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NHS prescribing advisers have told GPs not to switch patients who were taking rofecoxib on to another cox-2 inhibitor as doubts grow over safety.

The National Prescribing Centre reviewed data on cox-2s and found 'clear evidence' they had no gastrointestinal benefits over conventional NSAIDs and increasing evidence of cardiovascular risks.

The centre's MeReC Extra bulletin suggested GPs should use non-NSAID therapies or conventional NSAIDs rather than alternative cox-2s (see right).

The bulletin is funded by NICE and its findings will have important implications for the NICE review of cox-2 inhibitors, due to report in May next year.

Dr Rubin Minhas, a member of the NICE cox-2 review group and a GP in Gillingham, Kent, said his practice had decided to avoid all new prescriptions of cox-2s and was reviewing all its patients on the drugs, not just those on rofecoxib.

'We have adopted the policy of avoiding cox-2s wherever possible. There is some emerging evidence suggesting cardiovascular risk is not confined to the single drug,' he said.

Dr Neal Maskrey, medical director of the National Prescribing Centre, said: 'We have clear evidence that coxibs show no significant GI advantage. GPs' first priority is to review whether an NSAID is needed at all. The second priority would be to prescribe an NSAID with low GI risk, such as ibuprofen.'

The recommendations came as a survey of 300 GPs in the UK revealed widespread confusion over how to handle the switch from rofecoxib.

The Pfizer study, presented at a conference on cox-2 inhibitors in Frankfurt earlier in the month, found 57 per cent of GPs planned to move patients to another cox-2, while the rest had either not decided or favoured alternative treatments.

Professor Tom MacDonald, professor of clinical pharmacology at the University of Dun-dee, said: 'Personally, I think the companies that manufacture cox-2 inhibitors have to prove to us that they don't cause cardiovascular disease. People are scared right now. Are the rofecoxib issues true of all cox-2s? Who knows.'

Dr Peter Elliot, a GP in east London and prescribing lead for Redbridge PCT, said: 'NSAIDs are an option but I would try to use an alternative painkiller. There has been enough alarm for a lot of people to be wary.'

Taking patients off

rofecoxib

·Consider whether non-drug interventions, paracetamol or topical rubefaciants are appropriate instead of NSAID

·If NSAID is necessary, prescribe one with low risk of serious GI toxicity such as ibuprofen at its lowest recommended dose for shortest possible period

·In patients at high risk of GI bleed, use NSAID plus gastroprotection

By Emma Wilkinson

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