With a new study that indicates a leading arthritis painkiller could raise the risk of heart attacks, Celebrex users in Bermuda are advised to talk to their doctor if they have concerns and to follow dosage guidelines carefully.

Celebrex, one of the fastest moving prescription drugs at local pharmacies, is now being monitored closely by its manufacturer Pfizer Inc. and the Federal Drug Administration in the United States.

Its future is uncertain but scientists are carrying out additional tests to determine the full extent of the drug?s potential side effects.

Vioxx, an anti-arthritis drug in the same class used by thousands of Bermudians over the last four years, was withdrawn from the market by manufacturer Merck in September after it was found to be responsible for a higher incidence of heart attack.

Senior medical officer Brenda Davidson advised people to exercise their common sense when taking the drug and to communicate with their physician.

?People should be aware of the guidelines issued by the manufacturer and to follow the guidelines on dosage, not to overdose and to follow the prescription intakes, don?t double up or skip a dose,? said Dr. Davidson.

It is difficult to determine how many people are using the drug locally since specific numbers are not collected as data, said Dr. Davidson.

Tracy Marra, president of the Bermuda Pharmaceutical Association, said there was no position the association was taking at the moment about use of the drug Celebrex since studies were ongoing. Patients were advised to see their doctor if they had any concerns but not to get alarmed since the anti-inflammatory medication was effective in pain prevention.

Dr. Marra said patients were advised to talk to their doctor but not to get alarmed.

?Patients need information because at the end of the days it?s their health, the patient and the doctor should come to a decision about what drug to use and what are the possible side effects,? she said.

Last week drugs giant Pfizer Inc. said it had no plans to pull the painkiller off the market despite the data which showed patients using the drug in a long-term cancer study had increased cardiovascular risks.

Bermuda has a significant number of arthritis suffers in a small population who depend on the drug, which is found to work more effectively without causing stomach upsets.

When it comes to dispensing the drug, pharmacies at different areas of the Island distribute different amounts.

The Clarendon Pharmacy in Paget dispenses less than ten prescriptions every day, said pharmacist Nicole Graham yesterday.

Peter French, a pharmacist at the Southside Pharmacy in St. David?s, said a ?fair amount? of capsules were distributed daily with an estimate of 400 capsules dispensed in the last month.

?This is one of the fastest moving capsules on the shelf,? said Mr. French. ?A lot of the warnings about Celebrex are already listed in the leaflets which patients can discuss with their doctor.?

Head pharmacist at Hamilton Pharmacy, Hillary Evans Turner, said Celebrex was a hot seller in the United States, compared to Bermuda where people who were on the drug were on relatively low dosages not exceeding 400 mg.

?Most people who take this are on the drug for a short period of time at a low dosage. Sales have picked up since Vioxx was taken off the market. It makes up a small portion of our local market,? said Ms Evans Turner.

Celebrex is approved in the United States for treatment of osteoarthritis and pain at doses of 100 milligrams to 200 milligrams a day, or double that for rheumatoid arthritis. It was approved by the FDA in 1998 and has been prescribed to 27 million Americans, according to Pfizer.

Patients in the cancer study were taking 400 milligrams to 800 milligrams of Celebrex daily or placebos, Pfizer said in a news release.

Compared with placebo users, the risk of heart trouble was 2.5 times greater for patients taking 200 mg of Celebrex twice daily and 3.4 times greater for those who took 400 mg twice daily.

About 3,600 patients took part in the five-year study, the release said. A third study is under way.