The online version of The Merck Manual—Second Home Edition takes advantage of the flexibility of the web to present updates, changes, and corrections on a regular basis. Thus, the online version may contain material not yet in print. Details on updates and new topics appear below.
Rofecoxib, one member of the class of pain and arthritis drugs known as COX-2 inhibitors (coxibs), appears to increase the risk of heart attack and stroke after long-term use and has been withdrawn from the market. The potential for similar adverse effects with other coxibs is currently being studied. Because one recent study has shown a 2.5-fold increase in cardiovascular problems with another member of the class, celecoxib, current FDA recommendations are to limit use of any coxib to people at high risk of gastrointestinal bleeding, who have a history of intolerance to other NSAIDs, or who are not doing well on other NSAIDs. Caution should be taken with use of coxibs for long periods or by people with risk factors for heart attack and stroke.