Professional Documents
Culture Documents
Pregnancy Category C
Drug classes
NSAID
Analgesic
Specific COX-2 enzyme blocker
Therapeutic actions
Analgesic and anti-inflammatory activities related to inhibition of COX-2 enzyme, which
is activated in inflammation to cause the signs and symptoms associated with
inflammation; not thought to affect the COX-1 enzyme, which protects the lining of the
GI tract and has blood clotting and renal functions.
Indications
• Relief of signs and symptoms of osteoarthritis and adult rheumatoid arthritis
• Treatment of primary dysmenorrhea
Available forms
Tablets—10, 20 mg
Dosages
ADULTS
• Osteoarthritis and rheumatoid arthritis: 10 mg/day PO.
• Primary dysmenorrhea: 20 mg PO bid as needed.
PEDIATRIC PATIENTS
Safety and efficacy not established in patients < 18 yr.
Pharmacokinetics
Route Onset Peak
Oral Varies 2–3 hr
Metabolism: Hepatic; T1/2: 8–11 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Adverse effects
• CNS: Headache, dizziness, neuralgia, neuropathy, tremors, anxiety
• CV: Arrhythmia, hypertension, CHF, hypotension, edema
• Dermatologic: Rash, pruritus, sweating, Stevens-Johnson syndrome, toxic
epidermal necrolysis, dry mucous membranes, urticaria, exfoliative dermatitis,
erythema multiforme
• GI: Abdominal pain, diarrhea, dyspepsia, nausea, flatulence, hemorrhoids,
abdominal fullness
• Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia,
eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis,
altered hepatic function
• Respiratory: URI, sinusitis, coughing, dyspnea, rhinitis
• Other: Back pain, flulike illness, myalgia, anaphylaxis, angioedema
Interactions
Drug-drug
• Increased risk of GI bleeding if combined with aspirin
• Risk of decreased antihypertensive effect if given with ACE inhibitors; monitor
patient closely and adjust dosage as needed
• Increased lithium levels and risk of toxicity if taken concomitantly; monitor
patient closely
• Risk of increased anticoagulant effects if taken with warfarin; monitor INR
closely and adjust dosage accordingly
• Increased serum levels of valdecoxib with fluconazole and ketoconazole; monitor
patient closely
Nursing considerations
Assessment
• History: Allergy to valdecoxib, salicylates, other NSAIDs, sulfonamides, any
component of the drug; pregnancy; lactation; impaired renal or hepatic function;
fluid retention; hypertension; CHF; ulcer; GI bleeding
• Physical: Skin (color, lesions), T, orientation, reflexes, peripheral sensation, P,
BP, edema, R, adventitious sounds, liver evaluation, CBC, clotting times, liver
and renal function tests
Interventions
• Administer drug with food or after meals if GI upset occurs.
• Discontinue drug at first sign of skin rash or hypersensitivity.
• Establish safety measures if CNS or visual disturbances occur.
• If overdose occurs, institute emergency procedures—gastric lavage, induction of
emesis, supportive therapy.
• Provide further comfort measures to reduce pain (positioning, environmental
control), and to reduce inflammation (warmth, positioning, rest).
Teaching points
• Take the drug with food or after meals if GI upset occurs.
• Do not exceed the prescribed dosage.
• These side effects may occur: Drowsiness, dizziness (use caution when driving or
operating dangerous machinery if these occur); GI upset, diarrhea (eat frequent
small meals; consult with health care provider if severe).
• Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers,
severe abdominal pain, changes in color of urine or stool.
Adverse effects in Italic are most common; those in Bold are life-threatening.