Celecoxib (Oral)

The primary purpose accomplished by celecoxib is in the relief of pain and swelling due to various medical conditions in the body, and it does this by blocking the enzyme which is responsible for making prostaglandins, which encourage pain and swelling.

Overview

Celecoxib is a drug which is taken orally for the management of pain and swelling at sites of inflammation around the body. Some of the medical conditions it is most commonly used for include menstrual pain and discomfort, juvenile arthritis, chronic arthritis, ankylosing spondylitis, and in the treatment of hereditary polyps.

It is a non-steroidal inflammatory drug which works by blocking the enzyme in the body which is responsible for creating prostaglandins, which are cyclic fatty acid compounds that cause several effects which mimic hormones, including inflammation. It should be taken at mealtimes, to reduce the potential for an upset stomach, and it should be ingested with a full glass of water to ensure that it flushes through the system.

There are some fairly serious warnings and precautions associated with using celecoxib, or any other NSAID drug, so a doctor will only prescribe celecoxib when it is deemed that the benefits of treatment outweigh the possible risks to any given patient. Even so, any patient using this drug should be closely monitored for signs of potential reactions, which are described elsewhere in this article.

Condition Treated

  • Arthritis, ankylosing spondylitis, menstrual pain, hereditary polyps in the colon

Type of Medicine

  • Non-steroidal inflammatory drug (NSAID)

Side Effects

There are a huge number of potential side effects which can occur when using celecoxib, and the severity of the side effects range from very mild to very severe, as categorized below. Any actions taken in response to the appearance of these side effects should depend on which categories they appear in, because that will relate to the level of health hazard indicated. The side effects which can occur when using celecoxib that require no medical attention at all will generally subside all by themselves with no treatment, as a patient's body adjusts to the usage of the medication. For these milder medication side effects which become bothersome to a patient, the family doctor may be able to provide some kind of treatment which will mitigate their effects or eliminate them entirely.

The side effects considered mild and requiring no medical attention are as follows:

  • style="font-weight: 400;">back pain
  • a runny nose or stuffy nose
  • burning sensation in the throat or a sore throat
  • 400;">heartburn
  • 400;">headache
  • persistent gas or bloating
  • difficulty falling asleep
  • anxiety or nervousness
  • cloudy or bloody urine
  • loss of energy or persistent fatigue
  • hearing loss
  • muscle pain or stiffness
  • tingling sensation in the fingers or toes
  • bone deformity
  • 400;">breast pain
  • ringing noise in the ears
  • unexplained loss of appetite
  • loss of height
  • 400;">depression
  • burning sensation or pain while urinating
  • moving or walking difficulty
  • swallowing problems
  • sensitivity to sunlight with the potential for severe sunburn
  • swelling or redness in the arms and legs
  • pain during sexual intercourse
  • unexplained pain in the arms, ribs, back, or legs
  • irregular or pounding heartbeat
  • puffiness around the eyelids, lips, or tongue
  • change in taste
  • persistent constipation
  • bloody stools,
  • unusual drowsiness
  • straining while defecating
  • spontaneous warm feelings or sweating
  • tenderness of muscles
  • sensation of pressure on the skin
  • unexplained tearing up or crying
  • 400;">hives
  • rashes
  • hoarseness
  • 400;">hair loss or hair thinning
  • white colored vaginal discharge, either with a mild odor or odorless
  • difficulty breathing
  • uncomfortable swelling around the anus
  • infection or inflammation
  • itching, lumps, pain, scarring, rashes, soreness, tingling, tenderness, ulceration, redness, or warmth at various sites on the body
  • vaginal itching
  • patches on the skin which are large and blue or purple in color
  • changes in the voice
  • sensation of weakness or heaviness in the legs
  • bleeding gums
  • bloating, peeling, blistering, or loosening of the skin
  • tiny red spots on the skin
  • irritation or redness around the eyes
  • skin lesions which are red, sometimes having a purple center
  • unsteadiness while walking
  • general shakiness
  • 400;">ulcers, sores, or white spots around the mouth or on the lips
  • persistent cramping of the stomach
  • swelling of the neck
  • very watery or bloody diarrhea.

