What is the recommended dosing for Celebrex (Celecoxib)?

Celecoxib (Celebrex) Dosing Recommendations

The recommended dosing for Celebrex (celecoxib) is 200 mg once daily or 100 mg twice daily for osteoarthritis, 100-200 mg twice daily for rheumatoid arthritis, and 200-400 mg daily for ankylosing spondylitis, using the lowest effective dose for the shortest duration possible to minimize cardiovascular and gastrointestinal risks. 1

Specific Dosing by Condition

Osteoarthritis

• Initial and maintenance dose: 200 mg once daily or 100 mg twice daily 1
• Both dosing regimens provide equivalent efficacy 2
• No additional benefit seen with doses higher than 200 mg daily 1

Rheumatoid Arthritis

• Initial and maintenance dose: 100-200 mg twice daily 1
• Some patients may derive additional benefit from the 200 mg twice daily dose 1
• Doses of 400 mg twice daily provide no additional benefit 1

Ankylosing Spondylitis

• Initial and maintenance dose: 200 mg once daily or 100 mg twice daily 1
• Can increase to 400 mg once daily if needed 1
• Higher response rate observed with 400 mg dose (53%) compared to 200 mg dose (44%) 1
• No significant difference in mean improvement between 200 mg and 400 mg doses 1

Acute Pain/Primary Dysmenorrhea

• 400 mg initially, followed by 200 mg if needed on first day
• 200 mg twice daily as needed on subsequent days 1

Special Populations

Elderly Patients

• No dose adjustment generally necessary
• For patients weighing less than 50 kg, initiate at the lowest recommended dose 1

Hepatic Impairment

• Reduce daily dose by approximately 50% in patients with moderate hepatic impairment (Child-Pugh Class B) 1
• Not recommended for patients with severe hepatic impairment (Child-Pugh Class C) 1

Renal Impairment

• No dose adjustment needed for mild to moderate renal impairment
• Not recommended for severe renal insufficiency 1

CYP2C9 Poor Metabolizers

• Consider starting at half the lowest recommended dose in patients known to be CYP2C9 poor metabolizers 1

Important Considerations and Precautions

Cardiovascular Risk

• Use the lowest effective dose for the shortest duration possible 3
• Celecoxib carries significant risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke 3
• Risk increases with duration of use and higher dosages 3
• Contraindicated for perioperative pain in coronary artery bypass graft surgery 3

Gastrointestinal Risk

• Can cause serious GI adverse events including bleeding, ulceration, and perforation 3
• Better GI safety profile than non-selective NSAIDs 3
• GI safety advantage may be negated when taken with aspirin 3

Monitoring Recommendations

• Monitor for signs of cardiovascular events, especially in patients with existing cardiovascular disease or risk factors 3
• Watch for signs of GI bleeding, particularly in elderly patients who are at greater risk 3
• Monitor renal function, especially in patients with pre-existing renal impairment 3

Comparative Efficacy

• Celecoxib has similar efficacy to naproxen and other NSAIDs for pain relief and functional improvement in osteoarthritis and rheumatoid arthritis 1, 4
• In Hispanic patients with knee osteoarthritis, celecoxib 200 mg once daily was as effective as naproxen 500 mg twice daily 5

By following these dosing recommendations and considering patient-specific factors, celecoxib can provide effective symptom relief while minimizing potential risks.