Introduction - The coxib controversies

Much concern has arisen in the past year concerning the occurrence of serious cardiovascular adverse reactions from rofecoxib, celecoxib and some other members of the coxib group of NSAIDs. Factors underlying the sudden appearance of these events have been proposed to include the use of high doses of the drugs, undue reliance on their safety profile from controlled clinical trails and potent marketing leading to exposure of a large population who would inevitably present risks of cardiovascular adverse events. Suggestions are presented for future uses of the coxibs and approaches for their more cautious use and marketing. The use of the term "COX-2 inhibitor" to describe the coxibs is unhelpful and should be avoided since all NSAIDs have some degree of COX-2 inhibitory effect, though they may vary in their selectivity. Coxibs should be set aside in a group of their own within the broader category of the NSAIDs in view of both their cardiovascular risk and unique pharmacology.