This grouping of side effects are manifestations which should be reviewed by your doctor at the earliest opportunity, rather than waiting for the next scheduled visit:

  • coughs
  • 400;">fevers
  • severe skin rashes
  • pronounced swelling of the face, feet, lower legs, or fingers
  • a severe sore throat
  • unusual growth in the breast
  • pain in the arms, back, or jaw
  • stools which are bloody, black, or tarry
  • blurred vision or double vision
  • strong burning sensation in the stomach or the chest
  • a persistent tingling or numbness in the hands, legs, feet, or arms
  • strong discomfort or pain in the chest
  • extreme heaviness or tightness felt in the chest
  • disorientation or confusion
  • severe congestion of the chest
  • strong cramps or diarrhea
  • persistent dry mouth
  • earache
  • unusual and irregular heartbeat
  • persistent heartburn
  • high blood pressure which is unusual for the patient
  • heavy vaginal bleeding which is not menstrual
  • increased hunger or thirst
  • persistent loss of appetite
  • tenderness in the stomach area
  • difficulty breathing when any kind of exertion is attempted
  • profuse sweating
  • painful cold sores at locations on the lips, eyes, nose, or genitals
  • unexplained nerve pain
  • increased desire to urinate
  • sudden loss of consciousness
  • stabbing pains around the body
  • soreness or redness around the toenails and fingernails
  • severe stomachache or stomach pain
  • stiff neck
  • swelling or redness around the ears
  • muscle aches and pains not due to exertion
  • nausea and vomiting
  • painful blisters located in the area of the trunk
  • unexplained weight loss
  • wheezing or extreme difficulty with normal breathing
  • weakness and fatigue
  • vomiting up blood or material which has the appearance of coffee grounds
  • sudden weight gain
  • unusual bleeding at various sites around the body
  • changes in skin coloration
  • stools which are clay-colored
  • neck veins which are dilated
  • weakness of the arms or legs on one side or the other of the body
  • sudden inability to speak
  • sores, blisters, or welts at various locations around the body
  • noticeable slurring of speech
  • seizures or convulsions
  • a pale blue color around the toes or fingers
  • very pale stool color
  • unusual bad breath
  • yellowish tinge to the skin or around the eyes.

There are some side effects which indicate that the patient may have taken an overdose, and in situations like these, immediate medical attention should be sought out to prevent symptoms from worsening or to bring on medical disaster for the patient.

Side effects in this category include the following:

  • sudden weight gain
  • extreme difficulty breathing
  • sudden decrease or stoppage in urination habits
  • sudden severe headache or prolonged headaches
  • extreme drowsiness or dizziness
  • persistent thirst which cannot be quenched

Dosage

There are several different approaches to proper dosage administration, and the dosage for any specific patient will depend on a number of factors including all of the following:

  • type of medical condition for which the patient is being treated
  • age group of the patient, i.e. child, adult, geriatric
  • strength of the medication
  • frequency of administration

For adults being treated for some kinds of acute pain, the initial dosage would be a standard 400 mg taken orally, to be followed up with an additional 200 mg if the pain condition has not subsided. Once the patient is on a maintenance program, the normal indicated dosage is 200 mg per day, and it is always advisable to take the lowest possible dosage of celecoxib for the management of acute pain.

For the treatment of an adult with a medical condition of dysmenorrhea, the initial dosage should be 400 mg taken orally, and this can optionally be followed up with another 200 mg, if conditions warrant the extra medication. A standard maintenance dosage for treatment of dysmenorrhea is 200 mg taken orally twice per day, and as always, the lowest possible dosage of celecoxib should be administered in order to adequately treat the condition.

For an adult being treated for osteoarthritis, a standard dosage of 200 mg taken orally once per day is indicated, or alternatively, a 100 mg capsule can be taken twice a day. If a lower dosage can be effective in treating osteoarthritis, that should be the dosage established as a normal maintenance treatment.

