Celebrex for Arthritis and Pain Management

Celebrex is a prescription nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain and inflammation associated with various forms of arthritis and other painful conditions. It is approved to relieve symptoms of osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, acute pain, and primary dysmenorrhea.

• Osteoarthritis (OA): Relief of signs and symptoms in adults.
• Rheumatoid arthritis (RA): Relief of signs and symptoms in adults.
• Juvenile rheumatoid arthritis (JRA): Relief of signs and symptoms in patients aged 2 years and older.
• Ankylosing spondylitis (AS): Management of signs and symptoms in adults.
• Acute pain (AP): Management in adults.
• Primary dysmenorrhea (PD): Treatment of menstrual pain in adults.

celecoxib

Celebrex works by selectively inhibiting the cyclooxygenase-2 (COX-2) enzyme, which plays a key role in the production of prostaglandins that cause inflammation and pain. By blocking COX-2, Celebrex helps reduce inflammation, swelling, and pain without strongly affecting COX-1, which protects the stomach lining.

General Instructions

Use the lowest effective dose for the shortest duration consistent with individual treatment goals. Capsules may be taken with or without food. For patients with difficulty swallowing, capsule contents can be mixed with applesauce and taken immediately.

Adults

• Osteoarthritis: 200 mg once daily or 100 mg twice daily.
• Rheumatoid arthritis: 100 to 200 mg twice daily.
• Ankylosing spondylitis: 200 mg once daily (single or divided dose). If no response after 6 weeks, trial of up to 400 mg daily may be considered.
• Acute pain and primary dysmenorrhea: Initial dose of 400 mg followed by 200 mg if needed on the first day; then 200 mg twice daily as needed.

Pediatrics (2 years and older)

• Juvenile rheumatoid arthritis: Dose based on weight: 50 mg twice daily for 10–25 kg; 100 mg twice daily for over 25 kg.

Special Populations

• Reduce dose by 50% in patients with moderate hepatic impairment (Child-Pugh B).
• Use caution and consider dose reduction in patients known or suspected to be poor CYP2C9 metabolizers.

• Known hypersensitivity to celecoxib, aspirin, other NSAIDs, or sulfonamides.
• History of asthma, urticaria, or allergic reactions after aspirin or NSAIDs.
• Use for peri-operative pain in coronary artery bypass graft (CABG) surgery.

Cardiovascular Risks

Celebrex may increase the risk of serious cardiovascular events such as heart attack and stroke, which can be fatal. This risk may be higher with longer use and in patients with existing cardiovascular disease or risk factors. It is contraindicated for peri-operative pain in coronary artery bypass graft surgery.

Gastrointestinal Risks

Use of Celebrex can cause serious, sometimes fatal, gastrointestinal bleeding, ulceration, and perforation at any time during therapy, often without warning symptoms. Elderly patients and those with a history of ulcers or GI bleeding are at increased risk.

Other Serious Warnings

• Potential for severe liver toxicity; discontinue if liver function worsens.
• May cause new or worsening hypertension; monitor blood pressure regularly.
• Fluid retention and edema possible; use caution in heart failure or fluid retention.
• Risk of renal injury with long-term use, especially in vulnerable patients.
• Severe allergic reactions and anaphylactoid responses may occur, especially in patients with aspirin sensitivity or asthma.
• Serious skin reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis can occur; discontinue at first sign of rash.

Common Side Effects

• Edema (fluid retention)
• Elevations in liver enzymes (usually mild)
• Anemia (rare)

Serious Side Effects

• Heart attack and stroke
• Severe gastrointestinal bleeding or ulceration
• Severe allergic reactions including anaphylaxis and angioedema
• Serious skin reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis
• Severe liver damage

• Concurrent use with other non-aspirin NSAIDs increases risk of adverse reactions and should be avoided.
• Use caution with medications metabolized by CYP2C9 such as warfarin and phenytoin; dose adjustments may be necessary in poor metabolizers.
• Concurrent use with aspirin increases gastrointestinal risk but does not consistently reduce cardiovascular risk.
• May impair the effectiveness of antihypertensive agents such as thiazide or loop diuretics.

Pregnancy: Avoid use starting at 30 weeks of gestation due to risk of premature closure of the fetal ductus arteriosus.

Breastfeeding: Information not provided.