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CAMHS won't see you now

Lobbying over the safety of MMR vaccine?

When I read about the withdrawal of Vioxx (rofecoxib) due to the increased risk of heart attack and sudden death I knew it would have a direct impact on my surgery that day. Sure enough, the first two patients we saw were taking Vioxx, understandably worried and looking for an alternative treatment.

Due to recent press coverage, there is much confusion among patients about the best treatment for them, and GPs are equally perplexed. Should patients be given an alternative cox-2 or an older non-steroidal anti-inflammatory drug?

As we all know, all medicines have side-effects. It is important to

remember that other cox-2s have not demonstrated the same side-effects as Vioxx in clinical trials and that cox-2s are less problematic when it comes to gastrointestinal side-effects.

Understandably, some patients may not wish to be prescribed ­ and GPs may not wish to prescribe ­ another cox-2, for fear of the same problem seen with Vioxx occurring six months down the line with their new treatment. Furthermore, none of the cox-2s have study data past 18 months of treatment. The distress this would cause to patients is not worth considering, let alone the impact a

'class effect' would have on a GP's appointment schedule.

Patients not wishing to be prescribed another cox-2 should be reassured: equally effective treatment is available in the form of an NSAID. But despite their clear therapeutic benefit and history, NSAIDs can cause side-effects, most notably GI side-effects.

It is important these side-effects are explained to patients, as well as the fact that they can be protected from them, if, following clinical guidance, they are

co-prescribed a proton pump inhibitor.

Dr Alun Cooper

Member of the Primary Care Society of Gastroenterology,

GP prescribing adviser

Crawley PCT, West Sussex

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