Celecoxib

Celecoxib is used for both inflammatory arthritis, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and osteoarthritis (OA). For treatment of OA, celecoxib is a first-line treatment option. 

For treatment of inflammatory arthritis, celecoxib may help control symptoms but does not alter the course of the disease. Generally, celecoxib is used as an adjunct to disease-modifying anti-rheumatic drug (DMARD) or biologic treatment.

Celecoxib is available in capsule form and taken orally.

Celecoxib is available in 100 mg and 200 mg capsules. The typical dosage is 100 mg twice daily or 200 mg once daily. Your prescriber will tell you the dose that is right for you.

Celecoxib works by blocking an enzyme called cyclooxygenase-2 (COX-2). This enzyme is responsible for converting arachidonic acid into prostaglandin, which plays a role in inflammation. By blocking COX-2, celecoxib reduces inflammation in the body and pain.

Some people will notice the effects of celecoxib within the first few hours of taking a dose. For others, the effects may not be evident for days and even up to a week or two after the medicine has been started.

Celecoxib may not be appropriate for everyone, and some people should avoid taking the medication. Your healthcare provider may recommend you avoid using celecoxib if you have:

• had an allergic reaction to NSAIDs or acetylsalicylic acid (ASA) (e.g., Aspirin®)
• asthma that worsens while taking ASA
• had a recent ulcer in the stomach or small bowel
• kidney or liver disease
• significant congestive heart failure
• had a recent heart attack or stroke or experienced serious chest pain related to heart disease
• an allergy to sulfa medication

Celecoxib should be used with caution if you:

• are over age 65
• have had a previous stomach ulcer
• are taking blood thinners, such as warfarin (Coumadin®)
• are taking multiple NSAIDs (including low-dose ASA)
• have significant risk factors for heart attack or stroke (using NSAIDs may increase this risk)

You must be careful to avoid taking more than one NSAID (over the counter and prescription), including celecoxib, at a time as this may increase the risk of developing a stomach ulcer. The only exception would be if you are taking low dose ASA for cardiovascular protection. ASA is not commonly used or recommended for treatment of arthritis pain. 

NOTE: Please speak with your healthcare provider before starting therapy with an NSAID. 

In general, celecoxib is tolerated fairly well. More common side effects include stomach issues, such as bloating, nausea, stomach pain, heartburn and constipation. Celecoxib is generally better tolerated in terms of stomach issues compared to other NSAIDs.

Rare side effects of celecoxib include:

• allergic reactions such as skin rashes or wheezing
• headaches, dizziness or ringing in the ears (tinnitus)
• unusual bruising or bleeding
• kidney problems
• gastrointestinal problems — celecoxib can cause irritation to the stomach, causing nausea and vomiting

Celecoxib has been custom-designed to minimize the risk of stomach ulcers that is associated with other NSAIDs. It is not known if this advantage is maintained with long term celecoxib therapy and this advantage is substantially reduced for people taking low dose aspirin for cardiovascular protection.

Ulcers usually cause stomach pain, nausea and sometimes vomiting, but in some people ulcers produce no symptoms. Signs of stomach bleeding may include vomit that looks like it has “coffee grounds” in it, vomiting blood or black, tarry bowel movements. Let your healthcare provider know if you:

• have any stomach pain, nausea, heartburn or indigestion
• notice any black or bloody stools,
• are vomiting blood or “coffee ground” material
• fluid retention — celecoxib can cause fluid retention with swelling of the ankles
• blood pressure — celecoxib can increase blood pressure, which should be monitored periodically, especially if you have hypertension

Take celecoxib as prescribed and contact your healthcare provider if you have any concerns while taking the medication. 

Taking celecoxib with food may help reduce stomach upset. 

If your healthcare provider determines that you are high risk to develop a stomach ulcer, the combination of celecoxib with a medication to protect the lining of the stomach may be considered. There are currently two available types of stomach protection medications: misoprostol and proton pump inhibitors.

Blood work is not normally required while taking celecoxib. However, if you take celecoxib regularly, your doctor will likely monitor your blood pressure and order periodic blood tests to ensure that celecoxib is not causing problems or affecting your kidneys.

Store this medication at room temperature (15-30 degrees Celsius) and keep it out of reach of children.