Overview
Celecoxib is a selective COX-2 inhibitor NSAID used for pain and inflammation management. It provides analgesic and anti-inflammatory effects while having reduced gastrointestinal toxicity compared to non-selective NSAIDs. It is commonly prescribed for osteoarthritis, rheumatoid arthritis, and acute pain conditions.
Mechanism of Action
Selectively inhibits cyclooxygenase-2 (COX-2), reducing prostaglandin synthesis responsible for pain, inflammation, and fever. Unlike traditional NSAIDs, it has minimal effect on COX-1 at therapeutic doses, which reduces gastrointestinal side effects.
Indications
- Osteoarthritis
- Rheumatoid arthritis
- Acute pain
- Ankylosing spondylitis
- Primary dysmenorrhea
Common Doses
- 50 mg
- 100 mg
- 200 mg
- 400 mg
Dosage
Typically 100-200 mg twice daily for osteoarthritis, 100-200 mg twice daily for rheumatoid arthritis, and 400 mg initially followed by 200 mg as needed for acute pain. Maximum daily dose is 400 mg for most indications.
Contraindications
- Known hypersensitivity to celecoxib or any component
- History of asthma, urticaria, or allergic reactions to aspirin or other NSAIDs
- Patients with severe anaphylactic reactions to NSAIDs
- In the setting of CABG surgery
- Patients with allergic-type reactions to sulfonamides
Side Effects
- Headache
- Dyspepsia
- Diarrhea
- Abdominal pain
- Peripheral edema
- Hypertension
- Increased risk of cardiovascular events
- Gastrointestinal bleeding
- Hepatotoxicity
- Renal impairment
- Anaphylactic reactions
- Serious skin reactions
Interactions
- Anticoagulants (warfarin) - increased bleeding risk
- Aspirin - increased GI bleeding risk
- ACE inhibitors/ARBs - reduced antihypertensive effect
- Diuretics - reduced efficacy
- Lithium - increased lithium levels
- Methotrexate - increased toxicity risk
- Cyclosporine - increased nephrotoxicity
- CYP2C9 inhibitors (fluconazole) - increased celecoxib exposure
- Corticosteroids - increased GI ulceration risk
Counseling Points
- Take with food or milk to reduce stomach upset
- Report signs of GI bleeding (black stools, vomiting blood)
- Monitor blood pressure regularly
- Report signs of allergic reaction (rash, swelling, difficulty breathing)
- Avoid alcohol consumption
- Do not use for fever reduction in children
- Not a substitute for low-dose aspirin for cardiovascular protection