to the IMMP, in order to facilitate the determination of risk factors.

* At the time of this data analysis, the use of celecoxib in New Zealand was double that of rofecoxib.

Competing interests (author): Merck Research Laboratories have provided research grants for the IMMP. Merck Sharp & Dohme (NZ) Ltd are the sponsors of Vioxx™ (rofecoxib).

Correspondence to Dr David Coulter, CARM, PO Box 913, Dunedin.

References

1. Jiang H-K, Chang D-M. Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports. Clin Rheumatology 1999;18:339-345.
2. Clark DWJ, Ghose K. Neuropsychiatric reactions to non-steroidal anti-inflammatory drugs (NSAIDs): The New Zealand experience. Drug Safety 1992;7:460-465.