Practical approaches to minimizing gastrointestinal and cardiovascular safety concerns with COX-2 inhibitors and NSAIDs

Table 2 The clinicians' guide to NSAID therapy in the post-rofecoxib/valdecoxib age

Risk	No/low NSAID gastrointestinal risk	NSAID gastrointestinal risk
No cardiovascular risk (no aspirin)	Traditional NSAID	Traditional NSAID + PPI
		or
		Coxib + PPI¹ (if necessary)
		Consider non-NSAID therapy
Cardiovascular risk (consider aspirin)	Traditional NSAID² plus PPI if gastrointestinal risk warrants gastroprotection	A gastroprotective agent must be added if a traditional NSAID² is prescribed
	Consider non-NSAID therapy	Consider non-NSAID therapy

¹The US Food and Drug Administration has determined that over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs; including cyclo-oxygenase [COX]-2 selective agents), when used as monotherapy, may be linked to potentially life-threatening gastrointestinal bleeding [20]. ²Ibuprofen should be used cautiously in individuals taking aspirin. PPI, proton pump inhibitor. Reproduced with permission from [25]. Copyright ^© 2004 Am Med Pubg Assn.

ISSN: 1478-6362