For an adult being treated for rheumatoid arthritis, a standard dose of 100 or 200 mg of celecoxib taken orally is indicated, at most twice in a single day. Whatever the lowest dosage of celecoxib can be which still manages the arthritic pain condition, that should be the dosage settled upon.

For an adult being treated with ankylosing spondylitis, a standard dosage would be 200 mg taken orally once in a given day, or two 100 mg capsules taken twice daily. If no relief has been experienced after six weeks, an increase of dosage should be considered up to 400 mg taken orally each day, and if the 400 mg dosage does not achieve the desired results, it would be advisable to consider an alternative medication, since celecoxib does not appear to be effective for this patient.

For juvenile patients being treated for rheumatoid arthritis, and having a weight between 10 kg to 25 kg, a capsule of 50 mg is indicated once per day. For juveniles weighing greater than 25 kg, a capsule of 100 mg can be taken orally twice each day, although, for all cases, the lowest possible dosage should be adopted, as long as it is still treating the rheumatoid arthritis condition adequately.

For those juvenile patients who cannot adequately metabolize CYP4502C9, an alternative medication should be considered.

Renal patients are not advised to use celecoxib, nor are liver patients advised to use celecoxib, since either of these medical conditions can be exacerbated by taking this medication.

Interactions

Celecoxib is known to interact with several other classes of drugs, and if you are taking any of those interacting drugs, there will be varying degrees of reaction that you might observe. For this reason, it is highly advisable to review with your doctor all the other medications which you are currently taking, including other prescription drugs, over-the-counter drugs, vitamins, and herbal supplements, as well as the dosage of each one of these. It will be well worth your while to prepare a comprehensive list which includes all these medications and supplements so as to provide a basis for review with your physician. This same document will also prove invaluable should you ever have a need to make an unplanned visit to a healthcare clinic or to a hospital emergency room. Any doctor other than your primary care physician would not be aware of your medical history or your list of drugs, and would be reluctant to prescribe any medication without knowing that information.

You should not take anti-depressant drugs while on a treatment program which includes celecoxib, for instance, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. Any of the drugs in this list can trigger profuse bleeding when used in conjunction with celecoxib, so they should be avoided.

There are other classes of drugs which also cause interactions with celecoxib, and should not be taken concurrently with it:

  • Lithium
  • Fluconazole
  • Any type of water pill (diuretic) such as furosemide
  • Blood thinners such as warfarin
  • Blood pressure medications, including all the following: candesartan, eprosartan, irbesartan, losartan, valsartan, telmisartan, and olmesartan
  • ACE inhibitors like Ramipril, quinapril, lisinopril, enalapril, and benazepril

There are also a number of common medications which can have interactions with celecoxib, including all of the following:

  • Metoprolol
  • Pregabalin
  • Cyclobenzaprine
  • Omega-3 polyunsaturated fatty acids
  • Levothyroxine
  • Albuterol
  • Acetaminophen
  • Ascorbic acid
  • Cyanocobalamin
  • Aspirin
  • Diphenhydramine
  • Salmeterol
  • Fluticasone
  • Duloxetine
  • Cetirizine
  • Esomeprazole
  • Hydrocodone
  • Cholecalciferol

Patients who have any of the following medications may have a serious reaction when taking celecoxib, and for that reason, physicians will not generally prescribe celecoxib for people who have medical conditions which include:

  • 400;">Asthma
  • Thrombosis
  • 400;">Anemia
  • Renal toxicities
  • Hepatoxicity
  • G.I. toxicity
  • Chronic rashes
  • Fluid retention

In addition to the above, there are other specific combinations of drugs which can produce reactions of either severe or moderately severe reaction. When celecoxib is used with any of the drugs on these two lists, reactions can be dangerous.

  • Severe reactions: cidofovir, ketorolac
  • Moderately severe: mifepristone, foscarnet, apixaban, betrixaban, edoxaban, rivaroxaban, dabigatran, mifamurtide, sodium phosphate bowel cleanser, diflunisal, pemetrexed, anti-coagulants, pralatrexate.

