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Celecoxib

Celebrex

Celebrex (celecoxib) is a prescription medication approved by the FDA to treat pain and inflammation associated with various conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain, and menstrual cramps. It belongs to the class of nonsteroidal anti-inflammatory drugs (NSAIDs) but selectively targets the COX-2 enzyme. While effective, Celebrex carries risks like cardiovascular events, gastrointestinal issues, and kidney problems. Proper dosing, monitoring for side effects, and consideration of individual risk factors are crucial when using this medication.

Product Overview

Celebrex (celecoxib) is a widely prescribed medication belonging to the nonsteroidal anti-inflammatory drug (NSAID) class. It is approved for treating various conditions characterized by pain and inflammation, such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain, and primary dysmenorrhea (menstrual cramps). Celebrex is also approved for juvenile rheumatoid arthritis in children aged 2 years and older.

Unlike traditional NSAIDs, which inhibit both COX-1 and COX-2 enzymes, Celebrex selectively targets the COX-2 enzyme responsible for producing inflammatory prostaglandins. By blocking COX-2, Celebrex effectively reduces inflammation and associated pain without significantly impacting the protective effects of COX-1 on the stomach lining and kidney function.

While Celebrex offers advantages over non-selective NSAIDs, it still carries risks. It has a boxed warning for increased risk of cardiovascular events like heart attack and stroke, especially with long-term use or high doses. Celebrex can also cause gastrointestinal issues, including ulcers, bleeding, and perforations, particularly in older adults or those with a history of gastrointestinal problems.

Proper dosing and monitoring are essential when taking Celebrex. Dosages vary depending on the condition being treated and individual factors like age and weight. Common side effects include gastrointestinal discomfort, headache, dizziness, and edema. More serious side effects, such as kidney problems, liver issues, and allergic reactions, require prompt medical attention.

Celebrex can interact with various medications, including other NSAIDs, blood thinners, corticosteroids, and certain antidepressants. Informing healthcare providers about all medications, supplements, and medical conditions is crucial to prevent potential interactions and ensure the safe use of Celebrex.

Uses of Celebrex

  • Celebrex is used and approved by the FDA for treating various conditions in adults, including:
    • Osteoarthritis (OA)
    • Rheumatoid arthritis (RA)
    • Ankylosing spondylitis, which is a type of arthritis affecting the spine
    • Acute pain, meaning short-term pain
    • Primary dysmenorrhea, commonly known as period pain or menstrual cramps
  • Celebrex is approved for the treatment of juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, in children aged 2 years and older.

How to Use Celebrex?

Dosage

It comes in the form of a capsules that you swallow and has the following strengths:

  • Celebrex 50 mg capsules
  • Celebrex 100 mg capsules
  • Celebrex 200 mg capsules
  • Celebrex 400 mg capsules

Recommended Dosage for Different Patients

For Acute Pain in Adults

  • Initial Dose: 400 mg as a single dose.
  • Follow-up Dose: 200 mg after 8–12 hours from the initial dose, if needed.
  • Subsequent Doses: 200 mg twice per day, as needed.

For Osteoarthritis in Adults

  • Daily Total: 200 mg per day.
  • Administration Options: As a single 200 mg dose once per day or as 100 mg taken twice per day.

For Rheumatoid Arthritis in Adults

  • Daily Dose: 100 mg to 200 mg taken twice per day.

For Ankylosing Spondylitis in Adults

  • Initial Daily Dose: 200 mg per day.
    • Can be taken as a single 200 mg dose once per day.
    • Alternatively, 100 mg should be taken twice per day.
  • Adjustment After 6 Weeks: If pain persists after 6 weeks, the dosage may be increased to a maximum of 400 mg per day.
    • This can be taken as a single 400 mg dose once per day.
    • Alternatively, 200 mg is taken twice per day.
  • Further Evaluation: If pain continues after 6 weeks on the increased dose, Celebrex may not be effective for your condition. Your doctor will likely consider alternative treatments.

