Tolerance induction to rofecoxib in a patient with Bartter's syndrome

Abstract

Rationale We performed a desensitization to rofecoxib in a patient with Bartter's syndrome (inherited renal defective salt reabsorption) and multiple drug intolerance syndrome. Methods A 28-year-old woman Bartter's syndrome had manifested generalized erythema and itching after taking rofecoxib (12.5 mg) and other anti-inflammatory drugs, despite a preventive antireactive therapy (loratadine 10 mg, cromolyn sodium 500 mg). Avoidance of non-steroidal anti-inflammatory drugs was recommended. Since she needed a COX II-inhibitor for Bartter's syndrome management, after a preliminary evaluation (negative prick and patch tests) we attempted a desensitization to rofecoxib, according to a new original protocol, on the basis of our encouraging previous experiences dealing with drug desensitization. Oral 8-day desensitizing treatment to rofecoxib was performed starting with an initial dose of 1 ml of a rofecoxib solution (2.5 mg/mL) diluted 1:10 5, progressively decreasing dilutions until the 6th day, when patient took 10 mL of the pure solution (25 mg); she received a cumulative dose of 37.5 mg on the 7th day and of 50 mg of rofecoxib on the 8th day. When the desensitization was completed, she went on taking 50 mg a day. Antihistamine medication (loratadine 10 mg/die) was administered during the treatment. Results The desensitization was well tolerated, without side effects, and the therapeutic daily dose (50 mg) has been rapidly reached (8 days). Conclusions In case of intolerance to rofecoxib, clinical tolerance induction, by our desensitizing protocol, can represent an useful tool.