Audit of Celecoxib and Rofecoxib Use: St Vincent's Public Hospital, Darlinghurst

Objectives: To review the usage of the cyclo‐oxygenase‐2 selective inhibitors (COX‐2 inhibitors)‐celecoxib and rofecoxib‐at St Vincent's Public Hospital (SVH), in relation to the existing SVH Formulary Guidelines and also ‘good clinical practice’ as defined from considerations of the literature.Method: Clinical pharmacists at SVH identified all patients receiving celecoxib or rofecoxib‐on admission, ceased at the point of admission, or commenced during admission‐over an eight‐week period (May‐June 2001). Data were collected from clinical notes and structured patient interviews.Results: Sixty‐five patients were included (29–92 years, 66% <65 years). A COX‐2 inhibitor was commenced for three patients, continued for 68% (44/65), and ceased either at the point of admission or during admission for 28% (18/65). Reasons for cessation included gastrointestinal bleed, acute renal failure, and haemorrhagic cerebrovascular accident. Change to a COX‐2 inhibitor was patient‐initiated for 21% and as aresult of side effects of previous medication for 8%. History of gastrointestinal ulceration was documented for 18% (12/65) of patients. An additional 18% (12/65) were considered at high risk of ulceration. Anti‐hypertensive medications were concomitantly prescribed in 43% of cases. Forty patients (62%) had impaired renal function (creatinine clearance >70 mL/min ). Of those patients continuing COX‐2 inhibitor therapy, 79% (37/47) were in accordance with current SVH guidelines. If precautions relating to concomitant hypertension, renal impairment and gastrointestinal safety were also considered, 46% of patients were treated in accordance with ‘good clinical practice’.Conclusion: This audit has identified that the SVH guidelines would benefit from review to encourage more appropriate use of COX‐2 inhibitors in all patient groups. In addition, we feel ongoing education of general practitioners is required, regarding the risk of COX‐2 inhibitor use in patients with hypertension and renal dysfunction.