coxibs

Coxibs are a subset of nonsteroidal anti-inflammatory drugs (NSAIDs) that selectively inhibit the enzyme cyclooxygenase-2 (COX-2). By targeting COX-2, they aim to reduce inflammation and pain while avoiding some of the gastrointestinal side effects associated with non-selective NSAIDs that inhibit both COX-1 and COX-2.

Mechanism and scope: COX-2 is an inducible enzyme upregulated in inflamed tissues. Inhibiting COX-2 decreases prostaglandin synthesis at sites of inflammation, helping relieve pain and swelling. Because COX-1 supports gastric mucosa protection and platelet function, COX-2 selectivity reduces ulcer risk but does not eliminate it. Coxibs can still affect renal function and fluid balance, and their safety profile depends on dosage and duration of use.

Examples and regulatory status: Celecoxib is the best known member of this class and remains available in many regions. Other selective COX-2 inhibitors, such as rofecoxib and valdecoxib, were withdrawn from the market in the early 2000s due to cardiovascular and other safety concerns. Etoricoxib and some other agents have continued to be approved in certain jurisdictions, while others have limited or no market availability.

Uses: Coxibs are used to treat pain and inflammation associated with conditions such as osteoarthritis and rheumatoid arthritis, particularly when there is concern about gastrointestinal ulcers from traditional NSAIDs. They are also used for acute pain conditions in some cases. They should be prescribed at the lowest effective dose for the shortest duration, especially in patients with cardiovascular risk factors.

Safety considerations: Long-term use of certain coxibs is associated with increased risk of cardiovascular events in some populations. They may be contraindicated in patients with recent heart attack or stroke and may interact with anticoagulants, diuretics, and antihypertensive medications. Renal impairment and edema are possible adverse effects, requiring monitoring.