December 2006, Volume 36 Number 12 , p 24 - 24
Flasar, Cathy RN, BC, FNP, MSN; Wentz, Joan D. RN, MSN
Many of my older patients have osteoarthritis. Can they safely use selective or nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) to treat their chronic pain? - —A.D., MD.
Cathy Flasar, RN, BC, FNP, MSN and Joan D. Wentz, RN, MSN, reply: Your concern is understandable. Two selective NSAIDs, the cyclooxygenase-2 (COX-2) inhibitors rofecoxib (Vioxx) and valdecoxib (Bextra), were withdrawn from the market because of cardiovascular risks. Celecoxib (Celebrex) is the only COX-2 inhibitor available in the United States. Nonselective NSAIDs such as ibuprofen are available over the counter (OTC); others like diclofenac are available by prescription.
Like the other COX-2 inhibitors, celecoxib has been found to raise cardiovascular risks, but the risk is dose-related. (The higher the dose, the greater the risk.) Ibuprofen and diclofenac appear to carry the lowest cardiovascular risk of all the NSAIDs except aspirin.