Medication Names:
Cox 2 Selective Inhibitors: Celecoxib (Celebrex®), Rofecoxib (Vioxx®), Valdecoxib (Bextra®)
On Label Use:
Non Steroidal Antiinflammatories are used for the treatment of Inflammatory Arthritis. All three medications have limited FDA approval to treat acute pain.
Pain Use:
Treatment of acute and chronic inflammatory pain
Treatment of acute and chronic non-inflammatory pain as early rung of the the WHO analgesic ladder. It appears to work on decending modifying pathways from the brain to the spinal cord.
Synergy with Opioid analgesics
Therapeutic Benefit:
Decrease in acute and chronic pain levels
Decrease in inflammation and prevention of chronic inflammation
Prevention of Sympathetic coupling secondary to chronic inflammation
Adding a Non steroidal to an opioid may increase the length of time of medication activity and provides an additional strategy for controlling pain.
Dose Range:
Celecoxib 100 mg to 400 mg in single or divided doses. Celecoxib can be used at 800 mg daily (400 mg bid) for the treatment of familial polyposis of the GI tract.
Rofecoxib 12.5 to 50 mg in single doses
Valdecoxib 10 to 20 mg in a single dose and 20 mg bid for PMD pain.
Titration:
None necessary. To check for allergic response or GI discomfort start at the lowest 100 to 200 mg of Celecoxib and increase to 400 mg after a week, or begin 12.5 mg of Rofecoxib and increase this to 25 mg in a week. Valdecoxib should be started at 10 mg daily and titrated in a week to 20 mg daily.
Celecoxib may be started at 400 mg for acute pain and Rofecoxib at 50 mg. Celecoxib may be used at 400 mg for as long as needed. The current recommendation for Vioxx at 50 mg is a five day maximum. Valdecoxib and be used at 20 mg bid for 5 days, as well, but should then be lowered to 10 to 20 mg daily.
Side Effects:
GI discomfort, dyspepsia, dizziness, drowsiness are infrequent side effects
Allergic cross reaction with patients allergic to sulfa based antibiotics can occur with Celecoxib
Rofecoxib can cause increased blood pressure and should be used with caution in patients, who already have this condition.
Drug Interactions:
Drug interactions are low. Rofecoxib does displace Coumadin from protein binding sites and may increase the INR for patients on Coumadin. Valdecoxib may lower serum lithium levels.
Dependency or Abstinence Syndrome:
None
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