Drug risks: Doctors have been advised to stop prescribing a group of controversial arthritis drugs, known as Cox 2 inhibitors, by an influential doctors and pharmacists' publication.
The advice coincides with the latest warning to doctors here from the pharmaceutical company, Pfizer, about the dangers of one of its Cox 2 drugs.
Pfizer said its drug Bextra (Valdecoxib) was contraindicated for the treatment of post-operative pain following coronary bypass surgery after two separate research trials found the drug carried a higher rate of heart attack and strokes in patients recovering from heart surgery.
The pharmaceutical company also revised its product information for Bextra to warn of the risk of serious and sometimes fatal skin reactions in people taking the drug. It said the reported rate of skin reactions, which included potentially fatal reactions such as Stevens-Johnson Syndrome and toxic epidermal necrolysis, "appears to be greater for valdecoxib as compared to other Cox 2 selective inhibitors".
Meanwhile the Drugs and Therapeutics Bulletin, an independent monthly review of medical treatment published by the Consumer Association in Britain, said: "We can see few, if any, situations in which Cox 2 is unequivocally indicated... We see potential hazard in prescribing a Cox 2 to a patient who is at risk from cardiovascular disease."
Its latest edition also advises doctors to prescribe all anti-inflammatory drugs, including Cox 2 inhibitors, "at the lowest effective dose and in accordance with the precautions set out in the summary of product characteristics current at the time. The patient should be carefully monitored and reviewed regularly to avoid unnecessary repeat prescriptions."
Concerns about Cox 2 inhibitors, the latest version of an established group of drugs called non- steroidal anti-inflammatory drugs (NSAIDS), were made public last September when Merck Sharp and Dohme withdrew their then market leader, Vioxx, after it was linked to an increased risk of heart attack and stroke.
In December, Pfizer announced that one of its Cox 2 inhibitors, Celebrex (celecoxib), was associated with a doubling of risk of cardiovascular side effects on patients who took the drug in higher dosage. Despite this, the company has decided to keep both Celebrex and Bextra on the market in Europe and the US. The European Medicine Control Agency, at which the Irish Medicines Board (it licenses drug use in the Republic) is represented, is due to issue a report on the use of Cox 2 inhibitors later this month.
More than one million patients with osteoarthritis and rheumatoid arthritis are prescribed Cox 2 drugs in Britain. The drugs are also used in treating sports injuries and painful periods.