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Painkiller Cox-2 inhibitor alternatives considered

Alternatives should now be considered for painkiller Cox-2 inhibitors

ACC says health practitioners should now consider prescribing alternatives for painkillers known as Cox-2 inhibitors in the wake of a review which concludes their benefits may be outweighed by increased risk of heart attacks and strokes.

“ACC is committed to helping provide claimants with safe medications for their treatment, but a Medsafe review released today indicates the risk of Cox-2 inhibitors to the general population is too high,” says ACC Corporate Medical Advisor Dr Kevin Morris.

He says the review has raised issues not only about Vioxx, which was withdrawn from the international market last year, but also about other Cox-2 inhibitors that remained in use such as Celebrex, Arcoxia, Mobic, Dynastrat and Bextra.

Dr Morris says Cox-2 inhibitors (also known as Cyclo-Oxygenase-2 inhibitors) were commonly prescribed to some ACC claimants for the treatment of pain and inflammation due to musculoskeletal disorders. He says they had been generally considered safer than other anti-inflammatory medications because they did not cause the same level of gastrointestinal side effects such as bleeding.

ACC is aware that Medsafe has noted today that there is currently insufficient evidence to quantify either the risks associated with the dose and duration of use for each Cox-2 inhibitor, or the factors which may increase risk of heart attacks and strokes.

However Medsafe has also noted that there is a real risk to the health of claimants with a previous history of heart attacks or strokes, or who have a strong family history of heart disease or a history of diabetes, hypertension, smoking or who are being treated for high cholesterol.

“We owe it to our claimants to minimise the possibility of adverse medical events,” Dr Morris says. “In Medsafe’s opinion, the possible increased risk of heart attack and stroke outweigh the benefits of Cox-2 inhibitors for the general population. ACC claimants taking Cox-2 inhibitors on a regular basis should now discuss the continuing use of these medications with their GP or specialist”.

The Best Practice Advocacy Centre has recently issued guidance on alternative analgesic options and management (NSAIDS – strategies for minimising harm) which is available online at http://www.bpac.org.nz

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