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Harris ClearfieldMDa professor at Drexel University College of Medicine in Philadelphiatells WebMD the findingsdo make me somewhat more confident in prescribingCelebrexto ulcerative colitis patients who are in remissionHe says that it willhoweverbe necessary to monitor patients for potential side-effects of long-term use.

The Coxib and traditional NSAID TrialistsCollaboration meta-analysis of randomized controlled trials demonstrated an approximately twofold increase in hospitalizations for heart failure in COX-2 selective-treated patients and nonselective NSAID-treated patients compared to placebo-treated patientsIn a Danish National Registry study of patients with heart failureNSAID use increased the risk of MIhospitalization for heart failureand death.

In patients with JRA who are known or suspected to be poor CYP2C9 metabolizersconsider using alternative treatmentssee Use in Specific populationsand CLINICAL PHARMACOLOGY

Use the lowest effective dosage for the shortest possible durationAvoid administration of more than one NSAID at a timeAvoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleedingFor such patientsas well as those with active GI bleedingconsider alternate therapies other than NSAIDsRemain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapyIf a serious GI adverse event is suspectedpromptly initiate evaluation and treatmentand discontinue CELEBREX until a serious GI adverse event is ruled outIn the setting of concomitant use of low-dose aspirin for cardiac prophylaxismonitor patients more closely for evidence of GI bleedingsee DRUG INTERACTIONS

Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascularCVthrombotic eventsincluding myocardial infarctionMIand strokewhich can be fatalBased on available datait is unclear that the risk for CV thrombotic events is similar for all NSAIDsThe relative increase in serious CV thrombotic events over baseline conferred by NSAID use appears to be similar in those with and without known CV disease or risk factors for CV diseaseHoweverpatients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic eventsdue to their increased baseline rateSome observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatmentThe increase in CV thrombotic risk has been observed most consistently at higher doses.

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