💊 Celecoxib (Celecoxib)

🏷️ Brand names & manufacturers

Celebrex🏭 Viatris Specialty LLCDailyMed

Vyscoxa🏭 Carwin Pharmaceutical Associates, LLCDailyMed

Celecoxib🏭 Actavis Pharma, Inc.DailyMed

Celecoxib🏭 Unichem Pharmaceuticals (USA), Inc.DailyMed

Celecoxib🏭 Alembic Pharmaceuticals LimitedDailyMed

✅ What it is used for

• Management of signs and symptoms of osteoarthritis (OA)
• Management of signs and symptoms of rheumatoid arthritis (RA)
• Juvenile rheumatoid arthritis (JRA) in patients 2 years and older
• Ankylosing spondylitis (AS)
• Management of acute pain in adults
• Primary dysmenorrhea

🧪 Active ingredient

The active ingredient is celecoxib, which inhibits prostaglandin synthesis (primarily via COX-2 inhibition). Prostaglandins mediate pain and inflammation, so this produces analgesic, anti-inflammatory, and antipyretic effects.

🌿 Benefits

• Relieves pain and inflammation in arthritic conditions
• Manages acute pain
• Relieves menstrual pain (primary dysmenorrhea)
• Did not reduce platelet aggregation or increase bleeding time in clinical trials, but it is not a substitute for aspirin for cardiovascular prophylaxis

📝 How to use

• The dose and duration are set by your doctor or pharmacist; do not change them on your own.
• Use the lowest effective dose for the shortest duration consistent with treatment goals.
• Taken by mouth; doses can be taken without regard to meals.
• For children who have difficulty swallowing capsules: per the label, the capsule contents may be carefully emptied onto a level teaspoon of cool or room-temperature applesauce and swallowed immediately with water, as directed by the doctor.

💊 Dosage forms

• Capsules: 50 mg, 100 mg, 200 mg, and 400 mg

🔄 Drug interactions

• Anticoagulants (e.g., warfarin), antiplatelet drugs (e.g., aspirin), SSRIs and SNRIs: increased risk of bleeding; monitor for signs of bleeding.
• Aspirin at analgesic doses: not generally recommended due to increased bleeding and GI adverse reactions; celecoxib is not a substitute for low-dose aspirin for cardiovascular protection.
• ACE inhibitors, ARBs, and beta-blockers: NSAIDs may diminish antihypertensive effect, and co-administration in elderly, volume-depleted, or renally impaired patients may increase the risk of worsening renal function.
• CYP2C9 substrates (e.g., warfarin, phenytoin): caution in known or suspected CYP2C9 poor metabolizers.

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👨‍⚕️ For healthcare professionals

Mechanism of action

Celecoxib's analgesic, anti-inflammatory, and antipyretic effects are believed to result from inhibition of prostaglandin synthesis, primarily via COX-2 inhibition. Peak plasma levels occur about 3 hours after an oral dose; it is highly protein bound (>97%), primarily metabolized by CYP2C9, with a half-life of approximately 11 hours. At studied doses it did not reduce platelet aggregation or increase bleeding time.

Labeled dosing

General adult dosing per label: OA 200 mg/day as a single dose or 100 mg twice daily; RA 100–200 mg twice daily; AS 200 mg daily (single or divided), with a trial of 400 mg daily if no effect after 6 weeks; acute pain and primary dysmenorrhea 400 mg initially, plus an additional 200 mg if needed on day 1, then 200 mg twice daily as needed. JRA: 50 mg twice daily for 10–25 kg; 100 mg twice daily for >25 kg. Reduce dose by 50% in moderate hepatic impairment (Child-Pugh B); not recommended in severe hepatic impairment; in known or suspected CYP2C9 poor metabolizers, initiate at half the lowest recommended dose. Final dosing is determined by the prescriber.

• Use the lowest effective dose for the shortest duration.
• Contraindicated in the setting of CABG surgery.
• May be given without regard to meal timing.
• Monitor blood pressure, renal and hepatic function, and hemoglobin/hematocrit as clinically indicated.
• Not a substitute for low-dose aspirin for cardiovascular protection.

🎓 Key points for students

• Class: COX-2-selective NSAID.
• Boxed warning: cardiovascular thrombotic events and GI bleeding, ulceration, and perforation.
• Contraindications: sulfonamide allergy, aspirin/NSAID-triggered asthma/urticaria/allergic reactions, CABG setting.
• Metabolized by CYP2C9; reduce dose 50% in poor metabolizers or moderate hepatic impairment.
• Overdose: supportive care, no specific antidote; consider activated charcoal if seen early or large ingestion.
• Avoid at about 30 weeks gestation and later due to risk of premature ductus arteriosus closure.