The evidence continues to pile up against the prescribing of high dosesof the arthritis pain reliever rofecoxib (Vioxx) because of its effect on bloodpressure and the risk of serious heart trouble. Researchers have beentracking the number of prescriptions for nonsteroidal anti-inflammatorydrugs (NSAIDs), which include ibuprofen, naproxen, celecoxib (Celebrex),and rofecoxib in patients over age 49 enrolled in Tennessee's Medicaidprogram. Of the 40,000 participants, 10,000 were taking rofecoxib andmore than 1000 were high-dose users, eg, 30-day supplies of 50 mg ormore. The recommended dose is half that amount for long-term use. Notonly has the 50-mg dose not been more effective, but it has also beenlinked to an increased risk of heart attacks. Both celecoxib and rofecoxibhave been prescribed because they are easier on the stomach than otherNSAIDs. Researchers at Vanderbilt University Medical Center have beenwarning physicians about high doses of Vioxx and Celebrex since 2000.The Lancet published a study on the TennCare participants that year statingthat patients on high doses of Vioxx had almost twice the rate of seriousheart problems compared with patients not on the drug. Similar findingshave 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 ? itshould be harder to prescribe drugs that would potentially do harm."