Examples of Selective COX-2 Inhibitors
The selective COX-2 inhibitors include celecoxib (the only one currently available in the United States), as well as etoricoxib, valdecoxib, parecoxib, rofecoxib, and lumiracoxib 1, 2.
Currently Available Agent
- Celecoxib (Celebrex) is the sole COX-2 selective inhibitor remaining on the U.S. market 1, 3
- Rofecoxib and valdecoxib were withdrawn from the U.S. market due to increased cardiovascular risks 3
Complete List of Selective COX-2 Inhibitors
The selective COX-2 inhibitors can be categorized by chemical structure:
Sulfonamide Class
- Celecoxib - currently marketed in the U.S.
- Valdecoxib - withdrawn from market
- Parecoxib - a prodrug of valdecoxib 2
Methylsulphone Class
- Rofecoxib - withdrawn from market
- Etoricoxib - available in some countries 2
Phenylacetic Acid Derivative
- Lumiracoxib - approved in Europe 2
Key Distinguishing Features
These agents were specifically developed to selectively inhibit COX-2 while sparing COX-1, thereby providing anti-inflammatory effects with theoretically reduced gastrointestinal toxicity compared to nonselective NSAIDs 1. The mechanism involves blocking COX-2-mediated prostanoid synthesis in inflamed tissues while preserving COX-1-dependent gastroprotective prostaglandins in the GI tract 1.
Critical Safety Consideration
All selective COX-2 inhibitors carry increased cardiovascular thrombotic risk including myocardial infarction and stroke, which can be fatal 1. This risk increases with duration of use and is higher in patients with existing cardiovascular disease or risk factors 1. They are contraindicated for perioperative pain in coronary artery bypass graft (CABG) surgery 1.