Drug Interaction Report

GENERALLY AVOID: Concomitant use of COX-2 inhibitors with other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the potential for serious gastrointestinal toxicity including inflammation, bleeding, ulceration, and perforation. The risk is dependent on both dosage and duration of therapy.

MANAGEMENT: Concomitant use of COX-2 inhibitors with non-aspirin NSAIDs should generally be avoided. Some authorities consider this combination to be contraindicated due to the absence of any evidence demonstrating synergistic benefits and the potential for additive adverse reactions (AU,UK).

ADJUST DOSE: In-vivo studies have demonstrated that the absorption of bromfenac is greatly reduced if the drug is taken within three and one-half hours following a high fat meal. The concomitant administration of a high fat meal has led to a 75% reduction in peak plasma concentrations and a 60% reduction in total area under the curve. The mechanism has not been described.

MANAGEMENT: An increased dosage of bromfenac (from 25 to 50 mg) may be needed if a high fat meal is consumed. The clinician may want to warn the patient about subtherapeutic analgesic effects if high fat meals are regularly consumed.

The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category:

• DurAct (bromfenac)
• Vioxx (rofecoxib)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.