The two
cyclooxygenase isoforms (COX-1 and COX-2--coxibs) have overlapping functions and both are involved in the regulation of homeostatic and inflammatory processes in the various tissues. Treatment with highly selective
COX-2 inhibitors is associated with significantly fewer serious adverse gastrointestinal events than is treatment with the dual inhibitors--the non-selective
NSAIDs. Of the two
coxibs,
rofecoxib was shown to be much more selective than
celecoxib and with less interaction with other drugs. Various clinical studies have demonstrated that the
coxibs are equivalent, in anti-inflammatory,
analgesic and
antipyretic efficacy to comparator non-selective
NSAIDs in
osteoarthritis,
rheumatoid arthritis, post surgery
pain and
dysmenorrhea. Perioperative use of
coxibs reduces
pain,
opioid consumption and the risk of
bleeding caused by the non-selective
NSAIDs. The
coxibs show similar tolerability for renal, liver and cardiothrombotic events as compared to the non-selective
NSAIDs.
Coxibs are contraindicated in pregnancy, in nursing mothers and pediatric patients and should be used with caution in patients with
asthma. The impact of the
coxibs on the cardiovascular system is controversial. However,
coxibs should be used in caution and at the lowest recommended dose in patients with
hypertension,
ischemic heart disease and
heart failure. These drugs do not interfere with the
aspirin anti-platelet aggregation activity. Emerging evidence suggest that the
coxibs may also find potential use as supportive
therapy in various malignant
tumors and
intestinal polyps where COX-2 is overly expressed.