Rofecoxib

Safetychecker Summary for Rofecoxib
(for details about the summarized interactions, read the full article)

May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Sodium
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.	Antacids Calcium carbonate Food
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Lithium* Potassium Salt substitutes White willow*
Side effect reduction/prevention	None known
Supportive interaction	None known

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.

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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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.