Celecoxib: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Jan 24, 2020.
1. How it works
- Celecoxib helps relieve pain and inflammation by blocking COX-2 enzymes, which are responsible for the synthesis of prostaglandins (prostaglandins are released during inflammation and elevate body temperature and make nerve endings more sensitive to pain transmission). COX-2 enzymes release prostaglandins in response to infection or injury.
- Celecoxib belongs to a class of medicines known as NSAIDs (nonsteroidal anti-inflammatory drugs). It is specifically a COX-2 inhibitor.
- Effective for the relief of acute pain, including period pain (primary dysmenorrhea).
- Helps relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
- Does not cause dependence.
- Associated with fewer gastrointestinal-related adverse events compared to NSAIDs that inhibit both COX-1 and COX-2 enzymes.
- May be taken once or twice a day.
- Generic celecoxib is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Diarrhea, abdominal pain, flatulence, and dyspepsia. Incidence is less than most other NSAIDs (such as naproxen, diclofenac, and ibuprofen).
- A headache, sinusitis, and rhinitis have also been reported.
- Celecoxib, like all NSAIDs, is associated with an increased risk of serious, potentially fatal, adverse gastrointestinal events such as bleeding, ulceration, and perforation. The risk is greater for seniors, in people who drink alcohol, and in those with a previous history of serious gastrointestinal events.
- Celecoxib has been associated with an increased risk of serious cardiovascular events including stroke and heart attack. Most NSAIDs have a similar risk. Patients with pre-existing cardiovascular disease or risk factors for cardiovascular disease may be at greater risk. The risk also increases with duration of use.
- May not be suitable for some people including those with sulfonamide allergy or who have experienced asthma, urticaria, or an allergic-type reaction to aspirin or other NSAIDs.
- Because celecoxib is a sulfonamide it has the potential to cause severe skin reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which may be fatal.
- Caution may be required when using in people with preexisting cardiovascular disease including high blood pressure, congestive heart failure, a previous history of peptic ulcer disease or gastrointestinal bleeding, or kidney disease.
- Rarely, may cause elevations in liver enzymes and severe hepatic reactions, some fatal. Liver function should be monitored when celecoxib is taken for extended periods of time.
- Kidney damage has also been reported with NSAID use, either as a result of long-term administration or in people whose kidneys function is dependent on renal prostaglandins.
- Rarely, anaphylaxis-like reactions have been reported. The risk is highest in people with asthma who also have rhinitis, or in those who have reacted previously to aspirin or other NSAIDs.
- May interact with some other medicines such as warfarin, lithium, ACE inhibitors, and diuretics.
- Should not be used for pain relief during coronary artery bypass graft (CABG) surgery or given in late pregnancy (from 30 weeks gestation).
- The only formulation of celecoxib is an oral capsule which is taken by mouth.
- Only available on prescription (many NSAIDs are available over-the-counter).
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Use the lowest effective dose for the shortest possible time, or as directed by your doctor.
- May be taken once or twice daily.
- In those who have difficulty swallowing, a capsule of celecoxib may be opened and the contents mixed with applesauce and ingested immediately.
- See your doctor immediately if you develop chest pain, shortness of breath, weakness, or slurring of speech. If you have pre-existing cardiovascular disease, ensure you keep your regular check-ups with your doctor.
- Also contact your doctor urgently if you develop unexplained nausea or flu-like symptoms, a skin rash or an itch, fluid retention, blood in the stools or in sputum, or upper right abdominal pain.
- Tell your doctor if you have asthma or a history of rhinitis or hay fever before you take celecoxib.
- NSAIDs should not be used in the last 3 months of pregnancy; ask your doctor before using any medication during pregnancy.
- Avoid if you have a history of asthma or hives due to aspirin use or other NSAIDs, like naproxen.
- Celecoxib may make your skin more sensitive to the sun. Avoid spending excessive periods of time in the sun, and wear sun-protective clothing and a broad-spectrum SPF 30+ sunscreen when outside.
6. Response and Effectiveness
- Peak levels of celecoxib are reached approximately 3 hours after an oral dose. The pain-relieving effects of celecoxib may last up to 24 hours.
Medicines that interact with celecoxib may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with celecoxib. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with celecoxib include:
- anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
- corticosteroids, such as dexamethasone
- diuretics, such as furosemide
- medications that lower blood pressure, such as ACE inhibitors (eg, benazepril, captopril), ARBs (such as candesartan, irbesartan), or beta-blockers (eg, atenolol, sotalol)
- methotrexate and other drugs used to treat rheumatoid arthritis
- nonsteroidal anti-inflammatories (NSAIDs), such as diclofenac, etodolac, ibuprofen, meloxicam, nabumetone, or naproxen
- other medications that inhibit or induce cytochrome enzymes CYP2D6, such as fluoxetine, bupropion, duloxetine
Alcohol can increase the likelihood of gastrointestinal side effects with celecoxib, and possibly liver and kidney damage.
Note that this list is not all-inclusive and includes only common medications that may interact with celecoxib. You should refer to the prescribing information for celecoxib for a complete list of interactions.
Celecoxib. Revised 09/2019. Drugs.com https://www.drugs.com/ppa/celecoxib.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use celecoxib only for the indication prescribed.
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More about celecoxib
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- Drug class: cox-2 inhibitors
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Other brands: Celebrex