The evidence continues to pile up against the prescribing of high doses of the arthritis pain reliever rofecoxib (Vioxx) because of its effect on blood pressure and the risk of serious heart trouble. Researchers have been tracking the number of prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, celecoxib (Celebrex), and rofecoxib in patients over age 49 enrolled in Tennessee's Medicaid program. Of the 40,000 participants, 10,000 were taking rofecoxib and more than 1000 were high-dose users, eg, 30-day supplies of 50 mg or more. The recommended dose is half that amount for long-term use. Not only has the 50-mg dose not been more effective, but it has also been linked to an increased risk of heart attacks. Both celecoxib and rofecoxib have been prescribed because they are easier on the stomach than other NSAIDs. Researchers at Vanderbilt University Medical Center have been warning physicians about high doses of Vioxx and Celebrex since 2000. The Lancet published a study on the TennCare participants that year stating that patients on high doses of Vioxx had almost twice the rate of serious heart problems compared with patients not on the drug. Similar findings have been reported including an increased risk of heart attack, congestive heart failure, high blood pressure, and edema. Marie R. Griffin, MD, MPH, professor of preventive medicine at Vanderbilt, remarked, "You hate to make people jump through hoops to get things, but ? it should be harder to prescribe drugs that would potentially do harm."