COMMON BRAND NAME(S):
Bextra

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Uses: (1) Both medicines relieve sudden (acute) nonarthritic pain in adults (orthopedic and dental pain); (2) relieves signs and symptoms of osteoarthritis (both medicines); (3) treats primary dysmenorrhea; (4) relieves signs and symptoms of rheumatoid arthritis; (5) celecoxib reduces the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP).

Other (unlabeled) generally accepted uses: (1) Based on the way that they work, both could have a role in Alzheimer's disease; (2) may have a role in treating carcinoma in situ of the bladder; (3) could be useful in ankylosing spondylitis; (4) rofecoxib may have a role in sudden (acute) migraines.

How These Drugs Work: Inhibit cyclooxygenase (COX) II. Since COX II is the COX type (isoform) that is mostly responsible for inflammation and pain, this results in relief of pain and inflammation. COX II also causes fever in humans (along with other compounds), so these medicines work to lower fevers if they occur. Because COX I works to maintain kidney function and has a protective role in the stomach, lack of inhibition of this isoform by both medicines should result in a much more favorable gastrointestinal side effect profile than nonselective NSAIDs for most patients.

Available Dosage Forms and Strengths

Celecoxib:
Capsules - 100 mg, 200 mg

Rofecoxib:
Oral suspension - 12.5 mg/5 ml, 25 mg/5 ml
Tablets - 12.5 mg, 25 mg, 50 mg

Usual Adult Dosage Ranges
Celecoxib:

Osteoarthritis: 100 mg twice daily or 200 mg once a day.
Rheumatoid arthritis: 100 mg twice a day, increased as needed and tolerated to 200 mg twice daily.
Sudden pain or primary dysmenorrhea: acute pain treatment is started with 400 mg right away (stat) an option for an additional 200 mg on the first day. Dosing is continued at 200 mg twice a day if needed.
FAP: 400 mg twice a day (taken with food).

Rofecoxib:

Osteoarthritis: Dosing is started at 12.5 mg once daily. The dose may be increased as needed and tolerated to 25 mg daily. The lowest effective dose should be used.
Rheumatoid arthritis: 25 mg once a day is appropriate and is also the maximum dose.
Sudden pain or primary dysmenorrhea: 50 mg once daily is used (use for more than 5 days). May have an opioid sparing effect in patients taking opioids (medicines such as morphine).
Note: Actual dosage and schedule must be determined for each patient individually.

Conditions Requiring Dosing Adjustments

Liver Function: Celecoxib: Lower doses recommended for celecoxib in moderate liver compromise. Lowering usual doses by half (50%) is appropriate. Not recommended for use in severe liver (hepatic) problems. Rofecoxib:
Use in mild (Child-Pugh score of less than 6) liver problems (dysfunction) showed that rofecoxib achieves similar blood levels as in healthy patients. A small amount of data in moderate (Child-Pugh 7-9) liver disease shows that blood levels are roughly 53% increased. Dose decreases by half (50%) appear prudent, and the lowest possible dose should be used. This medicine has NOT been studied in severe liver failure.

Kidney Function: Rofecoxib and celecoxib have not been studied in advanced kidney (renal) disease and are NOT recommended for use in those situations.

Dosing Instructions: Celecoxib and rofecoxib: May be taken with or without food. Higher doses of celecoxib are best taken with food to increase how much gets into the body. Taking these medicines with a full glass of water is a good idea. Use of rofecoxib in treating pain or in primary dysmenorrhea has only been studied for up to 5 days. An oral rofecoxib suspension is available if you have trouble swallowing pills. The suspension should be shaken well before a dose is taken. The pill and suspension form give the benefit of equal dosing (are bioequivalent). For both medicines: If you forget a dose: take the missed dose as soon as you remember it, unless its nearly time for your next scheduled dose-if this is the case, skip the missed dose and simply take the regularly scheduled dose. DO NOT double doses.

Please Note: The information contained on this page is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

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