Warnings

There are a number of precautions and warnings which should be observed by any patient who is on a program of treatment involving celecoxib. Disregarding these warnings could result in serious health hazards, so if you have any questions about the precautions and warnings listed below, make sure to thoroughly discuss them with your doctor, rather than run any personal health risk.

If you know you are allergic to celecoxib or any other nonsteroidal anti-inflammatory drug, you should not be taking celecoxib. The allergic signs to look for are a pronounced swelling of the facial area, possibly in the lips, tongue, or mouth. This will generally happen immediately after ingesting celecoxib, and if you should notice any of these signs of swelling, you should discontinue use of the drug, and seek emergency medical attention before symptoms worsen.

In addition, if you are allergic to any other medications that you know of, you should discuss them with your doctor, so he/she can make a determination on whether there might be any interaction with celecoxib.

It's always advisable to have a thorough review of your medical history with your doctor before embarking on any program of treatment with a new drug. With regard to taking celecoxib, you should particularly point out any family history of asthma or other respiratory issues, liver disease, stomach or intestinal disorders, any history of chronic bleeding or ulcers, recurring heartburn, heart disease such as angina, heart attack, or stroke, high blood pressure, nasal growth such as polyps, and any types of blood disorders such as anemia or problems with clotting.

It is possible for kidney problems to develop when using nonsteroidal inflammatory drugs, including celecoxib. People most at risk of developing kidney problems are those who tend to be persistently dehydrated, or who have a medical history of heart failure or kidney disease. Older adults are also somewhat more at risk of developing kidney problems when using celecoxib. To avoid some of the potential risk of taking this drug, you should attempt to stay well hydrated, drinking as many fluids as possible every day.

Some patients have reported stomach bleeding while being treated with celecoxib, and the potential for stomach bleeding is significantly increased in cases where patients are drinking excess alcohol or smoking.

Anytime you are about to have some kind of surgery, including oral surgery, you should discuss with your doctor and surgeon the details of your treatment program with celecoxib. It may be necessary to discontinue your usage of celecoxib or to lower the dosage of it when you have some kind of surgery planned.

When celecoxib is used to treat children who have juvenile rheumatoid arthritis, there is a significantly increased risk of dangerous bleeding or clotting issues, and this situation must be closely monitored because of the severity of the potential reaction. The condition is known as disseminated intravascular coagulation, and is characterized by a sudden bleeding or bruising, which shows up in various areas of the body on the skin, particularly in the areas of the fingers and toes. Any juvenile who is taking celecoxib and exhibits bluish fingers or toes, or show signs of unexplained bruising around the body, should have medical treatment as soon as possible.

Any woman who is pregnant currently or plans to become pregnant should have a thorough discussion with the family doctor about the benefits of celecoxib versus the risks which may be incurred. There is an elevated risk of miscarriage when taking celecoxib, as well as an increased difficulty of getting pregnant in the first place, and for this reason, celecoxib should only be prescribed in cases where it is clearly needed by a pregnant woman, or a woman who anticipates becoming pregnant.

It is not advisable to use celecoxib especially during the first or last trimesters of pregnancy because of the potential for harm to the unborn fetus, and for the increased risk of difficulty during the period of labor and delivery.

It is known that celecoxib does pass through breastmilk to nursing infants, and while no specific health risks have been reported because of this association, it is still advisable to consult with the family doctor prior to breastfeeding.

As with any nonsteroidal anti-inflammatory drug, celecoxib increases the risk of serious gastrointestinal problems in the body including bleeding, ulceration, and even a perforation of the stomach lining or the lining of the intestines. In the most extreme cases, this can prove to be fatal for the patient, and it can occur at almost any time during treatment with celecoxib. Since there are rarely any warning symptoms which can be harbingers of the serious internal issues, any patient who already has a history of stomach problems or bleeding would not be a good candidate for treatment was celecoxib.

