.
Rofecoxib is used to treat acute painful conditions, chronic pain associated with osteoarthritis, and pain from menses (dysmenorrhea). It is in a family of medications known as COX-2 nonsteroidal anti-inflammatory drugs (NSAIDs).
Interactions with Dietary Supplements
Calcium carbonate
Taking rofecoxib at the same time as calcium carbonate supplements can reduce the absorption
of the drug.1 Therefore, people taking rofecoxib who are taking calcium carbonate
supplements should take the calcium carbonate an hour before or two hours after the drug.
Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts
to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of
lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.2 Since major
changes in lithium blood levels can produce unwanted side effects or interfere with its
efficacy, NSAIDs should be used with caution, and only under medical supervision, in people
taking lithium supplements.
Potassium
Some people taking nonsteroidal anti-inflammatory drugs develop high blood levels of
potassium, which might cause serious side effects.3 Though no studies have
investigated whether rofecoxib increases blood potassium levels, people taking the drug who
wish to take supplemental potassium or use salt substitutes should consult with their
healthcare practitioner.
Interactions with Herbs
White willow bark
(Salix alba)
White willow bark contains salicin, which is related to
aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been
converted to salicylic acid in the body. The administration of salicylates like aspirin to
individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.4
Though no studies have investigated interactions between white willow bark and NSAIDs, people
taking NSAIDs should avoid the herb until more information is available.
Interactions with Foods and Other Compounds
Food
Taking rofecoxib with food dramatically slows the speed, but not the overall absorption of the
drug.5 Therefore, unless stomach upset occurs, people should take rofecoxib on an
empty stomach when rapid relief is desired.
Antacids
Taking rofecoxib at the same time as antacids containing
calcium carbonate, as well as aluminum and magnesium hydroxide, reduces the absorption of the
drug.6
Sodium
Studies have shown that taking NSAIDs may result in sodium retention, which might result in water retention, swelling, weight gain, and high blood pressure. Water retention and swelling have been
observed in people taking rofecoxib.7 Controlled research is needed to determine
whether people taking rofecoxib for long periods of time might benefit from a low-salt diet. Individuals who experience water retention,
swelling, or increased blood pressure while taking rofecoxib should notify their
practitioner.
Summary of Interactions for Rofecoxib
| Depletion or interference | Sodium |
|---|---|
| Adverse interaction | Lithium* Potassium Salt substitutes White willow* |
| Side effect reduction/prevention | None known |
| Supportive interaction | None known |
| Reduced drug absorption/bioavailability | Antacids Calcium carbonate Food |
For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
References:
1. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1912–5.
2. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.
3. Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition. Am J Med 1999;107:65–71S.
4. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.
5. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1912–5.
6. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1912–5.
7. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1912–5.
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