Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Celecoxib may increase MI risk

A systematic review published in the Journal of the Royal Society of Medicine has concluded that celecoxib (Celebrex)® increases the risk of myocardial infarction.

These findings are duplicated in another paper investigating the efficacy and upper GI tolerability of celecoxib versus diclofenac or naproxen.

The findings in both papers are not statistically significant and the latter study was not designed to detect these differences. Despite this the MHRA have issued a statement reminding clinicians of the current recommendations issued in 2005.

The recommendations are as follows:

  • Selective COX-2 inhibitors must not be used in patients with heart disease and/or stroke, patients with moderate-severe heart failure or in patients with peripheral arterial disease
  • Prescribers should exercise caution when prescribing COX-2 inhibitors to patients with risk factors for heart disease.
  • The lowest effective dose of selective COX-2 inhibitor should be used for the shortest necessary period. Periodic re-evaluation is recommended, especially for osteoarthritis patients who may only require intermittent treatment.

Action: Clinicians should be follow of the MHRA recommendations in relation to COX-2 inhibitor and NSAID prescribing.

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