Celecoxib
Indications
Celecoxib is used for:
Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis, Dysmenorrhea, Acute pain, Familial adenomatous polyposis
Adult Dose
Oral
Osteoarthritis
Adult: 200 mg/day as a single dose or in 2 divided doses. May increase to 200 mg bid, if necessary.
Rheumatoid arthritis
Adult: 100-200 mg bid.
Dysmenorrhoea; Pain relief
Adult: Initially, 400 mg followed by 200 mg if necessary on the 1st day. Maintenance: 200 mg bid.
Ankylosing spondylitis
Adult: Initially, 200 mg/day as a single dose or in 2 divided doses. May increase to 400 mg/day after 6 wk.
Hepatic impairment: Moderate (Child-Pugh category B): Reduce dose by 50%. Severe (Child-Pugh category C or ?10 score): Contraindicated.
Child Dose
Juvenile idiopathic arthritis
Child: >2 yr >10 kg to <25 kg: 50 mg bid;
>25 kg: 100 mg bid.
Renal Dose
Administration
May be taken with or without food. Dose for OA/RA may be given w/ or w/o meals, but doses for FAP must be given w/ meals.
Contra Indications
Hypersensitivity including those in whom attacks of angioedema, rhinitis and urticaria have been precipitated by aspirin, NSAIDs or sulfonamides. Severe hepatic impairment; severe heart failure; inflammatory bowel disease; peptic ulcer; renal impairment (creatinine clearance <30 mL/min); pregnancy and lactation.
Precautions
History of GI bleeding; renal/hepatic insufficiency; asthma or allergic disorders; hypertension; monitor Hb or haematocrit levels for signs of anaemia. History of cerebrovascular disease or ischaemic heart disease (IHD).
Lactation: Drug enters breast milk; use caution
Pregnancy-Lactation
Pregnancy category: C; D at >30 weeks' gestation (may cause premature closure of ductus arteriosus)
Lactation: Drug enters breast milk; use caution
Interactions
May increase plasma level w/ CYP2C9 isoenzymes (e.g. fluconazole). May increase serum level of lithium. May reduce effect of antihypertensives and diuretics. May increase anticoagulant effect of warfarin.
Adverse Effects
Side effects of Celecoxib :
>10%
Headache (10-16%), Hypertension (13%)
1-10%
Fever (9%), Dyspepsia (8.8%), Upper respiratory tract infection (8.1%), Arthralgia (7%), Cough (7%), Vomiting (6%), Diarrhea (5.6%), Gastroesophageal reflux (5%), Sinusitis (5%), Abdominal pain (4.1%), Nausea (3.5%), Back pain (2.8%), Insomnia (2.3%), Pharyngitis (2.3%), Flatulence (2.2%), Rash (2.2%), Dizziness (2%), Peripheral edema (2%)
<1%
Anemia, Erythema multiforme, Exfoliative dermatitis, Hepatitis, Jaundice, Stevens-Johnson syndrome, Toxic epidermal necrolysis
Frequency Not Defined
Increased serum asparate aminotransferase concentration
Potentially Fatal: Serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
Mechanism of Action
Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor primarily responsible to reduce mediators of pain and inflammation. Its action is due to inhibition of prostaglandin synthesis via inhibition of COX-2.