Study of gastrointestinal toxicity of selective COX-2 inhibitors in comparison with conventional NSAIDs


  • Hima Bindu K. Department of Pharmacology, Kakatiya Medical College, Warangal-506007, Telangana, India
  • Venkat Rao G. Retired Associate Professor, Department of Orthopaedics, Kakatiya Medical College, Warangal-506007, Telangana, India



Adverse drug reactions, Conventional NSAIDs, COX-2 inhibitors, Gastric toxicity


Background: Adverse gastrointestinal events are the commonest unwanted effects of the NSAIDs, and are believed to result mainly from the inhibition of gastric COX-1, which is responsible for the synthesis of prostaglandins that normally inhibit acid secretion and protect the mucosa. Previous studies report, that selective COX-2 inhibitors are safer when compared to non-selective cyclooxygenase inhibitors, regarding their adverse effects on gastrointestinal system. But, recent studies reveal, that gastrointestinal safety of these selective COX-2 inhibitors is not much better than that of conventional NSAIDs. In view of the wider usage of selective COX-2 inhibitors, the study has been taken up to report, whether selective COX-2 inhibitors have got any advantages over conventional NSAIDs or not, in regard to their gastrointestinal side effects.

Methods: Patients were divided into eight groups, fifteen patients of each. Each group was given one of the NSAIDs from the eight drugs those were selected for the study, for 15 days. In the selected group, along with the symptomatic assessment of gastric toxicity, both pre and post-treatment values of Hb% are estimated, tabulated & subjected to statistical analysis.

Results: Both the drugs, diclofenac & meloxicam have shown significant changes in the Hb% values (‘p’ value 0.02 each), whereas selective COX-2 inhibitors like nimesulide & celecoxib were no less in gastric toxicity, in comparison with diclofenac, on symptomatic assessment.

Conclusions: In our short-term study, selective COX-2 inhibitors did not show any advantage over non-selective NSAIDs regarding their gastrointestinal toxicity.


Dhikav V, Singh S, Anand KS. Newer non-steroidal anti-inflammatory drugs - A review of their therapeutic potential and adverse drug reactions. JIACM. 2002;3(4):332-8.

Aggarwal KK. Paracetamol, An analgesic with excellent gastrointestinal tolerability. Ind J Clin Pract. 1999;10(2):69-72.

Russell R. Non-steroidal anti-inflammatory drugs and gastrointestinal damage­ problems and solutions. Postgraduate Med J. 2001;77:82-8.

Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B, et al. For the VIGOR Study group; comparison of upper gastrointestinal toxicity of iofecoxib and naproxen in patients with rheumatoid arthritis. New Eng J Med. 2000;343(21):1520-8.

Fries JF, Miller SR, Spitz PW, Williams CA, Hubert HB, Bloch DA. Toward an epidemiology of gastropathy associated with non-steroidal anti-inflammatory drug use. Gastroenterology. 1989;96(2):647-55.

Roth SH. NSAID gastropathy - The central issue; Drugs. 1990;40(Suppl.5):25-8.

Brooks PM, Richard D. Non-Steroidal anti-inflammatory drugs - Differences and similarities; New Eng J Med. 1991;324(24):1716-24.

Steinfeld S, Poriau S. Patient and physician satisfaction with rofecoxib in osteoarthritis: Results of the EVA (Experience with VIOXX in Arthritis) survey. CMRO. 2001;17(2):81-7.

Kehlet H, Dahl JB. Are perioperative non-steroidal anti-inflammatory drugs ulcerogenic in the short term? Drugs. 1992;44(Suppl 5);38-41.

Riguez LAGR, Jick HS. Risk of upper gastro intestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. The Lancet. 1994;343:769-72.

Griffin MR, Piper JM, Htery JRD, Snowden MRN, Ray WA. Non-steroidal anti-inflammatory {ory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Inter Med. 1991;114(4):257- 63.

Rampal P, Moore N, Van Ganse E, Le Parc JM, Wall R, Schneid H, et al. Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the- counter doses. J Inter Med Res. 2002;30:301-8.

Henry D, Lim LLY, Rodriguez LAG, Gutthann SP, Carson JL, Griffin M, et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs; results of a collaborative meta-analysis. British Med J. 1996;312:1563-6.

Vainio H, Morgan G. Cyclo-oxygenase -2 and breast cancer prevention. British Med J. 1998;317:828.

Feldman M, Mahon AT. Do cyclooxygenase inhibitors provide benefits similar to those of traditional non-steroidal anti-inflammatory drugs, with less gastro intestinal toxicity? Ann Inter Med. 2000;132(2):134-43.

Deeks JJ, Smith LA, Bradley MD. Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of (Steoarthritis and rheumatoid arthritis; systematic review of randomized controlled trials. British Med J. 2002;325:619-23.

Weckx LL, Ruiz JE, Duperly J, Mendizabal GA, Rausis MB, Piltcher SL, et al. Efficacy of celecoxib in treating symptoms of viral pharyngitis; a double-blind, randomized study of celecoxib versus diclofenac; J Int Med Res. 2002;30(2):185-94.

Boers M. NSAIDS and selective COX-2 inhibitors: competition between gastro protection and cardio protection; The Lancet. 2001;357;1222-3.

Emery P, Zeidler H, Kvien TK, Guslandi M, Naudin R, Stead H, et al. Celecoxib versus diclofenac inlong-term management of rheumatoid arthritis; randomized double-blind comparison; The Lancet. 1999;354:2106-11.

Juni P, Rutjes AWS, Dieppe PA. Are selective COX-2 inhibitors superior to traditional non-steroidal anti-inflammatory drugs? ; British Med J. 2002;324:1287-8.

Cutts C, Lacaze A, Tett S. A Clinical audit of the prescribing of celecoxib and rofecoxib in Australian rural general practice. British J Clin Pharmacol. 2002;54:522-7.

Hrachovee JB, Mora M. Reporting of 6 - months VS 12-months data in a clinical trial of celecoxib; JAMA. 2001;286(19):2398.




How to Cite

K., H. B., & G., V. R. (2016). Study of gastrointestinal toxicity of selective COX-2 inhibitors in comparison with conventional NSAIDs. International Journal of Research in Medical Sciences, 4(12), 5180–5184.



Original Research Articles