The major advantage of the COX-2 inhibitors is their decreased GI effects and formation of gastric ulcerations compared with the COX nonselective agents. However, once an ulcer is present, COX-2 is induced in response, and the COX-2 enzyme is essential for wound healing. Therefore, celecoxib and rofecoxib can delay in wound healing and increase the time for ulcer repair and tissue regeneration. Patients with gastric ulcers should be switched if possible to another antiinflammatory to allow ulcers to heal.
Celecoxib is contraindicated during pregnancy, since COX-2 levels must be maintained for ovulation and onset of labor. COX-2 seems to be involved into the regulation of the renin-angiotensin system, and both cele-coxib and rofecoxib use are associated with transient sodium retention.
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