Celecoxib

(sel-eh-cox-ib)

Trade Name(s):

Celebrex

Capsules

100 mg

Capsules

200 mg

Indicates Canadian trade names.

Class:

COX-2 inhibitor

Action:
Reduces inflammation (eg, pain, redness, swelling, heat), fever, and pain by inhibiting chemicals in the body that cause inflammation, fever, and pain. This is probably caused by the inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2) isoenzyme.

Indications:
Relief of symptoms of osteoarthritis; relief of symptoms of rheumatoid arthritis in adults; reduction of the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP), as an adjunct to usual care (eg, endoscopic surveillance, surgery).

Contraindications:
Allergy to celecoxib or any of its ingredients; allergy to sulfonamides; aspirin triad (eg, asthma, nasal polyps, allergy to aspirin); previous allergic reactions following aspirin or other NSAID use (eg, asthma, hives, rash).

Route/Dosage:

Osteoarthritis

Adults:
PO 200 mg/day administered as a single dose or as 100 mg bid.

Rheumatoid Arthritis

Adults:
PO 100 to 200 mg bid.

FAP

Adults:
PO Continue usual medical care for FAP patients while on celecoxib. To reduce the number of adenomatous colorectal polyps in patients with FAP, the recommended dose is 400 mg (2 x 200 mg capsules) bid. Take with food.

Interactions:

ACE Inhibitors: NSAIDs may diminish the antihypertensive effect of ACE inhibitors.

Aspirin: Concomitant administration with celecoxib may result in an increased rate of GI ulceration or other complications.

Fluconazole: Increase in celecoxib plasma concentration may occur because of inhibition of celecoxib metabolism.

Furosemide: NSAIDs can reduce the natriuretic effect of furosemide and thiazides in some patients.

Lithium: Mean steady-state lithium plasma levels increased 17% in subjects receiving lithium with celecoxib.

P450 2C9 Inhibitors: There is a potential for an in vivo drug interaction with drugs that are metabolized by P450 2D6.

Warfarin: Monitor anticoagulant activity, particularly in the first few days, after initiating or changing celecoxib therapy in patients receiving warfarin or similar agents, since these patients are at an increased risk of bleeding complications.

Lab Test Interferences:
None well documented.

Adverse Reactions:

CNS:: Dizziness; headache; sleeplessness.
GI:: Stomach pain; diarrhea; indigestion; gas; nausea.
RESP:: Sinus infection; congested or runny nose; upper respiratory tract infection; sore throat.
OTHER:: Back pain; swelling of arms or legs; accidental injury; rash.

Precautions:

Pregnancy: Category C.

Lactation: Undetermined.

Children: Safety and effectiveness in patients < 18 yr have not been established.

Elderly: Initiate therapy with lowest recommended dose.

Asthma: Use with caution in patients with preexisting asthma.

GI effects: Serious GI toxicity (eg, bleeding, ulcerations, perforations) can occur at any time, with or without warning symptoms.

Patient Care Considerations

Administration/Storage:

Store at room temperature 25°C (77°F); excursions permitted 15 to 30°C (59 to 86°F).
Do not administer to patient who has experienced asthma, urticaria, or hypersensitity reactions after taking aspirin or other NSAIDs.
Do not administer to pregnant women or nursing mothers.
Administer the lowest therapeutic dose possible as prescribed for each patient.
Do not administer to patients with hypersensitivity to sulfonamides, NSAIDs, aspirin, celecoxib, or any of their ingredients.
Administer to adults > 18 yr.

Assessment/Interventions:

Assess for signs and symptoms of hypersensitivity.
Take a complete drug history and monitor potential drug/drug interactions and contraindications that should be reported to the primary care provider.
Monitor for signs of GI bleeding, adverse CNS symptoms, and any other adverse events.
Monitor for signs of skin rash.
Monitor for signs and symptoms of decreased renal function: Serum creatinine, BUN, unexpected weight gain, edema.
Monitor for signs of hypophosphatemia and hyperchloremia.
Monitor hepatic function, as decreased hepatic function may require a reduced dose.

Patient/Family Education:

Instruct patient to take medication as prescribed.
Advise patient to inform primary care provider if taking or planning to take any otc medications as there is potential for drug interactions.
Advise patient with sensitive stomach to take medication with food to help avoid GI distress.
Instruct patient to promptly report signs or symptoms of GI ulceration or bleeding, skin rash, unexplained weight gain, or edema to primary care provider.
Inform patient of the warning signs and symptoms of hepatotoxicity (eg, nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness, flu-like symptoms) and to stop therapy and contact the primary care provider should any of these occur.
Instruct patient to seek immediate emergency help in case of an anaphylactoid reaction.
Warn women with childbearing potential to avoid becoming pregnant and apprise them of the potential hazard to the fetus, especially in the third trimester.
Warn nursing mothers of the danger of transferring the drug to the baby through the mother's milk. Make a decision to discontinue the drug or nursing in collaboration with the primary health care provider.
Instruct patient to report any unusual reaction or concern to the primary care provider.