Celecoxib


Article Author:
Brandon Cohen


Article Editor:
Charles Preuss


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
5/17/2019 3:50:05 PM

Indications

Celecoxib has numerous indications, both FDA approved, and non-FDA approved.

The FDA recommends celecoxib and other NSAIDs (non-steroidal anti-inflammatory drugs), along with acetaminophen, as first-line analgesics for patients with osteoarthritis and rheumatoid arthritis. Celecoxib also has an FDA indication for the management of acute pain in adult women and primary dysmenorrhea. Furthermore, the FDA also recommends the use of celecoxib as an adjunct therapy in patients with familial adenomatous polyposis to reduce the number of colorectal polyps.[1]

Off-label, celecoxib can be used for a wide variety of musculoskeletal and rheumatologic conditions including ankylosing spondylitis, juvenile idiopathic arthritis, and gout. It is also being used increasingly in hospital protocols as part of a multimodal perioperative pain management regimen, frequently given pre-operatively along with adjunct pain medications including acetaminophen and/or pregabalin.[2]

Mechanism of Action

Celecoxib is chemically designated as 4-[5-(4-methylphenyl)- 3-(trifluoromethyl)-1H-pyrazol-1-yl] benzenesulfonamide and is a diaryl-substituted pyrazole. The mechanism of action of celecoxib is due to selective inhibition of cyclooxygenase-2 (COX-2) which is responsible for prostaglandin synthesis, an integral part of the pain and inflammation pathway.[3] This activity gives celecoxib its analgesic, anti-inflammatory, and antipyretic activity. Celecoxib does weakly inhibit COX-1 and therefore, may affect platelet function to a lesser extent.

Celecoxib also has anticancer properties discussed below and exerts its anticancer properties by binding cadherin-11 (CDH11) which likely plays a significant role in malignant progression of cancerous cells.[4]

Celecoxib is extensively metabolized through cytochrome P450 2C9 (CYP2C9) and may have interactions with other medications that are substrates of CYP2C9.[5]

Administration

Celecoxib is a medication that is taken orally and comes in 50-, 100-, 200-, and 400-mg doses. In rare cases, celecoxib can also be added to customized compounds for topical administration with or without the use of iontophoresis or other topical delivery mechanisms. It is not available via any other route of administration.

Adverse Effects

Like all NSAIDs, celecoxib carries an FDA boxed warning for cardiovascular risk including the increased risk of heart attacks and strokes. As a selective COX-2 inhibitor, celecoxib also faces scrutiny for increased cardiovascular risk, since another selective COX-2 inhibitor, rofecoxib, was withdrawn from production in 2004 due to cardiovascular risk concerns. Large reviews have had mixed results regarding whether celecoxib carries non-inferior or increased cardiovascular risk compared to ibuprofen and naproxen.[6][7]

Also like all NSAIDs, celecoxib carries an additional FDA boxed warning for gastrointestinal (GI) effects including bleeding, ulceration, and perforation of the stomach and intestines. This adverse effect makes it particularly dangerous to susceptible populations such as the elderly.

In addition to these, celecoxib may cause new or worsening hypertension, fluid retention in patients with congestive heart failure, renal toxicity, liver toxicity, anaphylactic reactions, and skin changes ranging from a non-severe rash to Stevens-Johnson syndrome.

Contraindications

Due to its cardiovascular risk, celecoxib is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graph (CABG) surgery.

Celecoxib also contains a sulfonamide group and is contraindicated in patients who have demonstrated severe allergic reactions to sulfonamide drugs. Studies have shown that allergies to sulfonamide antimicrobials are indeed a risk factor for allergic reactions to sulfonamide chemical group. Non-antimicrobial drugs which contain a sulfonamide chemical group such as celecoxib, a history of penicillin allergy is at least as strong a risk factor for an allergic reaction. Thus, providers should understand that this phenomenon is likely not due to sole cross-reactivity of sulfonamide-containing antimicrobials and non-antimicrobials and that certain patients have an increased propensity to celecoxib allergy if they are allergic to any antimicrobial drug.[8]

Since CYP2C9 metabolizes celecoxib, it should be used with caution in patients taking medicines that inhibit CYP2C9, for example, fluconazole which is an antifungal drug.[5]

Like all NSAIDs, celecoxib should not be taken after 29 weeks of pregnancy.

Monitoring

Due to the risk for celecoxib to cause new or worsening hypertension, fluid retention in patients with congestive heart failure, renal toxicity, liver toxicity, anaphylactic reactions, and skin changes ranging from a non-severe rash to Stevens-Johnson syndrome, it is important for prescribers to monitor patients for adverse drug reactions. Prescribers should monitor a patient's blood pressure, renal and liver function, and monitor for signs and symptoms of GI bleeding.

Patients taking such medications as lithium or warfarin should have the concentrations of these drugs monitored more closely as well due to celecoxib's renal toxicity and inhibition of CYP2C9, respectively. Plasma concentrations of celecoxib are not routinely monitored for therapeutic efficacy.

Toxicity

Unfortunately, no antidotes for celecoxib overdose are available. However, celecoxib is a relatively safe medication overall. During FDA trials, no overdoses of celecoxib were reported. Doses up to 2400 mg per day for 10 days did not result in serious toxicity.

