OBJECTIVES: Canadian guidelines for adequate nonsteroidal anti-inflammatory drug (NSAID) utilisation in patients with gastrointestinal (GI), cardiovascular (CV), congestive heart failure (CHF) and renal risk factors have been recently published. The objective is to describe concordance of NSAID utilisation with current clinical practice guidelines during two time-periods: April 1, 2005 to March 31, 2007 (post- rofecoxib withdrawal period) and April 1, 2002 to March 31, 2004 (pre-rofecoxib withdrawal period) in Quebec, Canada. METHODS: Data were obtained from the physician and medication claims databases of the Quebec Health Insurance Agency. All prescriptions for celecoxib or traditional NSAIDs (tNSAIDs) dispensed to patients 50 years of age or older were evaluated for concordance with the guidelines. Prescriptions were stratified by patient GI, CV, CHF and renal risk factors and four risk categories (low, moderate, high, and very high) were considered in each condition (GI, CV, CHF and renal). RESULTS: Of celecoxib prescriptions, 87.2% were adequate in the post-period and 86.5% in the pre-period; while adequate prescriptions for tNSAIDs were 72.6% in the post-period and 70.1% in the pre-period. Inadequate prescriptions for celecoxib in the post-period were those prescribed to the low GI risk group (10.1%) and to either the very high renal risk group (1.3%) or very high CHF risk group (1.7%).  In the post-period, 4,457 (0.5%) prescriptions of celecoxib in the low or moderate GI risk groups received a gastroprotective agent (GPA) co-prescription that was not apparently adequate. Among celecoxib prescriptions requiring a GPA co-prescription as per recent guidelines, only 30.0% had one that was adequate. Similarly, only 30.0% of the tNSAID prescriptions dispensed to those with GI risks received a GPA co-prescription. CONCLUSIONS: About 87% of celecoxib and 70% of tNSAID prescriptions were adequate in both study periods according to recent guidelines. GPA co-prescription with NSAIDs remains greatly suboptimal.