Analgesic

Rofecoxib

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Rofecoxib, Vioxx

  • Precaution
  1. Vioxx voluntarily withdrawn from market October 2004
    1. Withdrawal due to increased risk of MI and CVA
  • Class
  • Advantages
  1. Less gastrointestinal adverse effects than other NSAIDs
    1. See NSAID Gastrointestinal Adverse Effects
  2. Appears safe in Aspirin and NSAID-induced Asthma
    1. Martin-Garcia (2002) Chest 121:1812-7 [PubMed]
  • Dosing
  1. Osteoarthritis: 12.5 to 25 mg PO qd
  2. Acute pain or Dysmenorrhea: 50 mg PO qd
  • Pharmacokinetics
  1. Oral Bioavailability: 92%
  2. Peaks: 2-3 hours (delayed by food intake)
  3. Half life: 17 hours
  4. Metabolized by hepatic reduction
  5. Factors increasing serum concentrations
    1. Age over 65 years old
    2. Hepatic insufficiency
  • Efficacy
  • Equivalent analgesia to 50 mg Vioxx
  1. Ibuprofen 400 mg
  2. Naproxen Sodium (e.g. Anaprox) 550 mg
  • Drug Interactions
  1. Decreased Vioxx serum concentrations
    1. Antacids (decrease Vioxx serum concentrations 20%)
    2. Rifampin (decrease Vioxx serum concentrations 50%)
  2. Increased concentrations of other medications
    1. Raises serum Methotrexate levels 23%
    2. Raises Warfarin levels - increases ProTime 10%
  • Adverse Effects
  1. See COX-2 Inhibitor for Nonfatal MI risk
    1. Confirmed in larger trial and withdrawn from market
  2. Diarrhea
  3. Nausea
  4. Dyspepsia
  5. Abdominal Pain
  6. Lower extremity edema
  7. Increased Blood Pressure