What are the side effects of COX-2 inhibitors and/or NSAIDs?
Common side effects of COX-2 inhibitors and NSAIDs may include:
- Abdominal pain
- Flatulence (gas)
- Peripheral edema
- Accidental injury
- Upper respiratory tract infection
- Indigestion (dyspepsia)
COX-2 inhibitors may increase the risk of serious, even fatal stomach and intestinal adverse reactions, such as ulcers, bleeding, and perforation of the stomach or intestines but to a lesser extent than other nonselective NSAIDs that block both COX-1 and COX-2. These events can occur at any time during treatment and without warning symptoms.
People allergic to sulfonamides, for example, trimethoprim (Trimpex, Proloprim, Primsol) and sulfamethoxazole (Bactrim), aspirin or other NSAIDs may experience allergic reactions to COX-2 inhibitors and should not take them. Serious allergic reactions have occurred in such patients.
NSAIDs, including COX-2 inhibitors, may increase the risk of heart attacks, stroke, and related conditions. This risk may increase in patients with risk factors for heart disease and related conditions and with longer duration of use; therefore to reduce the risk of heart attacks, stroke, and similar events the lowest effective dose and for the shortest duration of time should be used. NSAIDs should not be used after coronary artery bypass graft (CABG) surgery.
NSAIDs, including COX-2 inhibitors, may cause fluid retention. They should be used cautiously in patients with fluid retention or heart failure.
What drugs interact with COX-2 and/or NSAIDs?
- Combining COX-2 inhibitors with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin.
- COX-2 inhibitors increase the concentration of lithium (Eskalith, Lithobid) in the blood and may promote lithium toxicity.
- Persons taking the anticoagulant (blood thinner) warfarin (Coumadin, Jantoven) should have their blood tested when initiating or changing COX-2 treatment, particularly in the first few days, for any changes in the effects of the anticoagulant.
- COX-2 inhibitors, like other NSAIDs, may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure, including ACE inhibitors and angiotensin II antagonists.
- Persons who drink more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.
Reference: FDA Prescribing Information
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