Vioxx has been pulled off the market by Merck. Users are at increased risk of heart attack and stroke. The results were found 18 months after patients started using Vioxx. Patients who are currently taking Vioxx should contact their health care providers to discuss discontinuing use of Vioxx and possible alternative treatments. 9/30/04



Can cause adverse effects during pregnancy related to the inhibition of prostaglandin synthesis. Prolongation of gestation and labour, constriction of the ductus arteriosus, persistent fetal circulation, impairment of renal function and bleeding are risks of third trimester exposure of pregnant women to all inhibitors of cyclo-oxygenase. Most of these adverse effects can be prevented by discontinuing NSAIDs 8 weeks prior to delivery.
– Drug Saf 1998 Nov;19(5):389-410 — Treatment of inflammatory rheumatic disorders in pregnancy: what are the safest treatment options? — Ostensen M, Ramsey-Goldman R.



NSAIDs should not be taken by patients taking high-dose methotrexate, anticoagulants or alcohol. They should be avoided in elderly or renally impaired patients taking digoxin, and avoided over the long term in those taking other NSAIDs. It is possible that NSAIDs should not be given to patients taking lithium, but future studies should be conducted to confirm this. Use of NSAIDs likely is appropriate in the short term with patients taking antihypertensives, unless they have severe congestive heart disease. Aspirin should not be given to patients taking oral hypoglycemics, valproic acid or carbonic anhydrase inhibitors. Acetaminophen may be given in the short term to any patient with a healthy liver, but it should not be given to a patient who has stopped drinking alcohol after chronic intake. Opioids should not be combined with alcohol, and meperidine must be avoided in the patient who has taken monoamine oxidase inhibitors in the previous 14 days.
– J Am Dent Assoc 1999 Mar;130(3):397-407 — Adverse drug interactions in dental practice: interactions associated with analgesics, Part III in a series. — Haas DA.



Use caution with herbs that have an effect on the blood or are recommended for pain relief.



The combined use of warfarin and NSAIDs is generally discouraged because of the increased risk of bleeding in these patients. In patients receiving warfarin who also require NSAIDs, phenylbutazone and its analogs, high-dose aspirin, mefenamic acid, excessive use of topical methyl salicylate, and NSAIDs that are associated with a higher risk of bleeding peptic ulcers should be avoided. Patients should be closely monitored for anticoagulant control and bleeding complications during the combined use of warfarin and NSAIDs.
– Ann Pharmacother 1995 Dec;29(12):1274-83 — Adverse interactions between warfarin and nonsteroidal antiinflammatory drugs: mechanisms, clinical significance, and avoidance. — Chan TY.



You should not take NSAIDs if you have experienced asthma, hives, or allergic-type reactions after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). A few examples of other NSAIDs are ibuprofen, naproxen, diclofenac, nabumetone, and ketoprofen. Serious problems from stomach ulcers, such as bleeding, are well-known complications in people treated with NSAIDs. The likelihood of stomach problems increases the longer you take them.



Physicians should be aware of possible complications and only prescribe NSAIDs, including the new COX-2 drugs, to the elderly under close monitoring of kidney function and electrolyte tests.
– J Emerg Med 2002 May;22(4):349-52 — Fatal hyperkalemia related to combined therapy with a COX-2 inhibitor, ACE inhibitor and potassium rich diet. — Hay E, Derazon H, Bukish N, Katz L, Kruglyakov I, Armoni M.



All nonsteroidal anti-inflammatory drugs, including coxibs, can worsen arterial hypertension and heart failure. Combining a standard NSAID with a vitamin K antagonist increases the risk of bleeding. The same applies to coxibs. Available data point to a higher risk of severe cardiovascular events with rofecoxib than with naproxen. Rofecoxib should not be used in patients with coronary disease.
– Prescrire Int 2002 Dec;11(62):181-2 — Cardiovascular adverse effects of coxibs.