Bextra Drug InteractionsBextra may interact with other drugs you are taking. The following should be used as a guide only. Always tell your doctor any medications you are taking when Bextra is prescribed. Bextra and Aspirin: Concomitant administration of aspirin with valdecoxib may result in an increased risk of GI ulceration and complications compared to valdecoxib alone. Because of its lack of anti-platelet effect valdecoxib is not a substitute for aspirin for cardiovascular prophylaxis. Bextra and CE-inhibitors: Bextra and other NSAIDs may diminish the antihypertensive effect of ACE-inhibitors. This interaction should be given consideration in patients taking Bextra concomitantly with ACE-inhibitors. Bextra and Furosemide: Bextra and other NSAIDs can reduce the natriuretic effect of furosemide and thiazides in some patients. Anticonvulsants and Bextra: Steady state plasma exposure (AUC) of valdecoxib was decreased by 27% when co-administered with multiple doses of phenytoin. Patients already stabilized on valdecoxib should be closely monitored for loss of symptom control with phenytoin coadministration. Bextra and Lithium: Valdecoxib produced significant decreases in lithium serum clearance (25%) and renal clearance (30%) with a 34% higher serum exposure compared to lithium alone. Lithium serum concentrations should be monitored closely when initiating or changing therapy with Bextra in patients receiving lithium. Lithium carbonate had no effect on valdecoxib pharmacokinetics. Bextra and Warfarin: Valdecoxib caused a statistically significant increase in plasma exposures of R-warfarin and S-warfarin (12% and 15%, respectively), and in the pharmacodynamic effects (prothrombin time, measured as INR) of warfarin. Anticoagulant therapy should be monitored, particularly during the first few weeks, after initiating therapy with Bextra in patients receiving warfarin or similar agents. Bextra and Fluconazole ∧ Ketoconazole: Concomitant single dose administration of valdecoxib 20 mg with multiple doses of ketoconazole and fluconazole produced a significant increase in exposure of valdecoxib. Plasma exposure (AUC) to valdecoxib was increased 62% when coadministered with fluconazole and 38% when coadministered with ketoconazole. Bextra and Omeprazole: Coadministration with valdecoxib increased exposure of omeprazole (AUC) by 46%. Drugs whose absorption is sensitive to pH may be negatively impacted by concomitant administration of omeprazole and valdecoxib. However, because higher doses (up to 360 mg QD) of omeprazole are tolerated in Zollinger-Ellison (ZE) patients, no dose adjustment for omeprazole is recommended at current doses. Coadministration of valdecoxib with doses higher than 40 mg QD omeprazole has not been studied. Oral Contraceptives and Bextra: Valdecoxib did not induce the metabolism of the combination oral contraceptive norethindrone / ethinyl estradiol. Coadministration of valdecoxib and oral contraceptives increased the exposure of norethindrone and ethinyl estradiol by 20% and 34%, respectively. Although there is little risk for loss of contraceptive efficacy, the clinical significance of these increased exposures in terms of safety is not known. These increased exposures of norethindrone and ethinyl estradiol should be taken into consideration when selecting an oral contraceptive for women taking valdecoxib. Related Information
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