Hello Bob,
The effects of Vioxx (Rofecoxib,an NSAID (Non-steroidal
anti-inflammatory) and Cox-2 inhibitor, will vary person to person,
depending on age and condition of the person. A person suffering from
renal disease already seems to have one strike against them, and it
would seem prudent NOT to take Vioxx. However, the definitive answer
is from the FDA:
Page 3-4 of this document from the Food and Drug Administration
states: ?While renal insufficiency does not influence the
pharmacokinetics of rofecoxib, use of VIOXX in advanced renal disease
is not recommended at present because no safety information is
available regarding the use of VIOXX in these patients.
http://www.fda.gov/cder/foi/label/1999/21042lbl.pdf
Vioxx ? is not removed by hemodialysis; it is not known whether
rofecoxib is removed by peritoneal dialysis.?
http://www.rxlist.com/cgi/generic/rofecox_od.htm
Merck, the manufacturer of Vioxx, states ?Serious kidney problems
occur rarely, including acute kidney failure and worsening of chronic
kidney failure.?
http://www.vioxx.com/rofecoxib/vioxx/consumer/product_information/ppi/possible_side_effects.jsp
According to this Monheit Law site, Vioxx causes kidney damage. (Note:
I don?t often rely on medical advice found on a legal site, but this
site does quote reliable sources)
http://www.monheit.com/vioxx_celebrex/kidney_more_info.shtml#Is%20the%20benefit%20of%20Vioxx%20worth%20the%20risk%20of%20kidney%20failure
This article, from the WebMD site concurs with the legal site above.
?Though it is known that NSAIDs can cause kidney failure, this case is
the first to show that COX-2 inhibitors may be associated with the
condition, Roche and Fernandez-Alonso report in The Lancet. ?
http://my.webmd.com/content/article/33/1728_83308
Although Vioxx (and Celebrex) are reported to possibly cause kidney
troubles, be aware that numerous prescription and over the counter
drugs may do the same. From Nurse Week, ?Specifically, OTC and
prescription drugs and even herbal products can target the kidney and
liver for drug-induced toxicities. The causes of these toxicities are
complex, and certain patient populations are more susceptible than
others (Notably the elderly, renal patients).
The COX-2 enzyme produces pain mediators when inflammation is present.
COX-2 is also responsible for producing prostaglandins in the kidney
that maintain renal blood flow in patients with compromised
circulation, which decreases renal blood flow.The traditional NSAIDs
inhibit both of these enzymes while more selective COX inhibitors such
as rofecoxib (Vioxx) and celecoxib (Celebrex) selectively inhibit the
COX-2 enzyme.The same patients who are at risk for renal toxicity with
traditional NSAIDs are also at risk with the selective COX-2
inhibitors.?
http://www.nurseweek.com/ce/ce80a.asp
It appears Bob, that the answer would be that a dialysis patient
should not take Vioxx. On the other hand, you really should discuss
this with a nephrologist (kidney doctor). If the patient is in ESRD,
and the severity of the problem for which the patient takes Vioxx
warrants it, then the nephrologist may feel the gain is worth the
risk. If the patient is on short-term dialysis, then the doctor may
feel it is in the patient?s interest to refrain from using Vioxx for a
time. You can see how each patient?s medical history and current
condition play into the decision to continue (or not) with Vioxx.
Hope this helps you with the decision! If any part of my answer is
unclear, or I have duplicated information you already had, please
request an Answer Clarification before rating. By doing so, I will be
able to assist you further, if possible.
Regards,
crabcakes
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