Mary L. Chavez

Valdecoxib: A review

BACKGROUND Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen, naproxen, and related agents are nonselective inhibitors of both cyclooxygenase-1 (COX-1) and COX-2, which catalyze prostaglandin synthesis. This inhibition accounts not only for the analgesic, anti-inflammatory, and antipyretic effects of these agents, but also for side effects such as gastric mucosal damage and renal toxicity. Substantial evidence suggests that sparing COX-1 is advantageous for gastric safety. OBJECTIVE This article reviews available information on the new COX-2-selective inhibitor valdecoxib, including its clinical pharmacology, pharmacokinetics, adverse effects, potential drug interactions, and contraindications and warnings. Results of clinical trials of efficacy and tolerability are summarized. METHODS Articles for inclusion in this review were identified through searches of PubMed and MEDLINE (1966-December 2002) and International Pharmaceutical Abstracts (1970-December 2002). Search terms included valdecoxib, Bextra, COX-2-selective inhibitors, coxibs, and selective cyclooxygenase inhibitors. The reference lists of identified articles were reviewed for additional publications. Product information was also obtained from the manufacturer of valdecoxib. RESULTS Fourteen clinical studies involving > 4000 patients have been conducted. Valdecoxib was significantly more effective than placebo in the treatment of adult rheumatoid arthritis, osteoarthritis, pain associated with primary dysmenorrhea, and postoperative pain. Valdecoxib was comparable to naproxen for the treatment of rheumatoid arthritis in 1 study and equivalent to naproxen for the treatment of osteoarthritis in other studies. Three studies found valdecoxib comparable to naproxen sodium for the relief of moderate to severe pain due to primary dysmenorrhea, and others found valdecoxib comparable to oxycodone plus acetaminophen and significantly more effective than rofecoxib for the relief of pain associated with dental surgery (P < 0.05). Four safety studies and 2 reviews of clinical trials documented lower rates of endoscopic gastroduodenal ulcer formation with valdecoxib compared with ibuprofen, naproxen, and diclofenac (P < 0.001 to P < 0.05). Valdecoxib did not inhibit platelet function (bleeding time and platelet aggregation) in healthy adults or in the elderly. Due to the risk of potentially serious skin and allergic reactions, patients who are allergic to sulfa-containing drugs should not take valdecoxib. The drug should be discontinued immediately if rash develops. CONCLUSIONS In clinical trials, valdecoxib was effective for the treatment of osteoarthritis, rheumatoid arthritis, and moderate to severe pain associated with primary dysmenorrhea. As with the other COX-2-selective inhibitors (celecoxib and rofecoxib), valdecoxib appears to produce less gastrointestinal toxicity than conventional nonselective NSAIDs, although some of the relevant clinical studies have been published only as abstracts. Use of valdecoxib should be reserved for patients at risk for NSAID-induced gastrointestinal problems.

Treatment of hepatitis C with milk thistle

In a hypothetical case, a 35-year-old female presents to the pharmacy for a refill of her prescription oral contraceptive. She also asks about taking milk thistle. She states that several members of her “liver disease support group” are using the herbal supplement. She has recently been diagnosed with chronic hepatitis C and is currently receiving interferon alfa-2b and ribivarin. Her past history is significant for illegal drug and alcohol abuse in her early twenties.

PC-SPES for the treatment of prostate cancer?

A 73-year-old man recently attended his local USToo International prostate cancer support group and during the meeting several members were discussing using PC-SPES for treatment of their prostate cancer. The patients history is significant for prostate cancer and as a result he had a radical prostatectomy. Two years ago, he relapsed with bone metastases and he was subsequently treated with combined anti-androgen therapy. Over the last 6 months his symptoms and prostate-specific antigen have increased, despite anti-androgen withdrawal and a regimen of cancer chemotherapy. The patient is aware that his prostate cancer is incurable, but he wants to know if PC-SPES can help.

Treatment of Diabetes Mellitus with Ginseng

The effect of the various ginseng products (Asian, American and Panax ginseng) on blood glucose, data evaluating the effects and use in patients with diabetes mellitus are examined.

Soybeans as an Alternative to Hormone Replacement Therapy

The use of phytoestrogens in a theoretical case of a women with menopausal symptoms is discussed. The impact of breast cancer family history is also discussed in this context.