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Celebrex: Use Less to Lessen Heart Risk?

Analysis May Help Guide Use of Popular Painkiller in Heart Patients
WebMD Health News
Reviewed by Louise Chang, MD

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 cardiovascular event.

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 Boston.

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.

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