What are the potential side effects of Celebrex (celecoxib) in a 70-year-old patient?

From the Guidelines

Celebrex (celecoxib) can cause significant side effects in a 70-year-old patient, including gastrointestinal issues, increased cardiovascular risks, kidney problems, blood pressure elevation, and serious skin reactions, which require careful monitoring 1.

Common Side Effects

• Gastrointestinal issues such as stomach pain, heartburn, nausea, and diarrhea
• Increased cardiovascular risks, including heart attack, stroke, and blood clots, particularly with higher doses or prolonged use
• Kidney problems, manifesting as decreased urination, swelling in extremities, or fatigue
• Blood pressure elevation, which should be monitored regularly

Serious Side Effects

• Serious skin reactions like rash or blistering
• Liver damage, though rare, can present as yellowing of skin/eyes, dark urine, or abdominal pain
• Interactions with medications commonly prescribed to older adults, including blood thinners, certain antidepressants, and diuretics

Recommendations

• Lower starting doses are typically recommended for elderly patients, with careful monitoring for adverse effects 1
• Avoid COX-2 inhibitors, such as celecoxib, in persons at risk of cardiovascular events, and consider a nonselective NSAID with misoprostol or a PPI in persons who need GI protection when taking NSAIDs 1
• Monitor patients closely for signs of gastrointestinal bleeding, cardiovascular events, and kidney problems, particularly in the first six months of treatment 1

From the FDA Drug Label

Risk Factors for GI Bleeding, Ulceration, and Perforation Patients with a prior history of peptic ulcer disease and/or GI bleeding who used NSAIDs had a greater than 10-fold increased risk for developing a GI bleed compared to patients without these risk factors Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include longer duration of NSAID therapy; concomitant use of oral corticosteroids, antiplatelet drugs (such as aspirin), anticoagulants; or selective serotonin reuptake inhibitors (SSRIs); smoking; use of alcohol; older age; and poor general health status Most postmarketing reports of fatal GI events occurred in elderly or debilitated patients. Patients 65 years of age and older had an incidence of 1.40% at nine months, 3.06% when also taking ASA [see Clinical Studies (14. 7)]. Elevations of ALT or AST (three or more times the upper limit of normal [ULN]) have been reported in approximately 1% of NSAID-treated patients in clinical trials. NSAIDs, including celecoxib capsules can lead to new onset of hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. The Coxib and traditional NSAID Trialists’ Collaboration meta-analysis of randomized controlled trials demonstrated an approximately twofold increase in hospitalizations for heart failure in COX-2 selective-treated patients and nonselective NSAID-treated patients compared to placebo-treated patients Renal Toxicity Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury.

Potential side effects of Celebrex (celecoxib) in a 70-year-old patient include:

• Gastrointestinal (GI) risks: increased risk of GI bleeding, ulceration, and perforation, especially with a history of peptic ulcer disease or GI bleeding, concomitant use of other medications, or older age 2
• Hepatotoxicity: elevations of ALT or AST, sometimes fatal, cases of severe hepatic injury, including fulminant hepatitis, liver necrosis, and hepatic failure 2
• Hypertension: new onset or worsening of preexisting hypertension, contributing to increased CV events 2
• Heart Failure and Edema: increased risk of hospitalizations for heart failure, fluid retention, and edema 2
• Renal Toxicity and Hyperkalemia: long-term administration may result in renal papillary necrosis and other renal injury, especially in patients with impaired renal function, dehydration, or heart failure 2
• Common adverse events: abdominal pain, diarrhea, dyspepsia, flatulence, nausea, back pain, peripheral edema, dizziness, headache, insomnia, pharyngitis, rhinitis, sinusitis, upper respiratory infection, rash 2

From the Research

Potential Side Effects of Celebrex in a 70-year-old Patient

The potential side effects of Celebrex (celecoxib) in a 70-year-old patient can be understood by examining the available evidence from various studies.

• Gastrointestinal side effects: A study published in JAMA in 2000 3 found that celecoxib was associated with a lower incidence of symptomatic ulcers and ulcer complications compared to nonsteroidal anti-inflammatory drugs (NSAIDs). However, the risk of gastrointestinal side effects may still be present, particularly in elderly patients.
• Cardiovascular risk: A study published in Circulation in 2008 4 found that celecoxib was associated with an increased risk of cardiovascular events, particularly at higher doses. This risk may be more pronounced in patients with pre-existing cardiovascular disease.
• Allergic reactions: A case report published in Annals of Allergy, Asthma, and Immunology in 2001 5 described a patient who experienced anaphylaxis after taking celecoxib. While this is a rare side effect, it highlights the importance of monitoring patients for signs of allergic reactions.
• Other side effects: A review of celecoxib published in Drugs in 2000 6 found that the drug was generally well-tolerated, but may cause other side effects such as hepatotoxicity, renal toxicity, and chronic GI blood loss.

Special Considerations for Elderly Patients

Elderly patients may be more susceptible to the side effects of celecoxib due to age-related changes in physiology and the presence of comorbidities.

• A study published in Drugs in 2000 6 found that celecoxib was effective and well-tolerated in elderly patients with osteoarthritis, but the dose should be carefully selected to minimize the risk of side effects.
• Another study published in JAMA in 2000 3 found that the risk of gastrointestinal side effects was lower in patients taking celecoxib compared to NSAIDs, but the risk may still be present in elderly patients.

Sulfonamide Allergy

Celecoxib contains a sulfonamide substituent, which may be a concern for patients with a known sulfonamide allergy.

• A study published in Drug Safety in 2001 7 found that there is no documented cross-reactivity between sulfonamide antimicrobials and other sulfonamide-containing medications, such as celecoxib. However, patients with a known sulfonamide allergy should be monitored closely for signs of an allergic reaction.