For Primary Dysmenorrhea (Menstrual Cramps) in Adults

  • The dosage for managing primary dysmenorrhea, or menstrual cramps, in adults, is consistent with the dosage recommended for acute pain:
    • Initial Dose: 400 mg as a single dose.
    • Follow-up Dose: 200 mg after 8–12 hours from the initial dose, if needed.
    • Subsequent Doses: 200 mg twice per day, as needed.

For Juvenile Rheumatoid Arthritis (JRA) in Children Ages 2 Years and Older

  • The dosage of Celebrex for treating juvenile rheumatoid arthritis in children is determined based on body weight:
    • For children weighing 10 to 25 kilograms (approximately 22 to 55 pounds): 50 mg taken twice per day.
    • For children weighing more than 25 kilograms (over approximately 55 pounds): 100 mg taken twice per day.

For Juvenile Rheumatoid Arthritis (JRA)

  • Celebrex is approved for the treatment of juvenile rheumatoid arthritis (JRA) in children aged 2 years and older. The dosage depends on the child’s body weight:
    • For children weighing 10 to 25 kilograms (about 22 to 55 pounds): 50 mg taken twice per day.
    • For children weighing more than 25 kilograms (about 55 pounds or more): 100 mg taken twice per day.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

Celebrex can be taken once or twice daily, as directed by your healthcare provider. Follow these guidelines:

  • Once-Daily Dosing:
    • Take Celebrex at the same time each day.
    • You can choose any convenient time, but be consistent.
  • Twice-Daily Dosing:
    • Take one dose in the morning and one in the evening.
    • Try to space the doses about 12 hours apart.
  • For Acute (Short-Term) Pain, such as menstrual cramps:
    • Take your first dose when you start experiencing pain.
    • If needed, you can take a second dose 8-12 hours after the first.
    • After the initial doses, continue taking Celebrex twice daily as needed for pain relief.
    • Aim to take the twice-daily doses about 12 hours apart.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Celebrex Work?

Celebrex works by selectively inhibiting an enzyme called cyclooxygenase-2 (COX-2). This enzyme plays a key role in the production of prostaglandins, which are chemicals in the body that promote inflammation, pain, and fever. By blocking COX-2, Celebrex effectively reduces the levels of prostaglandins, leading to decreased inflammation and relief from pain.

Important Safety Information

Side Effects

Common side effects of Celebrex may include:

  • Gas
  • Upper respiratory infection, such as the common cold
  • Headache
  • Dizziness
  • Indigestion
  • Weight gain
  • Swelling of the hands or feet
  • Sinusitis (sinus inflammation)
  • Diarrhea
  • Nausea or vomiting
  • Abdominal pain

Serious side effects and their symptoms can include:

  • Kidney problems, like acute kidney failure.
  • Serious skin reactions, like a widespread itchy rash.
  • Heart failure and edema (fluid retention), signs may consist of:
    • Swelling, especially of your ankles or feet
    • Sudden unexplained weight gain
    • Shortness of breath
  • Allergic reaction.
  • High blood pressure, signs may consist of:
    • Chest pain
    • Dizziness
    • Headache
  • Anemia (low red blood cell count), signs may consist of:
    • Weakness
    • Fatigue
    • Skin that appears paler than usual
  • Hyperkalemia (high level of potassium in your blood), signs may consist of:
    • Muscle pain or cramps
    • Nausea
    • Weakness
  • Cardiovascular problems, like stroke & heart attack.
  • Liver problems, like liver damage.
  • Digestive problems, like ulcers (sores that are slow to heal).

