Can Celebrex (celecoxib) cause a patient to become unresponsive?

Can Celebrex Cause Unresponsiveness?

Celebrex (celecoxib) does not typically cause unresponsiveness as a direct adverse effect, but it can precipitate life-threatening anaphylaxis that may present with altered consciousness, hypotension, and respiratory distress requiring immediate emergency intervention.

Anaphylactic Reactions Leading to Unresponsiveness

• Celecoxib can cause anaphylaxis, which may manifest as acute onset of pruritus, urticaria, respiratory distress, and hypotension within minutes of ingestion 1
• A documented case describes a patient who became acutely ill with respiratory distress and hypotension after taking celecoxib, requiring treatment with epinephrine, corticosteroids, and intravenous fluids 1
• This anaphylactic presentation could render a patient unresponsive due to severe hypotension and respiratory compromise 1
• Importantly, anaphylaxis can occur even in patients who have previously tolerated celecoxib without difficulty 1

Other Serious Adverse Effects That Could Impair Consciousness

While not directly causing unresponsiveness, celecoxib is associated with multiple serious complications that could indirectly lead to altered mental status:

Cardiovascular Complications

• Celecoxib carries increased cardiovascular risk, particularly in elderly patients with pre-existing cardiovascular disease 2, 3
• Severe cardiovascular events (myocardial infarction, stroke, heart failure decompensation) could present with altered consciousness 3
• The American College of Cardiology recommends avoiding celecoxib entirely in patients with established cardiovascular disease or congestive heart failure 3, 4

Gastrointestinal Bleeding

• Severe GI bleeding could lead to hypovolemic shock and altered mental status 5, 2
• The risk is dramatically elevated in elderly patients (1 in 110 for adults over 75 years versus 1 in 2,100 for adults under 45) 2, 3

Renal Complications

• Approximately 2% of patients develop renal complications requiring discontinuation 2, 3
• Acute renal failure could contribute to altered mental status through uremic encephalopathy 5

Clinical Pitfalls to Avoid

• Do not dismiss the possibility of anaphylaxis even in patients who have previously tolerated celecoxib 1
• Avoid celecoxib entirely in elderly patients with cardiovascular disease, heart failure, or renal impairment 2, 4
• Monitor for hypersensitivity reactions as celecoxib can cause adverse reactions including angioedema in patients with NSAID intolerance, though most reactions are mild 6
• Consider drug interactions that could precipitate complications, such as increased INR with warfarin leading to intracranial hemorrhage 7

When to Suspect Celecoxib as the Culprit

If a patient becomes unresponsive after taking celecoxib, immediately assess for:

• Signs of anaphylaxis: urticaria, angioedema, wheezing, hypotension, tachycardia 1
• Cardiovascular events: chest pain, focal neurological deficits, severe dyspnea 3
• GI bleeding: hematemesis, melena, signs of hypovolemia 5, 2
• Timing: anaphylaxis typically occurs within minutes of ingestion 1