April 1, 2008 (Chicago) -- Now there's scientific proof to back what many
doctors advise: If you take the popular painkiller Celebrex, use the lowest dose
possible to get relief, especially if you have risk factors for heart disease.
A pooled analysis of data from six studies shows that people who take 400
milligrams of Celebrex twice a day have three times the risk of having heart
attacks, other heart problems, strokes, or cardiovascular disease death,
compared with people who don't take the drug.
People who take 200 milligrams twice a day have nearly double the risk, and
those who take 400 milligrams once a day have a 10% higher risk of a
The researchers did not report on the once-daily 200-milligram dose of
Celebrex that is taken by most people with osteoarthritis because the
studies in the analysis did not include that dose.
At every dose, the more risk factors a person had for cardiovascular
disease, the greater the risk of Celebrex-related adverse events.
Celebrex a Last Resort for Heart Patients
"If you're at very low risk of cardiovascular disease, these data should
provide some comfort about taking [Celebrex]," says Scott D. Solomon, MD,
director of noninvasive cardiology at Brigham and Women's Hospital in
On the flip side, "patients at high risk for cardiovascular disease
should have a discussion with their doctor," he says.
Solomon tells WebMD that the analysis supports American Heart Association
(AHA) guidelines stating that people with heart risks should take the pain drug
Celebrex as a last resort and for the shortest possible time because of heart attack and stroke risk.
The guidelines, and Solomon, also say that caution could be warranted for
the long-term use of other nonsteroidal anti-inflammatory drugs (NSAIDs) --
with the exception of heart-protective aspirin.
Celebrex is a Cox-2 inhibitor, a type of NSAID. It's the only Cox-2
inhibitor on the market and already carries a "black box" warning that
notes heart attack and stroke risk.
The study, funded by the National Cancer Institute, involved the analysis of
six studies pitting Celebrex against placebo in nearly 8,000 patients being
treated for conditions other than arthritis.