Brand name:

Bextra

Pronounced: BEK-struh
Generic name: Valdecoxib

Why is this drug prescribed?

Bextra is a member of the relatively new class of painkillers called COX-2 inhibitors. It is prescribed for the relief of osteoarthritis, rheumatoid arthritis, and painful menstruation (dysmenorrhea).

COX-2 inhibitors are part of a larger group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). All the drugs in this category (including such familiar remedies as aspirin, Motrin, and Naprosyn) relieve pain and inflammation by limiting the effect of a natural enzyme called COX-2. Unlike the older NSAIDs, however, the new COX-2 inhibitors do not interfere with COX-1, a related enzyme that exerts a protective effect on the lining of the stomach. As a result, Bextra and other COX-2 inhibitors are less likely to cause the bleeding and ulcers that sometimes accompany sustained use of the older NSAIDs.

Most important fact about this drug

Although the chances of stomach or intestinal bleeding are low, a slight danger remains. Be sure to tell your doctor if you've ever had this type of problem, and be alert for signs of bleeding such as stomach discomfort or black, tarry stools. The problem becomes more likely the longer you take this medication, but can strike at any time without warning.

How should you take this medication?

Bextra can be taken with or without food, and can be taken along with antacids if necessary. Take it exactly as directed.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at once.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Bextra.

• More common side effects may include:
  Abdominal pain, diarrhea, headache, indigestion, nausea, swelling in the hands and feet, upper respiratory infection

• Less common and rare side effects may include:
  Abdominal fullness, abnormal or bloody stools, abnormal taste, acne, allergic reactions, anxiety, appendicitis, appetite changes, back pain, bad breath, bad dreams, belching, blood disorders, breast pain, brittle bones, bull's eye rash, burning or tingling sensation, cervical dysplasia, chest pain, chills, clotting problems, colitis, confusion, constipation, convulsions, coughing, cysts and tumors, dehydration, depression, digestive tract inflammation, dizziness, drowsiness, dry mouth, ear and vision problems, eye pain and problems, facial swelling, fatigue, fever, gallstones, general feeling of illness, generalized swelling, glandular problems, goiter, gout, hair loss, heart and circulation problems, heartburn, hemorrhoids, hepatitis, high cholesterol, high or low blood pressure, hot flushes, incontinence, impotence, infections, inflamed tendons or bones, intestinal problems and bleeding, joint problems, kidney failure, loss of sensation, mania, menstrual problems, migraine, mouth inflammation, muscle pain, muscle tension, nerve pain and problems, nervousness, nosebleeds, pain, prostate problems, psychosis, rash and other skin problems, respiratory problems, runny nose, skin inflammation, sleep problems, sore throat, stiff neck, stroke, swallowing problems, sweating, swelling around the eyes, tarry stools, thirst, tooth disorders, tremors, tumors, twitching, ulcer, urinary problems, vertigo, vomiting, weakness, weight changes

Why should this drug not be prescribed?

Do not take Bextra if you have ever had an allergic reaction to the drug, or if you're allergic to antibiotics known as sulfonamides (Bactrim, Cotrim, Septra).

In addition, do not take Bextra if aspirin or other NSAIDs have ever given you asthma, hives, or an allergic reaction. The possibility of a severe reaction exists.

Special warnings about this medication

Warning signs of a dangerous allergic reaction to Bextra include skin rash, swelling of the face, tongue, or throat, and difficulty breathing. Seek medical help immediately if these symptoms develop after a dose of Bextra.

Bextra is more likely to cause serious stomach problems if you've had ulcers or bleeding in the past. Older adults and those in poor health are also more vulnerable, as are people being treated with steroids such as prednisone or blood thinners such as aspirin and Coumadin. Other factors that increase your risk include smoking, alcoholism, and long-term use of NSAIDs. If you meet any of these criteria, use Bextra with extreme caution.

Bextra and other NSAIDs occasionally cause liver problems. Warning signs include nausea, fatigue, rash, itching, right upper stomach pain, flu-like symptoms, and yellowing of the skin and eyes. If you develop these symptoms, stop taking Bextra and call your doctor immediately.

Long-term use of NSAIDs such as Bextra can injure the kidneys, especially in people with heart failure, poor kidney function, or liver problems. Also at higher risk of a problem are older adults, individuals suffering dehydration, and people taking water pills or ACE inhibitors for high blood pressure. If any of these factors apply to you, make sure the doctor is aware of it. If you have advanced kidney disease, Bextra is not recommended.

Bextra sometimes causes fluid retention, which can aggravate swelling, high blood pressure, and heart failure. Use this drug with caution if you have any of these conditions.

Caution is also warranted if you have asthma. Bextra could trigger a serious attack, especially if you are also sensitive to aspirin.

If you've been taking a steroid medication for arthritis, do not discontinue it abruptly when you begin taking Bextra. Bextra is not a substitute for such drugs. Because Bextra relieves inflammation, fever, and pain, it may hide signs of an infection. Let any doctor you're seeing know that you're taking this drug.

Bextra has not been tested for use in children under 18.

Possible food and drug interactions when taking this medication

If Bextra is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Bextra with the following:

Aspirin
Blood pressure medications known as ACE inhibitors, including Capoten, Lotensin, and Vasotec
Cough medications containing dextromethorphan, such as Benylin and Robitussin Honey Cough
Fluconazole (Diflucan)
Ketoconazole (Nizoral)
Lithium (Eskalith, Lithobid)
Warfarin (Coumadin)
Water pills (diuretics) such as Lasix and HydroDIURIL

Special information if you are pregnant or breastfeeding

Bextra should never be used during the third trimester of pregnancy because it may cause problems in the developing baby. If you are pregnant or plan to become pregnant, consult your doctor.

It is not known whether Bextra appears in breast milk, but if it does, it could cause serious side effects in the nursing infant. If you decide to take Bextra, you should give up breastfeeding.

Recommended dosage

ADULTS

The recommended dose is 10 milligrams once a day.

Painful Menstruation

The recommended dose is 20 milligrams twice a day.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Warning signs of Bextra overdose may include:
  Drowsiness, lack of energy, nausea, stomach pain, vomiting

Stomach or intestinal bleeding may develop. Kidney failure, diminished breathing, and coma are possible, but rare.

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