II. Precautions
- Listed for historical purposes (and any international use that may still exist)
- Vioxx voluntarily withdrawn from market October 2004
- Withdrawal due to increased risk of MI and CVA
III. Mechanism
- Rofecoxib is an NSAID that is more COX2 selective (COX2 Inhibitor)
- Similar to Celecoxib (Celebrex)
IV. Dosing
- Osteoarthritis: 12.5 to 25 mg PO qd
- Acute pain or Dysmenorrhea: 50 mg PO qd
V. Adverse Effects
-
Cardiovascular Risk for Non-fatal MI
- See COX-2 Inhibitor for Nonfatal MI risk
- Confirmed in larger trial and withdrawn from market
- Less gastrointestinal adverse effects than other NSAIDs
- Appears safe in Aspirin and NSAID-induced Asthma
- Diarrhea
- Nausea
- Dyspepsia
- Abdominal Pain
- Lower Extremity Edema
- Increased Blood Pressure
VI. Pharmacokinetics
- Oral Bioavailability: 92%
- Peaks: 2-3 hours (delayed by food intake)
- Half life: 17 hours
- Metabolized by hepatic reduction
- Factors increasing serum concentrations
- Age over 65 years old
- Hepatic insufficiency
VII. Drug Interactions
- Decreased Vioxx serum concentrations
- Increased concentrations of other medications
- Raises serum Methotrexate levels 23%
- Raises Warfarin levels - increases ProTime 10%