Alerts/Letters
Fax Sent to Doctors and Pharmacists
22 February 2005
Important information for doctors and pharmacists:
Medsafe advises review of all patients on COX-2 inhibitors
- The increased risk of cardiovascular events outweighs the benefits of COX-2 inhibitors for the general population.
- Prescribers should immediately review the use of COX-2 inhibitors in patients at high absolute risk of cardiovascular events; COX-2 inhibitors should be discontinued in these patients.
- For all other patients, cessation of COX-2 inhibitor use should be discussed at the next scheduled doctor's appointment and alternative treatment options considered.
Medsafe's review concluded that there is a plausible biological mechanism to explain an increased risk of cardiovascular thromboembolic events associated with selective COX-2 inhibition. The level of risk may be partly dependent on dose and degree of COX-2 specificity. There is evidence of increased cardiovascular risk with long and short-term COX-2 inhibitor use in patients with or without cardiovascular risk factors.
However, there is currently insufficient evidence to quantify either the risks associated with the dose and duration of use for each COX-2 inhibitor, or the predisposing factors that may increase cardiovascular risk. Consequently, at this point in time, it is not possible to identify a group of patients in whom cardiovascular risk-free use of a COX-2 inhibitor can be assured.
Charts for calculating a patient's risk of cardiovascular disease are provided in the MIMS New Ethicals catalogue and on the New Zealand Guidelines Group web site (www.nzgg.org.nz).
Guidance on alternative analgesic options and management of patients at high risk of gastrointestinal harm has recently been issued by BPAC (NSAIDs - strategies for minimising harm) and is available on their web site: www.bpac.org.nz
Medsafe will further update prescribers about the status of the COX-2 inhibitors following a meeting of the Medicines Adverse Reactions Committee on 15 March 2005. In the meantime, there is additional information on the Medsafe web site:
- Minutes of Medsafe meeting with MARC Chair: www.medsafe.govt.nz/Profs/adverse.htm ยท
- Medsafe media statement including Q&A (to be released at 1pm today): www.medsafe.govt.nz/hot/MediaContents.htm
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Wellington. Phone (04) 496 2000 Fax (04) 496 2229