Rheumatology

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COX-2s: Renal, Cardiac Effects Produce Consternation

KEY POINT

Regardless of how selective the new COX-2 inhibitors may be in the GI tract, they should be used with caution—or not at all—in patients with chronic renal failure, severe cardiac disease, and hepatic failure. This need for caution is especially critical given the many unresolved issues about prostaglandin E2 and the arachidonic acid cascade. The bottom line is that the roles of COX-1 and COX-2 in maintaining organ function are much more complex than originally hoped and believed.

SOURCES

Lipsky PE et al. Unresolved issues in the role of cyclooxygenase-2 in normal physiologic processes and disease. Arch Intern Med. 2000;160:913–20. 

Perazella MA, Eras J. Are selective COX-2 inhibitors nephrotoxic? Am J Kidney Dis. 2000;35:937–40.

Dunn MJ. Are COX-2 selective inhibitors nephrotoxic [editorial]? Am J Kidney Dis. 2000;35: 976–7.

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