Appendix: Parecoxib and valdecoxib measurement by ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) Samples of parecoxib sodium and valdecoxib used as standard materials in the assay were a gift from Pfizer Australia Pty Ltd, North Ryde, Australia. Parecoxib and valdecoxib were extracted from 50 μL of milk by protein precipitation with 1 mL of methanol containing valdecoxib-13C215N (2 g/L) as internal standard (Toronto Research Chemicals Inc, North York, ON, Canada). A 20 μL aliquot of the supernatant was injected onto the UPLC-MS/MS. For extraction of parecoxib and valdecoxib from plasma, it was necessary to use a liquid-liquid extraction procedure. Aliquots of plasma (250 μL) and internal standard (50 μL of valdecoxib-13C215N; 100 ng/mL) were extracted with 100 μL of 1M HCl and 5 mL of dichloromethane. Because parecoxib is an acidic drug, extraction at low pH results in adequate recovery. Although valdecoxib is basic, the formation of a chloride salt, soluble in dichloromethane accounts for adequate recovery of both valdecoxib and the internal standard in the above conditions. After centrifugation (2,000 g for 5min) the top aqueous layer was aspirated to waste. The dichloromethane layer was transferred to clean glass tubes, and dried with a gentle stream of N2 at 50oC. The residue was reconstituted with 1 mL of methanol and 20 μL aliquots were injected onto the UPLCMS/MS system. The UPLC-MS/MS system consisted of a Waters Acquity UPLC (Milford, MA, USA) coupled with a Waters Premier XE MS-MS (Milford, MA, USA). The LC mobile phases were (A) 25% acetonitrile in 2 mM ammonium acetate / 0.1% formic acid, and (B) 50/50 methanol and 2 mM ammonium acetate in 0.1% formic acid. Elution of the analytes through a Waters OASIS HLB 2.1 x 20 mm x 5 μm column (Wexford, Ireland) was effected by an initial gradient flow of 0.6 mL/min 50% A and 50% B, then ramped to 100% B over 0.8 min, followed by 0.1 min reconditioning. In ESI+ mode, the MRM protonated adduct transitions m/z 315.2 to 220.2 and m/z 371.1 to 234.2 for valdecoxib and parecoxib respectively, and m/z 318.2 to 222.2 for valdecoxib-13C215N were monitored. Capillary voltage was set at 1.2 kV for both analytes, while cone voltages of 30 V and 35 V, and collision energies of 25 eV and 20 eV were used for valdecoxib and parecoxib respectively. The source temperature was 400oC for both analytes. Under these conditions, the retention times for valdecoxib and parecoxib, its labelled internal standard, were 1.1 and 1.3 min respectively. In plasma, linearity was established for both valdecoxib and parecoxib over the concentration range of 10 g/L to 1869 g/L (r2 = 0.999) and 9 g/L to 2010 g/L (r2 = 0.999) respectively. In milk, linearity was also established for both valdecoxib and parecoxib over the concentration range of 1 mcg/L to 201 g/L (r2 = 0.999) and 0.9 g/L to 217 g/L (r2 = 0.999) respectively. Matrix effects, absolute recovery, process efficiency and inter-patient (intra-day) variability (relative standard deviation; RSD) for the assay were investigated as previously described34 using 5 blank plasma and milk samples from different patients. For sample set 1, plasma was spiked with parecoxib at 10 g/L, 100 g/L and 2000 g/L, and with valdecoxib at 10 g/L, 100 g/L and 1000 g/L and milk was spiked with parecoxib at 1 g/L, 10 g/L and 100 g/L, and with valdecoxib at 1 g/L, 10 g/L and 100 g/L. Internal standard valdecoxib-13C215N at was spiked into plasma at 100 g/L and milk at 2 g/L. For sample set 2 spiked post-extraction addition extracts for the same 5 samples were also prepared at concentrations equivalent to those above by using a fixed volume of the extracts obtained after the methanolprecipitation (plasma), or after the dichloromethane extraction and reconstitution in methanol (milk) steps. Finally, for sample set 3 “pure solutions” of all analytes at concentrations equivalent to those described above were prepared by diluting with methanol. These data are summarized in the Appendix Tables 1 and 2 (see Supplemental Digital Content 3, http://links.lww.com/AA/A353). Additional intra-day RSD data (n=5) for parecoxib gave values of 6.5% at 1 g/L in plasma and 5.7% at 1.5 g/L in milk. For plasma, the inter-day RSD at 200 g/L, 400 g/L and 800 g/L (n=5) were 3.3%, 5.2% and 1.7% respectively for parecoxib, and 2.3%, 1.9% and 1.1% respectively for valdecoxib. For milk, the inter-day RSD at 10 g/L and 100 g/L (n=5) were 10.2% and 2.0% respectively for parecoxib and 7.2% and 2.2% respectively for valdecoxib. Limits of quantitation for the assay were set at 1.5g/L and 1 g/L for parecoxib in milk and plasma respectively and at 10g/L for valdecoxib in both milk and plasma.