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valdecoxib

(val dah cox' hib)


Bextra

Pregnancy Category C

Drug classes
NSAID
Analgesic
Specific COX-2 enzyme blocker

Therapeutic actions
Analgesic and anti-inflammatory activities related to inhibition of COX-2 enzyme, which
is activated in inflammation to cause the signs and symptoms associated with
inflammation; not thought to affect the COX-1 enzyme, which protects the lining of the
GI tract and has blood clotting and renal functions.

Indications
• Relief of signs and symptoms of osteoarthritis and adult rheumatoid arthritis
• Treatment of primary dysmenorrhea

Contraindications and cautions


• Contraindicated with allergy to valdecoxib, salicylates, other NSAIDs (more
common in patients with rhinitis, asthma, chronic urticaria, nasal polyps),
sulfonamides, or any component of the drug; lactation.
• Use cautiously with impaired renal or hepatic function, fluid retention,
hypertension or CHF, history of ulcer or GI bleeding, pregnancy (teratogenic
effects and lack of closure of the ductus arteriosus have been reported with use in
late pregnancy).

Available forms
Tablets—10, 20 mg

Dosages
ADULTS
• Osteoarthritis and rheumatoid arthritis: 10 mg/day PO.
• Primary dysmenorrhea: 20 mg PO bid as needed.
PEDIATRIC PATIENTS
Safety and efficacy not established in patients < 18 yr.

Pharmacokinetics
Route Onset Peak
Oral Varies 2–3 hr
Metabolism: Hepatic; T1/2: 8–11 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Adverse effects
• CNS: Headache, dizziness, neuralgia, neuropathy, tremors, anxiety
• CV: Arrhythmia, hypertension, CHF, hypotension, edema
• Dermatologic: Rash, pruritus, sweating, Stevens-Johnson syndrome, toxic
epidermal necrolysis, dry mucous membranes, urticaria, exfoliative dermatitis,
erythema multiforme
• GI: Abdominal pain, diarrhea, dyspepsia, nausea, flatulence, hemorrhoids,
abdominal fullness
• Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia,
eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis,
altered hepatic function
• Respiratory: URI, sinusitis, coughing, dyspnea, rhinitis
• Other: Back pain, flulike illness, myalgia, anaphylaxis, angioedema

Interactions
Drug-drug
• Increased risk of GI bleeding if combined with aspirin
• Risk of decreased antihypertensive effect if given with ACE inhibitors; monitor
patient closely and adjust dosage as needed
• Increased lithium levels and risk of toxicity if taken concomitantly; monitor
patient closely
• Risk of increased anticoagulant effects if taken with warfarin; monitor INR
closely and adjust dosage accordingly
• Increased serum levels of valdecoxib with fluconazole and ketoconazole; monitor
patient closely

Nursing considerations
Assessment
• History: Allergy to valdecoxib, salicylates, other NSAIDs, sulfonamides, any
component of the drug; pregnancy; lactation; impaired renal or hepatic function;
fluid retention; hypertension; CHF; ulcer; GI bleeding
• Physical: Skin (color, lesions), T, orientation, reflexes, peripheral sensation, P,
BP, edema, R, adventitious sounds, liver evaluation, CBC, clotting times, liver
and renal function tests

Interventions
• Administer drug with food or after meals if GI upset occurs.
• Discontinue drug at first sign of skin rash or hypersensitivity.
• Establish safety measures if CNS or visual disturbances occur.
• If overdose occurs, institute emergency procedures—gastric lavage, induction of
emesis, supportive therapy.
• Provide further comfort measures to reduce pain (positioning, environmental
control), and to reduce inflammation (warmth, positioning, rest).

Teaching points
• Take the drug with food or after meals if GI upset occurs.
• Do not exceed the prescribed dosage.
• These side effects may occur: Drowsiness, dizziness (use caution when driving or
operating dangerous machinery if these occur); GI upset, diarrhea (eat frequent
small meals; consult with health care provider if severe).
• Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers,
severe abdominal pain, changes in color of urine or stool.

Adverse effects in Italic are most common; those in Bold are life-threatening.