II. Precaution
- Vioxx voluntarily withdrawn from market October 2004
- Withdrawal due to increased risk of MI and CVA
III. Class
- NSAID: COX2 Inhibitor
- Similar to Celecoxib (Celebrex)
IV. Advantages
V. Dosing
- Osteoarthritis: 12.5 to 25 mg PO qd
- Acute pain or Dysmenorrhea: 50 mg PO qd
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. Efficacy: Equivalent analgesia to 50 mg Vioxx
VIII. Drug Interactions
- Decreased Vioxx serum concentrations
- Increased concentrations of other medications
- Raises serum Methotrexate levels 23%
- Raises Warfarin levels - increases ProTime 10%
IX. Adverse Effects
- See COX-2 Inhibitor for Nonfatal MI risk
- Confirmed in larger trial and withdrawn from market
- Diarrhea
- Nausea
- Dyspepsia
- Abdominal Pain
- Lower Extremity Edema
- Increased Blood Pressure