Names and pronunciation
(sel-eh-cox′ib) CeleBREX
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Individual generic drug information
Extracted information for celecoxib only.
(sel-eh-cox′ib) CeleBREX
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Func. class.: Nonsteroidal antiinflam- matory, antirheumatic
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Chem. class.: COX-2 inhibitor
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Do not confuse: CeleBREX/CeleXA /Cerebyx
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ACTION: Inhibits prostaglandin syn- thesis by selectively inhibiting cyclooxy- genase-2 (COX-2), an enzyme needed for biosynthesis
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USES: Acute, chronic rheumatoid arthritis, osteoarthritis, acute pain, pri- mary dysmenorrhea, ankylosing spondy- litis, juvenile rheumatoid arthritis (JRA); acute migraine (Elyxyb)
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Extracted information for celecoxib only.
CONTRAINDICATIONS: Preg- nancy; hypersensitivity to salicylates, iodides, other NSAIDs, sulfonamides; for perioperative pain in CABG Precautions: Breastfeeding, children <18 yr, geriatric patients, bleeding, GI/renal/ hepatic/cardiac disorders, PVD, hyperten- sion, severe dehydration, asthma, sulfa allergy, peptic ulcer disease, MI, stroke
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Black Box Warning: GI bleeding/perfora- tion, thromboembolism Black Box Warning: For cardiac disease that may be worse after taking product; MI, stroke; do not use with coronary ar- tery bypass graft (CABG) • CBC during therapy; watch for decreas- ing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; LFTs, serum creatinine/BUN • For blood dyscrasias (thrombocyto- penia): bruising, fatigue, bleeding, poor healing Black Box Warning: GI toxicity: black, tarry stools; abdominal pain; monitor stool guiac • Serious skin disorders: Stevens- Johnson syndrome, toxic epidermal necrolysis; may be fatal, treat symptomati- cally; may recur after therapy is discontin- ued; if severe, may require discontinuing • Beers: Avoid use in older adults; may increase risk of kidney injury, exacerbate heart failure, increase fluid retention Black Box Warning: Not to exceed rec- ommended dose; to notify prescriber im- mediately of chest pain, skin eruptions; to stop product if these occur • To check with prescriber to determine when product should be discontinued before surgery • That product must be continued for prescribed time to be effective; to avoid other NSAIDs, aspirin, sulfonamides Black Box Warning: To notify prescriber immediately of GI symptoms: black, tarry stools; cramping or rash; edema of ex- tremities; weight gain or hepatotoxicity: nausea, pruritus, yellowing skin, eyes, lethargy; itching, upper abdominal pain • To report bleeding, bruising, fatigue, mal- aise because blood abnormalities do occur • Pregnancy/breastfeeding: to report if pregnancy is planned or suspected; avoid use in breastfeeding; not to use during pregnancy, breastfeeding; those who are pregnant should register at the C Organization of Teratology of Information Specialists Autoimmune Diseases in Pregnancy Study (877-311-8972) HIGH ALERT
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SIDE EFFECTS CNS: Fatigue, nervousness, insomnia, headache CV: Stroke, MI, HF, hypertension, fluid retention GI: Nausea, anorexia, dry mouth, GI bleeding/ulceration INTEG: Serious (sometimes fatal) Stevens-Johnson syndrome, toxic epi- dermal necrolysis, exfoliative dermatitis, rash
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INTERACTIONS Increase: bleeding risk—anticoagulants, SNRIs, SSRIs, antiplatelets, thrombolytics, salicylates, alcohol Increase: adverse reactions—glucocor- ticoids, NSAIDs, aspirin Increase: toxicity—lithium Increase: celecoxib blood level— CYP2C9 inhibitors (fluconazole) Decrease: effect of aspirin, ACE inhibi- tors, thiazide diuretics, furosemide Drug/Lab Test Increase: ALT, AST, BUN, cholesterol, glu- cose, potassium, sodium Decrease: glucose, sodium, WBC, platelets
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Extracted information for celecoxib only.
DOSAGE AND ROUTES Acute pain/primary dysmenorrhea • Adult: PO 400 mg initially, then 200 mg if needed on first day, then 200 mg bid as needed on subsequent days; start with ½ dose for poor CYP2C9 metabo- lizers Osteoarthritis • Adult: PO 200 mg/day as a single dose or 100 mg bid Rheumatoid arthritis • Adult: PO 100-200 mg bid; start with ½ dose for poor CYP2C9 metabolizers Ankylosing spondylitis • Adult: PO 200 mg/day or in divided doses (bid) Juvenile rheumatoid arthritis (JRA) • Adolescent/child ≥2 yr (>25 kg): PO 100 mg bid • Child ≥2 yr (10-25 kg): PO 50 mg bid Migraine • Adult: PO 120 mg (4.8 mL) Hepatic disease • Adult: PO (Child-Pugh B) reduce dose by 50%; (Child-Pugh C) do not use
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Available forms: Capsules 50, 100, 200, 400 mg; oral solution 25 mg/mL
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Administer: • Do not break, crush, chew, or dissolve capsules; give with a full glass of water to enhance absorption; capsules may be opened into applesauce or soft food, in- gest immediately with water • With food, milk to decrease gastric symptoms (with higher doses [400 mg bid]); do not increase dose
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Extracted information for celecoxib only.
Evaluate: • Therapeutic response: decreased pain, inflammation in arthritic condi- tions; decreased number of polyps
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CLINICAL CONSIDERATIONS Assess • Pain of rheumatoid arthritis, osteoar- thritis; check ROM, inflammation of joints, characteristics of pain, baseline and periodically
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Patient and caregiver information:
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Extracted information for celecoxib only.
PHARMACOKINETICS Well absorbed, crosses placenta, metabolized by CYP2C9 in liver, some patients may be poor metaboliz- ers; very little excreted by kidneys/in feces, peak 3 hr, half-life 11 hr, protein binding ∼97%
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Filter the extracted dose blocks for this individual drug.
Acute pain/primary dysmenorrhea
• Adolescent/child ≥2 yr (>25 kg): PO 100 mg bid
Candidate age grouping · source page 248
Acute pain/primary dysmenorrhea
• Child ≥2 yr (10-25 kg): PO 50 mg bid Migraine
Candidate age grouping · source page 248