What are the contraindications for Celecoxib (celecoxib)?

Contraindications for Celecoxib

Celecoxib is absolutely contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. 1

Absolute Contraindications

• History of allergic reactions to sulfonamides: Although there is debate about cross-reactivity between sulfonamide antimicrobials and celecoxib, current labeling maintains this contraindication 2
• Perioperative pain in CABG surgery: This is a black box warning contraindication 1
• History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs: Patients with aspirin-exacerbated respiratory disease (AERD) may cross-react, though studies show celecoxib may be safer than traditional NSAIDs in this population 1, 3
• Third trimester of pregnancy: Avoid NSAIDs including celecoxib 6-8 weeks before term due to risk of premature closure of ductus arteriosus 1

Relative Contraindications (Use with Extreme Caution)

Cardiovascular Risk

• Established cardiovascular disease: Celecoxib may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke 1
• Risk factors for cardiovascular disease: Higher risk with longer duration of use 1
• Congestive heart failure: All NSAIDs can aggravate heart failure 1
• Hypertension: Celecoxib can increase blood pressure by approximately 5 mmHg 1

Gastrointestinal Risk

• History of GI bleeding or ulceration: Although celecoxib has better GI profile than traditional NSAIDs, it still carries risk 1, 4
• Elderly patients: Higher risk of serious GI adverse events 1
• Concomitant use with aspirin: Negates the GI protective advantage of celecoxib 1

Renal Risk

• Pre-existing renal disease: All NSAIDs including celecoxib can cause volume-dependent renal failure 1
• Concomitant use with ACE inhibitors or beta blockers: Increased risk of renal complications 1
• Cirrhosis: Increased risk of renal complications 1

Other Important Considerations

• Platelet disorders or thrombocytopenia: Avoid NSAIDs due to potential bleeding risk 1
• Concomitant use with anticoagulants: Significantly increased risk of GI bleeding (3-6 times higher) 1
• Hepatic impairment: Although rare, NSAIDs can cause idiosyncratic liver toxicity 1

Cross-Reactivity Considerations

• In patients with aspirin/NSAID hypersensitivity, cross-reactivity to celecoxib occurs in approximately 10.3% of cases 5
• Cross-reactivity is higher in patients with underlying chronic urticaria 5
• Patients who cannot tolerate acetaminophen are more likely to be intolerant to celecoxib 5

Risk Assessment Algorithm

1. Screen for absolute contraindications:

   • CABG perioperative pain setting
   • Known sulfonamide allergy
   • Third trimester pregnancy

2. Assess cardiovascular risk:

   • If patient has established CV disease or multiple risk factors, consider alternative therapy
   • If celecoxib is necessary, use lowest effective dose for shortest duration

3. Assess GI risk:

   • If history of GI bleeding/ulceration, consider adding PPI if celecoxib is necessary
   • If patient is on low-dose aspirin, recognize that GI protective benefit of celecoxib is diminished

4. Assess renal function:

   • Avoid in patients with significant renal impairment
   • Use with caution when combined with ACE inhibitors or beta blockers

5. Consider hypersensitivity risk:

   • In patients with AERD or history of NSAID reactions, consider oral challenge testing under medical supervision before prescribing for regular use

By carefully assessing these risk factors and contraindications, the appropriate use of celecoxib can be determined to minimize adverse outcomes related to morbidity and mortality.