Symptoms of celecoxib overdose would likely be similar to overdoses of other NSAIDs which include lethargy, drowsiness, nausea, vomiting, and epigastric pain. Activated charcoal may be administered for overdose treatment at the discretion of emergency medical providers if the patient presents within 4 hours of known or suspected ingestion of significant amounts of celecoxib. Due to high plasma protein binding, dialysis, urine alkalinization, or diureses are unlikely to have a significant therapeutic effect on celecoxib overdose.

Enhancing Healthcare Team Outcomes

Significant opportunities are available for improved interprofessional care coordination with regards to celecoxib.

In the inpatient setting, as mentioned above, celecoxib is increasingly being used as part of pre-operative and post-operative multimodal pain management algorithms. It has been shown in several small randomized trials that administering celecoxib peri-operatively for elective procedures such as total hip arthroplasties, total knee arthroplasties, and other procedures with some success in reducing pain and improving functionality such as early ambulation. The use of non-opioid medications to improve pain and function after surgery is becoming increasingly important due to societal and political pressure to reduce overall opioid analgesic consumption as a response to increasing rates of overdose deaths. It is therefore important for physicians, nurses, pharmacists, physical and occupational therapists, and other support staff to coordinate a concerted effort to set patient-specific goals regarding pain and function in the acute care and rehabilitative settings and to reinforce how celecoxib can be used to achieve these goals to the patient. Physicians and support staff must also maintain constant communication while monitoring the patient for improvements in pain and function and for possible adverse effects the patient may be experiencing.

In the outpatient setting, prescribers of celecoxib must also coordinate with pharmacists to prevent and monitor for unsafe drug interactions, and with the patient, family members, and caregivers to monitor therapeutic benefit and possible adverse drug effects.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Celecoxib - Questions

Take a quiz of the questions on this article.

Take Quiz
A 71-year-old man presents with dyspepsia and anemia. Endoscopy reveals inflammation and bleeding of the stomach probably due to the patient's self-treatment with naproxen for osteoarthritis. Which of the following is least likely to cause gastrointestinal upset while providing analgesia for the patient's osteoarthritis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following medications should not be given to patients who are severely allergic to sulfonamide drugs?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient reports to you that several of their family members have an inherited condition that causes numerous colonic polyps to develop that eventually progress to cancer. Which medication could be started to prevent the progression of polyps in this patient if they have inherited this disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with long-standing history of osteoarthritis on ibuprofen presents with dyspepsia. Which of the following is the best treatment for the patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Celecoxib can be prescribed to patients with?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not an indication for the use of celecoxib?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The drug celecoxib belongs in which drug class?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is a condition with the indication for treatment with celecoxib?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 32-year-old female with a known history of bipolar disorder presents to your clinic for follow-up. On physical exam, you note nystagmus and hyperreflexia. Her vital signs are normal. She is taking a typical medication used in the treatment of bipolar disorder. Which co-medication may contribute to her current condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Celecoxib - References

References

Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics., Strom BL,Schinnar R,Apter AJ,Margolis DJ,Lautenbach E,Hennessy S,Bilker WB,Pettitt D,, The New England journal of medicine, 2003 Oct 23     [PubMed]
Cadherin-11 in poor prognosis malignancies and rheumatoid arthritis: common target, common therapies., Assefnia S,Dakshanamurthy S,Guidry Auvil JM,Hampel C,Anastasiadis PZ,Kallakury B,Uren A,Foley DW,Brown ML,Shapiro L,Brenner M,Haigh D,Byers SW,, Oncotarget, 2014 Mar 30     [PubMed]
Wang B,Wang J,Huang SQ,Su HH,Zhou SF, Genetic polymorphism of the human cytochrome P450 2C9 gene and its clinical significance. Current drug metabolism. 2009 Sep     [PubMed]
Nissen SE, Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. The New England journal of medicine. 2017 Apr 6     [PubMed]
Tolloczko-Iwaniuk N,Dziemianczyk-Pakiela D,Nowaszewska BK,Celinska-Janowicz K,Miltyk W, Celecoxib in Cancer Therapy and Prevention - Review. Current drug targets. 2018 Aug 3;     [PubMed]
Pitchon DN,Dayan AC,Schwenk ES,Baratta JL,Viscusi ER, Updates on Multimodal Analgesia for Orthopedic Surgery. Anesthesiology clinics. 2018 Sep;     [PubMed]
Barcella CA,Lamberts M,McGettigan P,Fosbøl EL,Lindhardsen J,Torp-Pedersen C,Gislason GH,Olsen AS, Differences in cardiovascular safety with non-steroidal anti-inflammatory drug therapy - a nationwide study in patients with osteoarthritis. Basic     [PubMed]
McAdam BF,Catella-Lawson F,Mardini IA,Kapoor S,Lawson JA,FitzGerald GA, Systemic biosynthesis of prostacyclin by cyclooxygenase (COX)-2: the human pharmacology of a selective inhibitor of COX-2. Proceedings of the National Academy of Sciences of the United States of America. 1999 Jan 5     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.