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings 

  • Weight Gain: Some individuals who took Celebrex for osteoarthritis (OA) or rheumatoid arthritis (RA) reported weight gain during clinical trials. However, the frequency of weight gain in those using Celebrex for other conditions is currently unknown. If you experience sudden, unexpected weight gain while taking Celebrex, it is important to inform your healthcare provider. Rapid weight gain can potentially be a symptom of heart failure, which is a serious side effect associated with the use of Celebrex. 
  • Sulfa Allergy: Celebrex may be contraindicated if you’ve had an allergic reaction to sulfonamide medications like trimethoprim/sulfamethoxazole, sulfasalazine, or dapsone. Discuss with your doctor.
  • Allergic Reaction: Do not take Celebrex if you’ve had an allergic reaction or serious skin reaction to it or any of its ingredients.
  • NSAID Allergy: Celebrex should be avoided if you’ve experienced asthma attacks, hives, or allergic reactions to other NSAID drugs like aspirin, ibuprofen, or naproxen.
  • Asthma: Celebrex may trigger asthma attacks in some people with asthma. Consult your doctor.
  • High Blood Pressure: Celebrex can cause or worsen high blood pressure, increasing cardiovascular risks. Your doctor may need to monitor your blood pressure.
  • Heart Disease: If you have heart disease or risk factors like high blood pressure, high cholesterol, diabetes, or a history of heart attack, discuss the potential risks with your doctor.
  • Heart Failure: The medication can cause or worsen heart failure, leading to kidney problems. Report any new or worsening symptoms.
  • Liver Problems: The medication may cause liver issues or build up in the body if your liver isn’t functioning well. Your doctor may adjust the dosage and monitor your liver function.
  • Kidney Problems: The medication can sometimes cause or worsen kidney problems, especially if you become dehydrated. Discuss with your doctor if you have kidney issues.

Boxed Warning

Celebrex carries a boxed warning, the most serious type of warning from the U.S. Food and Drug Administration (FDA). A boxed warning highlights potentially dangerous or life-threatening effects associated with the use of a medication. This warning is designed to alert healthcare providers and patients about the significant risks involved in taking this drug, so they can carefully consider the benefits and risks before prescribing or using it.

  • Cardiovascular problems: Celebrex belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs can increase the risk of cardiovascular problems, such as heart attack and stroke, which can be life-threatening in some cases. The risk of these adverse effects is higher if Celebrex is taken at high doses or for extended periods. It is crucial to avoid taking Celebrex if you are scheduled for or have recently undergone coronary artery bypass graft surgery (also known as heart bypass surgery). This procedure is performed to improve blood flow to the heart. Using Celebrex for pain relief after this type of surgery can significantly increase the risk of experiencing a heart attack or stroke.
  • Digestive problems: As an NSAID (nonsteroidal anti-inflammatory drug), Celebrex can increase the risk of serious digestive problems. These include the development of ulcers (slow-healing sores), bleeding, and perforations (holes) in the digestive tract, specifically in the stomach and intestines. In some cases, these digestive issues can be life-threatening. It’s important to note that these serious digestive problems can occur at any time during Celebrex treatment and may not cause any noticeable symptoms initially. Individuals aged 65 years or older are at a higher risk of experiencing these adverse effects. Additionally, if you have a history of peptic ulcers or bleeding in the stomach or intestines, your risk is further increased. If you experience any symptoms such as abdominal pain, persistent nausea or vomiting, or notice blood in your stool, it is crucial to seek immediate medical attention, as these could be signs of a serious digestive problem related to Celebrex use.

