What is the proper dosing for Celebrex (Celecoxib)?

From the Guidelines

Celebrex dosing for Ankylosing Spondylitis should be 150 mg, with the option to increase to 300 mg based on clinical response. When considering the treatment of Ankylosing Spondylitis with Celebrex, it's essential to weigh the benefits against potential risks, particularly cardiovascular ones 1. The recommended dose of 150 mg can be adjusted to 300 mg if the patient's condition warrants it, as indicated in a recent study published in the British Journal of Dermatology 1.

Key Considerations

• The dose may need to be increased to 300 mg based on the patient's clinical response.
• It is crucial to monitor patients for potential side effects, especially those related to cardiovascular health.
• Patients should be advised to take Celebrex with food to minimize gastrointestinal irritation.

Clinical Application

In clinical practice, the decision to use Celebrex for Ankylosing Spondylitis at a dose of 150 mg, potentially increasing to 300 mg, should be made with careful consideration of the patient's overall health status, including any history of cardiovascular disease or risk factors for such conditions 1.

From the FDA Drug Label

1. 1 General Dosing Instructions Carefully consider the potential benefits and risks of celecoxib capsules and other treatment options before deciding to use celecoxib capsules. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5)].
2. 2 Osteoarthritis For OA, the dosage is 200 mg per day administered as a single dose or as 100 mg twice daily. 2.3 Rheumatoid Arthritis For RA, the dosage is 100 mg to 200 mg twice daily.
3. 4 Juvenile Rheumatoid Arthritis For JRA, the dosage for pediatric patients (age 2 years and older) is based on weight. For patients ≥10 kg to ≤25 kg the recommended dose is 50 mg twice daily. For patients >25 kg the recommended dose is 100 mg twice daily.
4. 5 Ankylosing Spondylitis For AS, the dosage of celecoxib capsules are 200 mg daily in single (once per day) or divided (twice per day) doses.
5. 6 Management of Acute Pain and Treatment of Primary Dysmenorrhea For management of Acute Pain and Treatment of Primary Dysmenorrhea, the dosage is 400 mg initially, followed by an additional 200 mg dose if needed on the first day.

The recommended dosage of celecoxib varies by condition:

• Osteoarthritis (OA): 200 mg per day as a single dose or 100 mg twice daily
• Rheumatoid Arthritis (RA): 100 mg to 200 mg twice daily
• Juvenile Rheumatoid Arthritis (JRA): 50 mg twice daily for patients ≥10 kg to ≤25 kg, 100 mg twice daily for patients >25 kg
• Ankylosing Spondylitis (AS): 200 mg daily as a single or divided dose
• Acute Pain and Primary Dysmenorrhea: 400 mg initially, followed by an additional 200 mg dose if needed on the first day, then 200 mg twice daily as needed 2

From the Research

Celebrex Dosage

• The recommended dosage of Celebrex is 200 or 400 mg/day for the symptomatic treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis in adults 3.
• In patients with osteoarthritis of the knee, celecoxib 100 and 200 mg and naproxen 500 mg twice daily were similarly efficacious and superior to placebo 4.
• All dosages of celecoxib (100 to 400 mg twice daily) and naproxen 500 mg twice daily produced significant anti-inflammatory and analgesic effects in patients with active rheumatoid arthritis 4.
• Celecoxib was well tolerated in clinical trials, with upper gastrointestinal complications occurring in significantly fewer patients treated with twice daily celecoxib 25 to 400 mg than in those receiving comparator NSAIDs 4.

Dosage Comparison

• A study comparing celecoxib with ibuprofen and naproxen found that celecoxib had a similar or lower risk of cardiovascular, gastrointestinal, and renal adverse events 5.
• Another study found that celecoxib was noninferior to ibuprofen or naproxen with regard to cardiovascular safety, with a lower risk of gastrointestinal events and renal events 6.
• The dosage of celecoxib used in these studies ranged from 100 to 400 mg twice daily, with a mean daily dose of 209 mg in one study 6.

Safety Profile

• Celecoxib has a promising gastrointestinal safety profile, with a lower incidence of upper gastrointestinal ulceration and complications compared to nonselective NSAIDs 4, 3.
• However, concomitant administration of celecoxib with low-dose cardioprotective aspirin may negate the GI-sparing advantages of celecoxib over NSAIDs 3.
• The risks of increased thrombotic cardiovascular events, or renovascular, hepatic or hypersensitivity reactions with celecoxib are small and similar to those with NSAIDs 3.