Can Celecoxib (celecoxib) cause gastrointestinal (GI) bleeding?

From the Guidelines

Yes, celecoxib can cause gastrointestinal (GI) bleeding, although it generally has a lower risk compared to traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Celecoxib (brand name Celebrex) is a selective COX-2 inhibitor that was specifically developed to reduce GI side effects while maintaining anti-inflammatory efficacy. Despite this improved safety profile, the risk of GI bleeding still exists, particularly in high-risk patients such as the elderly, those with a history of peptic ulcer disease, individuals taking blood thinners or corticosteroids, and those consuming alcohol regularly.

The use of COX-2-specific inhibitors, such as celecoxib, decreases the risk of developing gastrointestinal clinical events and complications by approximately 50% 1. However, the risk of GI bleeding is still present, and patients should be vigilant for warning signs such as black tarry stools, coffee-ground vomit, or abdominal pain.

Some key points to consider when prescribing celecoxib include:

• The typical dosage ranges from 100-200 mg twice daily, depending on the condition being treated.
• To minimize GI risks, celecoxib should be taken at the lowest effective dose for the shortest duration necessary.
• Patients with a history of GI events, such as ulcers or bleeding, are at higher risk of developing GI complications while taking celecoxib 1.
• The addition of proton pump inhibitors (PPIs) to therapy may help reduce the risk of GI bleeding, particularly in high-risk patients 1.

Overall, while celecoxib has a lower risk of GI bleeding compared to traditional NSAIDs, it is still important to carefully consider the risks and benefits of treatment and to monitor patients closely for signs of GI complications. The mechanism behind celecoxib's reduced but still present GI risk involves its selective inhibition of COX-2 enzymes while partially sparing COX-1 enzymes that help maintain the protective gastric mucosa.

From the FDA Drug Label

NSAIDs, including celecoxib cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with celecoxib capsules. Only one in five patients who develop a serious upper GI adverse event on NSAID therapy is symptomatic Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occurred in approximately 1% of patients treated for 3 to 6 months, and in about 2% to 4% of patients treated for one year.

Yes, celecoxib can cause GI bleed. The risk of GI bleeding is increased in patients with a prior history of peptic ulcer disease and/or GI bleeding, and in patients taking concomitant medications such as oral corticosteroids, antiplatelet drugs, or anticoagulants 2.

From the Research

Gastrointestinal Bleeding Risk with Celecoxib

• The risk of gastrointestinal (GI) bleeding with celecoxib has been evaluated in several studies 3, 4, 5, 6, 7.
• A study published in the Lancet in 2017 found that celecoxib plus a proton-pump inhibitor (PPI) was superior to naproxen plus a PPI in preventing recurrent upper GI bleeding in patients at high risk of both cardiovascular and GI events 3.
• Another study published in Arthritis and Rheumatism in 2007 found that the addition of a PPI to celecoxib conferred extra protection against GI bleeding in patients aged 75 years or older, but not in those aged 66-74 years 4.
• A study published in the Journal of Pain Research in 2018 found that celecoxib was associated with a lower risk of GI bleeding than traditional nonsteroidal anti-inflammatory drugs (NSAIDs) when treatment lasted for 120 days or more, but this relationship was not observed in patients without concomitant use of gastroprotective prophylaxis 6.
• A study published in Rheumatology in 2003 found that celecoxib was associated with a relative reduction in the incidence of symptomatic and complicated upper GI events compared with meloxicam 7.

Factors Influencing GI Bleeding Risk

• The risk of GI bleeding with celecoxib may be influenced by factors such as age, sex, history of upper GI problems, and concomitant use of NSAIDs or aspirin 3, 4, 6, 7.
• The use of a PPI with celecoxib may confer additional protection against GI bleeding in certain patient populations, such as those aged 75 years or older 4.
• The dose and duration of celecoxib treatment may also influence the risk of GI bleeding, with higher doses and longer treatment durations potentially increasing the risk 6.