Precautions

  • Effects on Older Adults: Individuals aged 65 years and older may have a higher risk of experiencing digestive problems while taking Celebrex compared to younger adults. These digestive issues can include ulcers (slow-healing sores), bleeding, or perforations (holes) in the stomach or intestine. Additionally, older adults may also have an increased risk of kidney problems associated with Celebrex use. As people age, their kidney function may decline, and they may need to take other medications, such as treatments for high blood pressure, which can further raise the risk of kidney-related side effects. To minimize the potential for side effects, older adults will typically start treatment with a lower dose of Celebrex (200 mg per day).
  • Alcohol: While alcohol does not alter how Celebrex functions in the body, combining alcohol with Celebrex can increase the likelihood of experiencing certain side effects. These can include nausea, indigestion, headaches, and dizziness. Additionally, one of the risks associated with Celebrex is an increased likelihood of developing ulcers and gastrointestinal bleeding. Consuming alcohol while taking Celebrex can further heighten this risk.
  • Pregnancy: Using NSAIDs (like Celebrex) after 20 weeks of pregnancy may increase certain risks. Avoiding Celebrex after 30 weeks of pregnancy is recommended, as NSAIDs can have harmful effects on the fetus during the last trimester. Discuss the potential risks and benefits with your doctor before taking Celebrex during pregnancy.
  • Fertility: In females, Celebrex may temporarily reduce fertility by delaying ovulation. This effect is reversible once the medication is stopped. If you are planning a pregnancy or trying to conceive, discuss the potential impact on fertility with your doctor before taking Celebrex.
  • Birth Control: If you or your partner can become pregnant, discuss appropriate birth control options with your doctor while taking Celebrex, as it may pose risks during pregnancy.
  • Breastfeeding: Celebrex can pass into breast milk. If you are breastfeeding, consult your doctor about the potential risks and benefits of taking Celebrex to help make an informed decision.

Missed Dose

  • If you miss a dose of Celebrex, take it as soon as you remember. 
  • If it is nearly time for your next scheduled dose, skip the missed dose. Don’t take 2 doses simultaneously to make up for a missed dose.
  • Consider using a medication reminder. This could be an alarm on your phone, a reminder app, or even a kitchen timer to ensure you take your medication at the correct times.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

If you take more than the recommended dosage of Celebrex it can lead to serious side effects. It is crucial to follow your doctor’s prescribed dosage instructions and not exceed the recommended amount. If you experience any of the following symptoms, it may indicate a Celebrex overdose, and you should seek immediate medical attention:

  • Lethargy (lack of energy)
  • Drowsiness
  • Nausea
  • Vomiting
  • Abdominal pain
  • Bleeding in the stomach or intestines (vomiting blood/coffee ground-like substance, blood in stool, black/tarry stools)
  • High blood pressure
  • Acute kidney failure (reduced urine output, dark urine, confusion)
  • Slow, shallow breathing
  • Coma

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

  • Store Celebrex capsules at room temperature between 68°F to 77°F (20°C to 25°C).
  • Keep the capsules in a tightly sealed container.
  • Avoid storing in damp or wet areas like bathrooms.
  • Protect the medication from moisture.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Celebrex Interactions

Celebrex can interact with various other medications, and these interactions can have different effects. Some interactions may reduce the effectiveness of Celebrex, while others can increase side effects or make them more severe.

Common Medications That May Interact with Celebrex

Before starting Celebrex, it is important to discuss all medications you are taking with your doctor and pharmacist. This includes all prescription and over-the-counter drugs, as well as any vitamins, herbs, and supplements. Sharing this information is crucial to prevent potential interactions.

If you have any concerns about drug interactions or if you are unsure about how other drugs might affect your Celebrex treatment, be sure to ask your doctor or pharmacist for more information. They can provide guidance tailored to your specific situation.

  1. Interactions with Other NSAIDs: Celebrex belongs to a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). It is important to avoid taking Celebrex with other NSAIDs, as doing so can significantly increase your risk of serious digestive issues. These issues may include ulcers (which are slow-healing sores), bleeding, or perforations (holes) in your digestive tract. Examples of NSAIDs to Avoid While Taking Celebrex:
  • Naprosyn (naproxen)
  • Naprelan (naproxen)
  • Aleve (naproxen)
  • Ibu-Tab (ibuprofen)
  • Advil (ibuprofen)
  • Motrin (ibuprofen)
  • Zipsor (diclofenac)
  • Aspirin (aspirin at pain-relieving doses)
  • Meloxicam (meloxicam)

Some over-the-counter pain relievers and cold and flu medications may also contain NSAIDs. It’s crucial to check with your doctor or pharmacist before taking any additional medications while you are using Celebrex. Generally, it’s best to avoid any medications that contain the NSAIDs listed above to prevent potential harmful interactions.