Elderly patients especially should have their medical history carefully reviewed for any incidence of peptic ulcer or gastrointestinal bleeding, since that puts them in a greater risk pool for gastrointestinal issues while taking celecoxib.

This drug should not be used by any patient who has undergone a coronary artery bypass graft, or for whom this medical procedure is being considered.

Any nonsteroidal anti-inflammatory drug such as celecoxib increases the risk of serious cardiovascular thrombotic action, including strokes and myocardial infarctions, either of which can prove fatal to the patient. This risk of cardiovascular thrombotic events has the potential to affect the patient early during treatment with celecoxib, and the risk of reaction increases the longer the program of treatment with celecoxib goes on.

Anyone who experiences chest pain, weakness, noticeably slurred speech, blurred vision, problems with balance, or difficulty breathing after taking celecoxib should seek immediate medical attention, as these could be signs of serious health problems developing.

If you notice changes in your stool such as black coloration, blood in the stool, or tarriness, you should call your doctor immediately, since these can be signs of stomach bleeding. Other signs of gastrointestinal problems are vomiting of material that looks like coffee grounds, or coughing up blood. Since these can all be signs of serious gastrointestinal problems like bleeding or perforation, you should immediately contact your doctor, to avoid a worsening of the condition or even fatality.

For the same reason, you should avoid drinking alcohol while on program of treatment which features celecoxib, because alcohol often acts to increase the risk of stomach bleeding, which can lead to dangerous results.

This drug should not be taken in larger or smaller dosages than those prescribed by your doctor, and all directions printed on the prescription label should be closely followed without deviation.

The best way to avoid an upset stomach or other stomach disorders when taking celecoxib is to accompany it with food or milk. For those who have difficulty swallowing medications, one of the best ways of ingesting celecoxib is to sprinkle the granules into a spoonful of applesauce prior to ingestion. The medication should be swallowed immediately without chewing, and the empty capsule should be discarded right away. If you have prepared a dosage of celecoxib for ingestion like this but do not immediately consume it, the mixture can be stored in a refrigerator for as long as six hours and still be usable.

Anyone who is on long-term program of treatment with celecoxib will probably need to have frequent blood tests as ordered by a family doctor, to determine whether or not any serious internal reactions are taking place.

Storage

Celecoxib should be stored at room temperature, no higher than about 77 degrees Fahrenheit, although higher temperatures are permissible for brief periods. It should be kept away from direct sunlight, and from high humidity areas. Bathrooms for instance, are poor locations for the storage of celecoxib, because temperatures routinely rise significantly, and humidity levels rise as well when household members are bathing or showering. This kind of environment can degrade celecoxib and reduce its effectiveness.

Celecoxib should always be kept out of the reach of pets and young children, so as to avoid the possibility of any unpleasant accidents or ingestion. For this reason, your celecoxib medications should not be stored in weekly pill reminder containers, since these are not normally equipped with locks or safety features which prevent access.

Unused celecoxib should not be flushed down the toilet or discarded in the sink, but when its expiration date has been exceeded, it should be disposed of properly, in accordance with instructions provided by your doctor or pharmacist. The FDA maintains a website which advises patients about proper disposal methods for most commonly used medications, and if you cannot reach your doctor or pharmacist for a recommendation, this website should provide assistance.

Summary

Celecoxib belongs to the class of drugs known as non-steroidal anti-inflammatory drugs, and is commonly used for the treatment of rheumatoid arthritis, osteoarthritis, menstrual pain, and ankylosing spondylitis. Since there are a number of side effects which are possible from a treatment program involving celecoxib, a thorough discussion with the family doctor is advisable before agreeing to any such treatment program.

There are also a number of precautions and warnings which should be considered prior to usage, and many of these warnings relate to a patient's existing medical condition or past medical history. Of particular note in this area, patients who have a history of stomach problems or bleeding are probably not good candidates for taking celecoxib.

Interactions with other drugs range from very mild to somewhat severe, so any patient considering treatment with celecoxib should always review with the family doctor any other medications currently being taken, so that potential interactions can be avoided.