Letter

Serious dermatologic reaction associated with valdecoxib: Report of two cases

This chapter discusses study results on anti-inflammatory and antipyretic analgesics. In a population-based study in Finland of co-prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) and other drugs that may potentiate their gastrointestinal toxicity, combining NSAIDs with corticosteroids, anticoagulants, or selective serotonin reuptake inhibitors (SSRIs) increased the risk of upper gastrointestinal haemorrhage by 15, 15, and 13 times respectively. The incidence of upper gastrointestinal haemorrhage was reported to be similar in patients taking either 75 or 325 mg of aspirin per day. Enteric-coated aspirin has been associated with gastroduodenal ulcer formation; the enteric coating has been shown to be toxic to the bowel and it is postulated that it is also toxic to the stomach. Contrasting data on the safety of rofecoxib in patients with pre-existing primary inflammatory bowel disease is also reported. In one study in 32 patients rofecoxib did not exacerbate inflammatory bowel disease, but in isolated cases inhibition of COX-2 in the large bowel worsened inflammatory bowel disease, as has again been reported in three patients exposed to rofecoxib—two patients developed inflammatory bowel disease de novo and one had exacerbation of pre-existing disease. These observations suggest that extreme caution should be taken when prescribing rofecoxib for patients with inflammatory bowel disease.