  1. Interactions with Blood Thinners: Celebrex, when taken with blood thinners, can increase your risk of bleeding, particularly in the stomach or intestines. Blood thinners are medications used to prevent or treat blood clots, which can be life-threatening. Types of blood thinners that may interact with Celebrex:
  • Anticoagulants, such as:
    • Eliquis (apixaban)
    • Pradaxa (dabigatran)
    • Jantoven (warfarin)
    • Xarelto (rivaroxaban)
  • Antiplatelets, such as:
    • Aspirin
    • Plavix (clopidogrel)
    • Brilinta (ticagrelor)

Note that aspirin, which is both a pain reliever and an antiplatelet, can further increase the risk of serious digestive problems when combined with Celebrex. If you are prescribed Celebrex while on blood thinners, monitor for any signs of bleeding in the stomach or intestines, and consult your doctor immediately if you experience symptoms such as abdominal pain, blood in your stool, or black, tarry stools.

  1. Interactions with Corticosteroids: These medications are used to reduce inflammation in the body. When combined with Celebrex, which is also used to reduce inflammation, there is an increased risk of serious digestive issues. Examples of Corticosteroids That May Interact with Celebrex:
  • Rayos (Prednisone)
  • Hydrocortisone
  • Dexamethasone

These drugs, while effective at managing inflammation, can exacerbate the gastrointestinal side effects associated with NSAIDs like Celebrex. This includes an increased risk of ulcers, bleeding, and perforation of the stomach or intestines.

  1. Interactions with Blood Pressure Medications: When Celebrex is taken with certain blood pressure medications, Celebrex might reduce their effectiveness, making it more challenging to manage your blood pressure. Blood Pressure Medications That May Be Affected by Celebrex:
  • Angiotensin Converting Enzyme (ACE) Inhibitors, such as:
    • Quinapril
    • Altace (ramipril)
    • Zestril (lisinopril)
  • Angiotensin II Receptor Blockers (ARBs), such as:
    • Atacand (candesartan)
    • Cozaar (losartan)
    • Diovan (valsartan)
  • Beta-blockers, such as:
    • Inderal LA (propranolol)
    • Innopran XL (propranolol)
    • Tenormin (atenolol)
    • Bisoprolol
  • Diuretics, such as:
    • Lasix (furosemide)
    • Diuril (chlorothiazide)
    • Hydrochlorothiazide

Additionally, taking Celebrex with diuretics, ACE inhibitors, or ARBs can increase your risk of kidney problems. To mitigate this risk ensure adequate hydration by drinking plenty of fluids. Your doctor may perform various tests to monitor your kidney function periodically.

  1. Interactions with Certain Antidepressants: Taking Celebrex along with certain antidepressants can increase the risk of gastrointestinal bleeding. This is particularly concerning with the following types of antidepressants:
  • Selective Serotonin Reuptake Inhibitors (SSRIs), such as:
    • Prozac (fluoxetine)
    • Zoloft (sertraline)
    • Celexa (citalopram)
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), such as:
    • Cymbalta (duloxetine)
    • Effexor XR (venlafaxine)
    • Pristiq (desvenlafaxine)

If you are prescribed both Celebrex and an antidepressant, watch for any signs of bleeding in the stomach or intestines, such as blood in your stool, black, tarry stools, or abdominal pain. Report any such symptoms to your doctor right away.

