Indications of Coxpain 90 mg
Coxpain 90 mg is indicated for the symptomatic relief of-
Rheumatoid arthritis (RA)
Ankylosing spondylitis, and
The pain and signs of inflammation associated with acute gouty arthritis.
For the short-term treatment of moderate pain associated with dental surgery.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Coxpain 90 mg is a non-steroidal anti-inflammatory drug (NSAID). It has anti-inflammatory, analgesic and antipyretic activities. Coxpain 90 mg is a selective cyclooxygenase-2 (COX-2) inhibitor.
Dosage & Administration of Coxpain 90 mg
For adult and adolescent over 16 years, in osteoarthritis, chronic musculoskeletal disorders & dysmenorrhea, the recommended dose of Coxpain 90 mg is 60 mg once daily. In rheumatoid arthritis, this dose is 90 mg once daily and in pain following dental surgery & acute gout, this dose is 120 mg once daily.
Dosage of Coxpain 90 mg
Adult and adolescent over 16 years:
Osteoarthritis: The recommended dose is 30 mg once daily. In some patients with insufficient relief from symptoms, an increased dose of 60 mg once daily may increase efficacy.
Rheumatoid arthritis: The recommended dose is 90 mg once daily.
Ankylosing spondylitis: The recommended dose is 90 mg once daily.
Acute gouty arthritis: The recommended dose is 120 mg once daily. In clinical trials for acute gouty arthritis, Coxpain 90 mg was given for 8 days.
Postoperative dental surgery pain: The recommended dose is 90 mg once daily, limited to a maximum of 3 days.
Some patients may require additional postoperative analgesia. As the cardiovascular risks of Coxpain 90 mg may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used. The patient's need for symptomatic relief and response to therapy should be re-evaluated periodically, especially in patients with osteoarthritis.
Interaction of Coxpain 90 mg
Oral anticoagulants: In subjects stabilized on chronic warfarin therapy, the administration of Coxpain 90 mg was associated with an increase in prothrombin time.
Diuretics, ACE inhibitors and Angiotensin II Antagonists: NSAIDs may reduce the effect of diuretics and other antihypertensive drugs.
Acetylsalicylic Acid: Coxpain 90 mg can be used concomitantly with acetylsalicylic acid at doses used for cardiovascular prophylaxis (low-dose acetylsalicylic acid).
Ciclosporin and tacrolimus: Although this interaction has not been studied with Coxpain 90 mg, coadministration of ciclosporin or tacrolimus with any NSAID may increase the nephrotoxic effect of ciclosporin or tacrolimus.
Lithium: NSAIDs decrease lithium renal excretion and therefore increase lithium plasma levels.
With food & others: Take without regards to meals.
Hypersensitivity to the active substance or to any of the excipients.
Active peptic ulceration or active gastro-intestinai (Gl) bleeding.
Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions after taking acetylsalicylic acid or NSAIDs including COX-2 (cyclooxygenase-2) inhibitors.
Pregnancy and lactation.
Severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score 10).
Estimated renal creatinine clearance <30 ml/min.
Children and adolescents under 16 years of age.
Inflammatory bowel disease.
Congestive heart failure (NYHA ll-IV).
Patients with hypertension whose blood pressure is persistently elevated above 140/90 mmHg and has not been adequately controlled.
Established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease.
Side Effects of Coxpain 90 mg
Side-effects may include palpitation, fatigue, influenza-like symptoms, ecchymosis; less commonly dry mouth, taste disturbance, mouth ulcer, appetite and weight change, atrial fibrillation, transient ischaemic attack, chest pain, flushing, cough, dyspnoea, epistaxis, anxiety, mental acuity impaired, paraesthesia, electrolyte disturbance, myalgia and arthralgia; very rarely confusion and hallucinations.
Pregnancy & Lactation
Coxpain 90 mg should be avoided in late pregnancy because it may cause premature closure of the ductus arteriosus. As it is excreted in breast milk, use of Coxpain 90 mg should be avoided during lactation.
Precautions & Warnings
Caution is advised with treatment of patients most at risk of developing a gastrointestinal complication with NSAIDs; the elderly, patients using any other NSAID or acetylsalicylic acid concomitantly or patients with a prior history of gastrointestinal disease, such as ulceration and Gl bleeding.
Patients with significant risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking) should only be treated with Coxpain 90 mg after careful consideration.
Administration of Coxpain 90 mg may cause a reduction in prostaglandin formation and, secondarily, in renal blood flow, and thereby impair renal function. Monitoring of renal function in such patients should be considered.
Caution should be exercised in patients with a history of cardiac failure, left ventricular dysfunction, or hypertension and in patients with pre-existing edema from any other reason.
Any patients with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormalliver function test has occurred, should be monitored. If signs of hepatic insufficiency occur, or if persistently abnormal liver function tests (three times the upper limit of normal) are detected, Coxpain 90 mg should be discontinued.
Coxpain 90 mg should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Coxpain 90 mg may mask fever and other signs of inflammation. Caution should be exercised when co-administering Coxpain 90 mg with warfarin or other oral anticoagulants.
Overdose Effects of Coxpain 90 mg
Administration of single doses of Coxpain 90 mg up to 500 mg and multiple doses up to 150 mg/day for 21 days did not result in significant toxicity. In the event of overdose, it is reasonable to employ the usual supportive measures, e.g., remove unabsorbed material from the Gl tract, employ clinical monitoring, and institute supportive therapy, if required.
Store at a temperature of below 30°C, protect from light & moisture. Keep out of reach of children.
Use In Special Populations
Safety and effectiveness of Coxpain 90 mg in pediatric patients have not been established.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Mode Of Action
Coxpain 90 mg is a potent, orally active cyclooxygenase-2 (COX-2) specific inhibitor within, and significantly above, the clinical dose range. Two isoforms of cyclooxygenase have been identified: cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 is responsible for prostaglandin-mediated normal physiologic functions such as gastric cytoprotection and platelet aggregation. Inhibition of COX-1 by nonselective NSAIDs has been associated with gastric damage and inhibition of platelet aggregation. COX-2 has been shown to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever. Selective inhibition of COX-2 by Coxpain 90 mg (within the clinical dose range) decreases these clinical signs and symptoms with decreased potential for Gl toxicity and effects on platelet aggregation. Coxpain 90 mg produced dose-dependent inhibition of COX-2 without inhibition of COX-1 at doses up to 150 mg daily. Coxpain 90 mg did not inhibit gastric prostaglandin synthesis.
The use of Coxpain 90 mg, as with any drug substance known to inhibit COX-2, is not recommended in women attempting to conceive. It is not known whether Coxpain 90 mg is excreted in human milk. Coxpain 90 mg is excreted in the milk of lactating rats. Women who use Coxpain 90 mg must not breastfeed.