Risks of COX-2 vs. NSAID?


A 60-year-old Hispanic man, L.C., is being discharged from your hospital after an episode of gastrointestinal bleeding. Prior to admission he was switched to naproxen 500 mg b.i.d. for his osteoarthritis when rofecoxib (Vioxx, Merck) was taken off the market. Dismissal orders include ongoing medications: metformin 850 mg b.i.d., pravastatin 40 mg q.d., ramipril (Altace, Aventis) 10 mg q.d., now with the addition of lansoprazole (Prevacid, TAP) 30 mg q.d. L.C.'s physician is in a quandary about whether to prescribe a different COX-2 inhibitor or an NSAID. Previously, L.C. failed to obtain pain relief from acetaminophen or salsalate therapy. What do you recommend?

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