Formulary
Celecoxib: Indications, Dosing, Side Effects and Interactions
Celecoxib clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Celecoxib: Indications, Dosing, Side Effects and Interactions
Celecoxib clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Pain and inflammation in osteoarthritis**
- **Adult** (By Mouth): 200 mg daily in 1-2 divided doses, then increased if necessary to 200 mg twice daily, discontinue if no improvement after 2 weeks on maximum dose.
**Pain and inflammation in rheumatoid arthritis**
- **Adult** (By Mouth): 100 mg twice daily, then increased if necessary to 200 mg twice daily, discontinue if no improvement after 2 weeks on maximum dose.
**Ankylosing spondylitis**
- **Adult** (By Mouth): 200 mg daily in 1-2 divided doses, then increased if necessary to 400 mg daily in 1-2 divided doses, discontinue if no improvement after 2 weeks on maximum dose.
Cautions
Allergic disorders; cardiac impairment (NSAIDs may impair renal function); coagulation defects; connective-tissue disorders; dehydration (risk of renal impairment); elderly (risk of serious side-effects and fatalities); history of cardiac failure; history of gastro-intestinal disorders; hypertension; left ventricular dysfunction; may mask symptoms of infection; oedema; risk factors for cardiovascular events
Contraindications
Active gastro-intestinal bleeding; active gastro-intestinal ulceration; cerebrovascular disease; inflammatory bowel disease; ischaemic heart disease; mild to severe heart failure; peripheral arterial disease
Side effects
Common or very common Angina pectoris; benign prostatic hyperplasia; cough; diarrhoea; dizziness; dysphagia; dyspnoea; fluid retention; gastrointestinal discomfort; gastrointestinal disorders; headache; hypersensitivity; hypertension; increased risk of infection; influenza like illness; injury; insomnia; irritable bowel syndrome; joint disorders; muscle tone increased; myocardial infarction; nausea; nephrolithiasis; oedema; skin reactions; vomiting; weight increased Uncommon Anaemia; anxiety; arrhythmias; breast tenderness; bronchospasm; burping; cerebral infarction; chest pain; conjunctivitis; constipation; depression; drowsiness; dysphonia; electrolyte imbalance; embolism and thrombosis; fatigue; haemorrhage; hearing impairment; heart failure; hepatic disorders; lipoma; lower limb fracture; muscle complaints; nocturia; oral disorders; palpitations; paraesthesia; tinnitus; vision blurred; vitreous floater Rare or very rare Acute kidney injury (more common in patients with pre-existing renal impairment); alopecia; angioedema; anosmia; ataxia; confusion; flushing; hallucination; intracranial haemorrhage; leucopenia; meningitis aseptic; menstrual disorder; myositis; nephritis tubulointerstitial; nephropathy; pancreatitis; pancytopenia; photosensitivity reaction; pneumonitis; seizures; severe cutaneous adverse reactions (SCARs); taste altered; thrombocytopenia; vasculitis Frequency not known Infertility Side-effects, further information For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non-steroidal anti-inflammatory drugs
Interactions
**Severe interactions:**
- Bleeding events in association with increases in prothrombin time have been reported, predominantly in the elderly, in patients receiving celecoxib concurrently with warfarin, some of them fatal.
- In a 28-day clinical study in patients with lisinopril-controlled Stage I and II hypertension, administration of celecoxib 200 mg BID resulted in no clinically significant increases, when compared...
- Among patients treated with celecoxib 200 mg BID, 48 % were considered unresponsive to lisinopril at the final clinic visit (defined as either cuff diastolic blood pressure >90 mmHg or cuff...
- Methotrexate In patients with rheumatoid arthritis celecoxib had no statistically significant effect on the pharmacokinetics (plasma or renal clearance) of methotrexate (in rheumatologic doses).
**Other interactions (26):**
- Pharmacodynamic interactions Anticoagulants Anticoagulant activity should be monitored particularly in the first few days after initiating or changing the dose of celecoxib in patients receiving...
- Therefore, patients receiving oral anticoagulants should be closely monitored for their prothrombin time INR, particularly in the first few days when therapy with celecoxib is initiated or the dose...
- Anti-hypertensives NSAIDs may reduce the effect of anti-hypertensive medicinal products including ACEinhibitors, angiotensin II receptor antagonists, diuretics and beta-blockers.
- As for NSAIDs, the risk of acute renal insufficiency, which is usually reversible, may be increased in some patients with compromised renal function (e.g.
- Ciclosporin and tacrolimus Co-administration of NSAIDs and ciclosporin or tacrolimus may increase the nephrotoxic effect of ciclosporin or tacrolimus, respectively.
- Renal function should be monitored when celecoxib and any of these medicinal products are combined.
Pregnancy
Avoid (teratogenic in animal studies).
Breast feeding
Avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment (no information available). Dose adjustments Manufacturer advises initial dose reduction of 50% in moderate impairment.
Renal impairment
In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). For celecoxib , avoid if creatinine clearance less than 30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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