Dear patient:

Non-steroidal anti-inflammatory medications, commonly referred to as NSAID’s are widely used for the treatment of arthritic conditions. These medications have provided significant pain relief, improved function and greater quality of life for millions of patients. These are available in lower doses without prescription and are available in higher doses by prescription. NSAID’s fall into two broad categories, one is COX2 specific and the other is not COX2 non-specific. COX2 non-specific drugs such as Aspirin, Ibuprofen (Motrin), Ketoprofen, Diclofenac, Ketoprofen anad tiaprofenic acid have an excellent affect on the reduction of inflammation associated with arthritis which reduces pain. However, they also have adverse affects on the stomach or gastric lining. This can lead to gastric distress, ulcers, bleeding and even fatal bleeding. COX 2 specific drugs were engineered to have the beneficial effect of reducing inflammation associated with arthritis, but to have a lesser adverse affect on the gastric lining and bleeding. Two COX2 specific drugs; Vioxx and Bextra were associated with a risk of cardiac disease and were removed from the market. Celebrex and Mobic however have not been found to be associated with cardiac issues. Some cardiologists do not recommend Mobic or Celebrex in patients with cardiac disease fearing that its chemical similarity to Vioxx and Bextra may lead to problems. Reports have clearly shown that significant risks may be associated with the use of NSAID’s. Published reports such as an article in the Annals of Internal Medicine (Sept. 15, 1997: 127, 429-438) by Tamblyn et al. al., states: “Each year use of NSAID’s lead to 7600 deaths and 76,000 hospitalizations in the U.S. annual y.” Thus, prescribing physicians and patients must weigh the potential benefits of the use of NSAID’s versus the risks. COX2 specific drugs such as Celecoxib may have a lower risk than COX2 non-specific drugs. An article by Silverstein, in JAMA, Sept 13, 2000: 284,(10) 1247-55, found a “lower symptomatic ulcer rate with Celebrex (at much higher doses than normal y clinical y prescribed) compared to the ulcer rate of non-COX2 specific NSAID’s (at normal y prescribed doses). It is my opinion that patients with gastric reflux (GERD), patients with ulcerative gastritis (ulcers) and patients with a history of ulcers or bleeding should not take COX2 non-specific NSAID’s. It is also my opinion that because many of the hospitalizations and even deaths associated with NSAID use are in patients who have NO history of gastric issues that it is simply wise to use the COX2 specific drugs as the primary treatment option. Many law suits are filed annual y against doctors who have prescribed COX2 non-specific NSAID’s when patients have suffered bleeding. Many insurance companies refuse to pay for COX2 specific NSAID’s. When this occurs, the patients have options. One is to cal their insurance company and complain. Two: the patient can pay for the COX2 specific drug. Third: the patient can choose to take a COX2 non-specific drug. If I have prescribed a COX2 specific drug for you and you have a history of gastric disease, then you should NOT take COX2 non-specific drugs! If I have prescribed the COX2 specific drug and you have a Cardiologist, you should check with the Cardiologist before taking this medication. If I have prescribed a COX2 specific drug and your insurance company wil not pay for it and you have no
history of gastric disease, then at your request, my office will authorize for a COX2 non-specific NSAID.
However, be aware this is not my preference and you must realize that I have advised you to take the
COX2 specific drug.

I take a COX2 NSAID daily, but I have no financial or business relationship with any drug manufacturer. Your signature indicates that you have read and that you understand this document.


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