Comparative Pharmacology
Head-to-head clinical analysis: BUTAZOLIDIN versus VIMOVO.
Peer-Reviewed Evidence
Head-to-head clinical analysis: BUTAZOLIDIN versus VIMOVO.
BUTAZOLIDIN vs VIMOVO
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), thereby reducing prostaglandin synthesis. Also has uricosuric effect at higher doses.
VIMOVO (esomeprazole and naproxen) is a fixed-dose combination. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), decreasing prostaglandin synthesis, thereby reducing inflammation, pain, and fever. Esomeprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by inhibiting the H+/K+ ATPase in gastric parietal cells. The combination is intended to reduce the risk of NSAID-associated gastric ulcers.
Butazolidin (phenylbutazone) is typically administered orally at 100-200 mg 3 times daily with meals, not to exceed 600 mg/day. Initial loading dose of 400 mg may be given on day 1, followed by 300-400 mg/day in divided doses. Duration should be limited to 7-10 days.
One tablet (naproxen 500 mg/esomeprazole 20 mg) orally twice daily.
None Documented
None Documented
Terminal half-life: 50-100 hours (prolonged in elderly or hepatic/renal impairment; accumulation risk evident within 5-7 days).
Naproxen: 12-17 hours (prolonged in elderly and renal impairment; dosing interval typically 12 hours). Esomeprazole: 1-1.5 hours (metabolized by CYP2C19 and CYP3A4; no accumulation after repeated dosing).
Primarily renal: ~60% as unchanged drug and glucuronide conjugates; biliary/fecal: ~40% (enterohepatic circulation).
Renal 50% as naproxen metabolites, <1% unchanged naproxen; less than 1% excreted unchanged in feces as esomeprazole; esomeprazole metabolites excreted in urine 80% and feces 20%.
Category C
Category C
NSAID
NSAID/PPI Combination