celecoxib: clinical use

Prescribing considerations

• Assess cardiovascular, gastrointestinal, renal, hepatic, allergy and bleeding risks, and review ongoing symptomatic benefit.
• Use particular caution in older people, dehydration, hypertension, oedema, renal or hepatic impairment, and with interacting medicines.
• Celecoxib may mask fever and other signs of inflammation.
• Consider CYP2C9 poor-metaboliser status where known or suspected.

Contraindications and cautions

• Hypersensitivity to celecoxib, product excipients or sulfonamides
• Active peptic ulceration or gastrointestinal bleeding
• Previous aspirin- or NSAID-associated asthma, rhinitis, nasal polyps, angioedema, urticaria or similar reaction
• Pregnancy; the selected product also contraindicates use in women who may become pregnant unless effective contraception is used
• Breastfeeding under the selected product information
• Severe hepatic or renal dysfunction
• Inflammatory bowel disease
• Congestive heart failure
• Established ischaemic heart disease, peripheral arterial disease or cerebrovascular disease

Monitoring

• Blood pressure and fluid retention
• Renal function in at-risk patients and with renin–angiotensin-system medicines, diuretics, ciclosporin or tacrolimus
• Liver function and symptoms of hepatic injury
• Gastrointestinal bleeding or ulceration
• INR with warfarin and clinical bleeding with any anticoagulant
• Lithium concentrations and methotrexate toxicity where applicable

Clinical pharmacology

Celecoxib selectively inhibits COX-2, reducing inflammatory prostaglandin synthesis. It is highly protein-bound, mainly metabolised by CYP2C9 and also inhibits CYP2D6; inactive metabolites are eliminated after hepatic metabolism.

Formulation and product differences

• The selected product is a hard gelatin capsule containing lactose and is essentially sodium-free.
• The selected capsule can be swallowed intact or opened and sprinkled onto specified soft foods; excipients, appearance, storage and opening instructions may differ between manufacturers.

Capsule

Route: Oral

Strengths: 100 mg, 200 mg