  1. Interactions with Digoxin (Lanoxin): Digoxin treats heart failure and irregular heartbeats. Taking Celebrex with digoxin can increase digoxin levels in your body, heightening the risk of its side effects. Your doctor will check your digoxin levels and adjust the dosage as necessary to ensure safety.
  2. Interaction with Lithium (Lithobid): This medicine manages certain mental health conditions like bipolar disorder and severe depression. Celebrex can increase lithium levels, increasing the risk of lithium side effects. Your doctor will monitor your lithium levels and make dosage adjustments as needed.
  3. Interaction with Methotrexate (Rasuvo, Trexall, Otrexup): Treats various types of cancer, rheumatoid arthritis (RA), and psoriasis. Using Celebrex with methotrexate can increase the risk of methotrexate side effects. Inform your doctor of any worsening or new side effects. Your doctor will monitor your condition closely and adjust your treatment if necessary.
  4. Interactions with Cyclosporine (Neoral, Gengraf, Sandimmune): These medications prevent organ transplant rejection; also used to treat rheumatoid arthritis (RA) and psoriasis. Taking Celebrex with cyclosporine can increase the risk of kidney problems. Your doctor will check your kidney function and adjust your treatment as necessary.
  5. Interactions with Pemetrexed (Pemfexy, Alimta): Pemetrexed treats certain types of cancer. Celebrex may increase the risk of side effects from pemetrexed. Report any new or worsening side effects to your doctor. They will monitor your condition closely and adjust your treatment if needed.
  6. Interactions with Fluconazole (Diflucan): It is an antifungal medication. Taking Celebrex with fluconazole can reduce the breakdown of Celebrex in your body, potentially increasing its levels and side effects. Your doctor may adjust the dose of Celebrex to manage this interaction.
  7. Interactions with Rifampin (Rifadin): This medicine is an antibiotic used to treat bacterial infections. Rifampin can increase the breakdown of Celebrex in your body, potentially reducing its effectiveness. Your doctor may adjust the dose of Celebrex to ensure it remains effective.

If you’re prescribed Celebrex along with any of these medications, regular monitoring by your healthcare provider is crucial. Adjustments to dosages and vigilant observation for side effects will help manage risks and maintain your health during treatment. Always communicate openly with your healthcare provider about how you’re feeling during treatment with these medications.

Interaction Between Celebrex and Herbs & Supplements

While there are no specific herbs or supplements reported to interact with Celebrex, it is important to exercise caution. The lack of reported interactions does not necessarily guarantee safety. Always consult with your doctor or pharmacist before incorporating any herbs or supplements into your regimen while taking Celebrex. This precaution helps ensure that all aspects of your health are managed safely.

Interaction Between Celebrex and Foods

Similarly, there are no specific foods known to interact with Celebrex. However, if you have any concerns or questions about certain foods while taking this medication, it’s advisable to discuss them with your doctor. They can provide personalized advice based on your health needs and the specifics of your treatment plan.

[Note: This isn’t a complete list, and there could be other drugs that interact with Celebrex. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Celebrex Alternatives

  • Ibuprofen
  • Acetaminophen
  • Oxycodone
  • Hydrocodone
  • Tylenol
  • Acetaminophen / hydrocodone
  • Gabapentin
  • Diclofenac
  • Advil
  • Enbrel
  • Cosentyx
  • Durolane

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Frequently Asked Questions

Is Celebrex for long-term use?

The length of time you may need to take Celebrex depends on the reason for its use. Celebrex is typically prescribed for short-term relief of acute pain, such as back pain or menstrual cramps. However, for chronic conditions like arthritis, your doctor may recommend long-term use of Celebrex if deemed safe for your individual situation. It’s important to note that Celebrex should be taken at the lowest effective dose and for the shortest duration possible. This helps minimize the potential risks associated with prolonged use.

Is Celebrex a blood thinner?

No, Celebrex is not a blood thinner. Blood thinners are medications specifically used to prevent and treat blood clots. Celebrex falls into a different category of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs), which are primarily used to manage pain and reduce inflammation.

How long does Celebrex stay in your system?

After you stop taking Celebrex, it takes approximately 2 days for the medication to be completely eliminated from your system. During this time, the levels of Celebrex in your body will gradually decrease until it is fully cleared. It’s important to follow your doctor’s instructions regarding the proper discontinuation of Celebrex and to report any lingering side effects during this elimination period.

Is Celebrex a strong painkiller?

Celebrex helps alleviate inflammation, swelling, stiffness, and joint pain associated with these conditions. While it is effective for many individuals, it is not typically considered a “strong” painkiller compared to opioids or other potent analgesics. Instead, it is valued for its dual role in reducing inflammation and relieving pain, making it suitable for conditions where both pain and inflammation are present.

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