What are the uses, contraindications, and adverse effects of Celebrex (celecoxib)?

Celebrex (Celecoxib): Uses, Contraindications, and Adverse Effects

Celecoxib (Celebrex) is a COX-2 selective inhibitor indicated for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain, and primary dysmenorrhea, but is contraindicated in patients with known hypersensitivity to sulfonamides, history of asthma or allergic reactions after taking NSAIDs, and in the setting of CABG surgery.

Uses

Celecoxib is FDA-approved for the following conditions:

1. Osteoarthritis: Provides symptomatic relief of pain and inflammation 1
2. Rheumatoid Arthritis: Reduces signs and symptoms of active disease 1
3. Ankylosing Spondylitis: First-line drug treatment for pain and stiffness 2
4. Acute Pain Management: Effective for post-surgical and other acute pain 3
5. Primary Dysmenorrhea: Relieves menstrual pain 4

Celecoxib demonstrates efficacy similar to traditional NSAIDs but with improved gastrointestinal safety profile when used at recommended doses (200-400 mg/day) 1.

Contraindications

Celecoxib is absolutely contraindicated in:

1. Known hypersensitivity to celecoxib or sulfonamides 5
2. History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs 5
3. Coronary artery bypass graft (CABG) surgery setting 5
4. Previous serious skin reactions to NSAIDs 5

Adverse Effects

Cardiovascular Effects

• Increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke 5
• Risk increases with higher doses and longer duration of use 5
• Patients with cardiovascular disease or risk factors are at higher risk 6
• For patients with cardiovascular concerns, naproxen is preferred over celecoxib 6

Gastrointestinal Effects

• Reduced risk of GI ulceration and bleeding compared to traditional NSAIDs, but risk still exists 2
• Approximately 1% of patients treated for 3-6 months develop upper GI ulcers, gross bleeding, or perforation 5
• Risk factors for GI complications include:
  • Prior history of peptic ulcer disease
  • Advanced age (≥65 years)
  • Concomitant use of aspirin, corticosteroids, or anticoagulants
  • Higher doses and longer duration of therapy 2, 5

Renal Effects

• Renal papillary necrosis and other renal injury with long-term use 5
• Fluid retention and edema 5
• Patients at highest risk: impaired renal function, dehydration, heart failure, liver dysfunction, elderly, and those taking diuretics or ACE inhibitors 5

Hepatic Effects

• Elevated liver enzymes (ALT, AST) in approximately 1% of patients 5
• Rare cases of severe hepatic injury including fulminant hepatitis, liver necrosis, and hepatic failure 5

Skin Reactions

• Serious skin reactions including Stevens-Johnson Syndrome, toxic epidermal necrolysis, and exfoliative dermatitis 5
• These can occur without warning and can be fatal 5

Other Adverse Effects

• Anaphylactic reactions in patients with and without known hypersensitivity 5
• Hematologic toxicity including anemia and increased risk of bleeding 5
• Premature closure of fetal ductus arteriosus if used during third trimester of pregnancy 5

Special Populations and Considerations

Elderly Patients

• Higher risk of adverse effects, particularly GI and renal complications 2
• Use lowest effective dose for shortest duration 2

Pregnancy

• Avoid use in third trimester (after 30 weeks gestation) due to risk of premature closure of fetal ductus arteriosus 5

Patients on Aspirin Therapy

• Concomitant use increases risk of GI complications 5
• The GI-sparing advantage of celecoxib may be negated when combined with low-dose aspirin 1

Risk Minimization Strategies

1. Use the lowest effective dose for the shortest duration possible 4
2. Consider adding a proton pump inhibitor for patients with both CV and GI risk factors 6
3. Monitor blood pressure, renal function, and signs of fluid retention in patients with cardiovascular risk factors 6
4. Regular laboratory monitoring (CBC, liver enzymes) for patients on long-term therapy 5
5. Avoid concomitant use with other NSAIDs or multiple doses of NSAIDs 2

In conclusion, celecoxib remains an effective treatment option for various inflammatory conditions, but careful consideration of individual patient risk factors for cardiovascular, gastrointestinal, and renal adverse effects is essential before prescribing.