Celecoxib, rofecoxib, and acute temporary visual impairment

doi:10.1136/bmj.327.7425.1214

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David Morris Coulter (david.coulter@stonebow.otago.ac.nz), director1,
David Walter John Clark, senior research fellow1,
Ruth Lesley Savage, senior research fellow2

¹Intensive Medicines Monitoring Programme, New Zealand Pharmacovigilance Centre, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9000, New Zealand
²Centre for Adverse Reactions Monitoring, New Zealand Pharmacovigilance Centre

Correspondence to: D M Coulter

Accepted 6 October 2003

Introduction

We present evidence of acute severe temporary visual disturbance with two of the new selective anti-inflammatory cyclo-oxygenase-2 (COX 2) inhibitors. We report two cases, one of temporary blindness and one that suggests a visual field defect together with five other less specific reports of blurred or abnormal vision (table 1). These reports were received while monitoring celecoxib and rofecoxib in the New Zealand intensive medicines monitoring programme. This national programme monitors selected newly introduced drugs.1 Monitoring of the COX 2 inhibitors celecoxib and rofecoxib started in December 2000.

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Table 1

Case reports of visual disturbance with COX 2 inhibitors

Case reports

Case 1

After knee replacement surgery, an 81 year old man in good health was taking 100 mg of celecoxib every morning for analgesia. Three weeks after starting celecoxib, he told his doctor that he had central loss of vision in a jellybean-like shape for a few hours after each dose. His only other treatment was weekly eye drops for blepharitis, which contained sulfacetamide, prednisolone, and phenylephrine. His blood pressure was normal. Celecoxib was discontinued, and the problem has not recurred in seven months.

Case 2

A 78 year old man was prescribed rofecoxib for shoulder pain. He took a first dose of 50 mg one evening and next day took 25 mg in the morning and evening with good relief of pain. The next morning he awoke unable to read the newspaper because his vision was blurred. He attempted to drive to his doctor but ran his vehicle into the back of a truck because he could not see; he fortunately …