CASE REPORTS - Ocular adverse effects associated with COX-2 inhibitors (Celebrex/celecoxib)

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Arch Ophthalmol. 2006;124:277-279.

Vol. 124 No. 2, February 2006

Ocular Adverse Effects Associated With Cyclooxygenase-2 Inhibitors

An important event in the treatment of inflammatory disease was the

identification of selective inhibitors of cyclooxygenase-2 (COX-2).

Cyclooxygenase-1 (COX-1) inhibitors are responsible for many of the

adverse effects of nonsteroidal anti-inflammatory drugs, such as

gastrointestinal disturbances, while blockage of COX-2 mediates the

anti-inflammatory activity with fewer adverse effects. Selective COX-2

inhibitors include rofecoxib (Vioxx; Merck & Co, West Point, Pa),

celecoxib (Celebrex; Pfizer Inc, New York, NY), valdecoxib (Bextra;

Pfizer Inc), and lumiracoxib (Prexige; Novartis Pharmaceuticals Corp,

Basel, Switzerland). Nimesulide (Ainex; Schering-Plough, Santiago,

Chile) (and other trade names), and etolodac (Lodine; Wyeth, Madison,

NJ) also exhibit selective COX-2 inhibition and can be included in

this class of medication which is used in the treatment of

osteoarthritis, rheumatoid arthritis, acute pain, and dysmenorrhea.1

Nimesulide and lumiracoxib are not approved by the Food and Drug

Administration and are not marketed in the United States and Merck

removed Vioxx from the market worldwide in September 2004 because of a

possible increased risk of heart attack and stroke.

From the literature, there are 8 case reports of visual disturbance

from treatment with COX-2 inhibitors.2-3 These include orange spots in

vision while taking celecoxib, temporary blindness from rofecoxib, a

jellybean-like area of vision loss centrally from celecoxib, and 5

cases of blurred vision (4 cases related to celecoxib and 1 related to

rofecoxib). The visual disturbances all resolved within 72 hours of

discontinuing the drug (positive dechallenge), however no rechallenge

data (that the adverse reaction reoccurred when restarting the drug)

is available.

Recently, a large number of inquiries and case reports were submitted

to the National Registry of Drug-Induced Ocular Side Effects

(www.eyedrugregistry.com) associating COX-2 inhibitors and visual

adverse effects, prompting an examination of this first large series

of spontaneous reports of possible adverse visual effects secondary to

COX-2 inhibitors. The possible etiologies of the adverse ocular

reactions are explored.

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Read the full article here:

http://archopht.ama-assn.org/cgi/content/full/124/2/277

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