What are the safest doses of Celebrex (celecoxib) and Neurontin (gabapentin) for elderly patients?

Safest Celebrex and Neurontin Doses for the Elderly

For elderly patients, the safest starting dose of Celebrex (celecoxib) is 100 mg once daily, and for Neurontin (gabapentin) it is 100 mg at bedtime, with gradual titration based on response and tolerability while monitoring for adverse effects. 1

Celebrex (Celecoxib) Dosing in the Elderly

Starting Dose and Titration

• Start with 100 mg once daily, which is the lowest effective dose to minimize cardiovascular and gastrointestinal risks 1, 2
• Avoid doses higher than 200 mg daily when possible, as higher doses are associated with increased risk of adverse effects 3
• Do not exceed 200 mg daily in patients with significant cardiovascular risk factors 1

Risk Considerations

• Elderly patients are at greater risk for serious gastrointestinal events including bleeding, ulceration, and perforation 1
• Risk of GI complications increases linearly at approximately 4% per year of advancing age 1
• Cardiovascular risk may increase with higher doses and duration of use 2, 4
• Consider the following risk factors before prescribing:
  • History of peptic ulcer disease (increases risk 2-4 fold) 1
  • Concomitant use of aspirin (negates GI-sparing advantages) 3, 5
  • Renal impairment 1
  • Cardiovascular disease 1

Safety Measures

• Consider gastroprotective agents (proton pump inhibitors) in high-risk patients 1
• Monitor renal function, blood pressure, and signs of heart failure 1, 2
• Avoid use in the setting of coronary artery bypass graft surgery 1
• Use the lowest effective dose for the shortest possible duration 3

Neurontin (Gabapentin) Dosing in the Elderly

Starting Dose and Titration

• Begin with 100 mg at bedtime or 100 mg three times daily 1
• Increase by 100-300 mg every 1-7 days as tolerated 1
• Reduce dosage in patients with impaired renal function 1
• Effective doses in elderly adults may be lower than standard adult doses of 900-3600 mg/day 1

Titration Schedule

• Week 1: 100 mg at bedtime
• Week 2: 100 mg twice daily
• Week 3: 100 mg three times daily
• Continue gradual titration based on response and tolerability 1

Monitoring and Precautions

• Monitor for common side effects: dizziness, somnolence, and mental clouding 1
• Be aware of gabapentin's nonlinear pharmacokinetics (saturable absorption) 1
• Allow 3-8 weeks for adequate titration plus 2 weeks at maximum tolerated dose to assess efficacy 1
• Adjust dose intervals in renal impairment based on creatinine clearance 1

Special Considerations for Elderly Patients

• Start at the lowest possible doses for both medications 1, 2
• Use slower titration schedules than would be used in younger adults 1
• Monitor more frequently for adverse effects 1
• Assess for drug interactions, particularly with:
  • Anticoagulants (with celecoxib) 2, 6
  • Aspirin (with celecoxib) 3, 5
  • Other CNS depressants (with gabapentin) 1
• Consider alternative therapies when appropriate:
  • Topical NSAIDs instead of oral celecoxib for localized pain 1
  • Topical lidocaine for localized neuropathic pain 1

Remember that elderly patients often require more cautious dosing strategies due to age-related changes in pharmacokinetics, increased sensitivity to adverse effects, and higher likelihood of comorbidities and polypharmacy 1.