Health Canada has asked Pfizer Canada to voluntarily discontinue sales of its drug Bextra in Canada until safety issues have been resolved. Pfizer has agreed and will be discontinuing sales.
Health Canada has asked the manufacturer to submit evidence to establish the safety of this drug product under the conditions of use for which it is recommended. In addition the manufacturer has been asked to provide Health Canada with a risk/benefit analysis indicating the product’s unique therapeutic advantage.
Health Canada’s decision is based on an ongoing review of information with regard to serious, potentially life-threatening skin reactions. It is based on Canadian and foreign data, including publicly available information from the United States. Health Canada has already published, on December 10, 2004 a public advisory indicating that serious potentially life threatening skin reactions had been reported in patients taking Bextra. The prescribing information and patient instructions were modified at that time to reflect the higher incidence of these events.
We encourage people taking Bextra to contact their physician to discuss discontinuing use and alternative treatments. After having consulted with a physician, consumers should return the product to their pharmacy. In order to avoid contaminating ground or municipal water systems, the product should not be flushed down the toilet or sink.
In addition to this action on Bextra Health Canada is also recommending important new usage restrictions for Celebrex(celecoxib), another selective COX-2 inhibitor.
The usage restrictions on Celebrex are based on Health Canada’s ongoing scientific review of the cardiovascular safety of selective COX-2 inhibitor non-steroidal anti-inflammatory drugs (NSAIDs). Products such as Celebrex and Bextra work by selectively blocking an enzyme commonly known as COX-2 that is linked to pain, inflammation and fever.
Health Canada’s ongoing scientific review started in the fall of 2004, when the long-term use of a similar drug, Vioxx(rofecoxib), was linked to an increased risk of heart attack and stroke, and its manufacturer withdrew it from the global market.
New restrictions concerning the use of Celebrex are as follows:
Patients who have had a heart attack or stroke, experienced serious chest pain related to heart disease, or who have had serious diseases of the heart such as congestive heart failure, should NOT use this medication.
Patients who have significant risk factors for heart attack or stroke should be aware that using this drug may increase this risk. Risk factors for heart attack and stroke include high blood pressure (treated or untreated), high cholesterol, diabetes and smoking. In consultation with their doctors, patients with such risk factors should consider using other types of medications or pain relief therapies.
This medication should be prescribed and used at the lowest possible dose, and for the shortest, necessary period of time.
Selective COX-2 inhibitor NSAIDs should only be used to treat the pain and inflammation of arthritis, and certain types of acute pain. These drugs may be used to treat osteoarthritis and rheumatoid arthritis. Celebrex may be used for the short-term (one week or less) management of moderate to severe pain in adults caused by conditions such as sprains, surgery or tooth extractions. In the past, Celebrex had been used to treat family polyposis (the presence of multiple polyps in the colon) but this indication was cancelled in December, 2004 and a public advisory was issued at that time.
Health Canada scientists continue to review Canadian and international safety data and other sources of information regarding cardiovascular risk and the use of other COX-2 inhibitor NSAIDs. They are also consulting external experts in fields such as cardiology, rheumatology and pharmacology. Health Canada will advise Canadians if other safety concerns arise.
Health Canada urges patients using CelebrexÂ® to consult their physicians in order to weigh the risks and benefits of these drugs in light of their own medical circumstances.