The American Heart Association suggests that a general plan for non-steroidal anti-inflammatory drugs is to use selective cyclooxygenase-2 (COX-2) inhibitors when drugs with fewer risks have failed and then for the shortest possible period, according to an advisory in the March 22nd issue of Circulation. The advisory affirms cautions issued by the U.S. Food and Drug Administration (FDA) in February 2005.

If the advisory is followed, potent agents in this class including the COX-2 inhibitors Celebrex (celecoxib) and Bextra (valdecoxib) would be “held in reserve, generally for short-term use,” said Joel S. Bennett, MD, a member of the writing group that drafted the advisory.

“We are recommending that patients use some common sense in selecting a medication to treat pain,” Bennett said. “In terms of drug choice, one rule is always best and it holds whether you are treating cancer or treating a headache: use the safest medicine first.”
Medications such as aspirin and acetaminophen in recommended doses and durations have minimal toxicity, which makes them good first choices, he said. “If those medicines don’t work, try a stronger agent such as naproxen.”

Bennett noted that low-dose aspirin is recommended to reduce the risk of second myocardial infarction and that many survivors of a first infarction do regularly take aspirin to limit myocardial damage.