Analgesic

Rofecoxib

search

Rofecoxib, Vioxx

  • See Also
  1. COX2 Inhibitor
  2. Celecoxib
  3. Nonsteroidal Anti-inflammatory
  • Precautions
  1. Listed for historical purposes (and any international use that may still exist)
  2. Vioxx voluntarily withdrawn from market October 2004
    1. Withdrawal due to increased risk of MI and CVA
  • Mechanism
  1. Rofecoxib is an NSAID that is more COX2 selective (COX2 Inhibitor)
  2. Similar to Celecoxib (Celebrex)
  • Dosing
  1. Osteoarthritis: 12.5 to 25 mg PO qd
  2. Acute pain or Dysmenorrhea: 50 mg PO qd
  • Adverse Effects
  1. Cardiovascular Risk for Non-fatal MI
    1. See COX-2 Inhibitor for Nonfatal MI risk
    2. Confirmed in larger trial and withdrawn from market
  2. Less gastrointestinal adverse effects than other NSAIDs
    1. See NSAID Gastrointestinal Adverse Effects
  3. Appears safe in Aspirin and NSAID-induced Asthma
    1. Martin-Garcia (2002) Chest 121:1812-7 [PubMed]
  4. Diarrhea
  5. Nausea
  6. Dyspepsia
  7. Abdominal Pain
  8. Lower Extremity Edema
  9. Increased Blood Pressure
  • 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
  • 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%
  • Efficacy
  • Equivalent analgesia to 50 mg Vioxx
  1. Ibuprofen 400 mg
  2. Naproxen Sodium (e.g. Anaprox) 550 mg
  • References
  1. Daniels (1999) Clin Pharmacol Ther 65:118 [PubMed]
  2. Ehrich (1999) Clin Pharmacol Ther 65:336 [PubMed]
  3. Fricke (1999) Clin Pharmacol Ther 65:119 [PubMed]
  4. (1999) Med Lett Drugs Ther 41(1056): 59-61 [PubMed]