Celecoxib
CELEBREX
Pronunciation: sel-e-KOX-ib
“2 Celebrating Cocks”
Two roosters → COX-2 selective cue
“The N said... NSAID”
What it isCOX-2-preferring NSAID; arthritis and acute pain.
Why this oneLargely spares platelet COX-1 and causes less GI ulceration than nonselective NSAIDs, useful when bleeding risk matters.
What limits itCardiovascular and renal toxicity remain; CYP2C9 poor metabolism or inhibition raises exposure. Sulfonamide hypersensitivity warrants caution.
Celecoxib prescription history
Animated chart of estimated U.S. prescriptions per year, NSAIDs (1914–2026). Celecoxib enters in 1999 (estimated).
FDA-approved for
- pain/arthritis (1998)
Sulfonamide
Sulfonamide-derived drug (non-antibacterial) — label warns
A primary aryl sulfonamide with a pyrazole, not an amine, para to the sulfonyl. No N4 aromatic amine, no N1 heterocycle: cross-reactivity after a sulfonamide-antimicrobial reaction is unlikely — sulfa-allergic patients reacted to sulfonamide non-antibiotics at 9.9% vs 1.6%, less often than to penicillin. The label warns anyway. After a celecoxib reaction there are no data that other sulfonamides, antimicrobial or not, need avoiding.
Open the sulfonamide hypersensitivity presentation → · sources [n] are on its References slide.
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Osteoarthritis | Adult | 200 mg QD or 100 mg BID | 200 mg QD or 100 mg BID | |
| Rheumatoid arthritis | Adult | 100-200 mg BID | 100-200 mg BID | |
| Juvenile RA | Peds >=2 yr | 50 mg BID (10-25 kg); 100 mg BID (>25 kg) | 50-100 mg BID by weight | |
| Ankylosing spondylitis | Adult | 200 mg QD or 100 mg BID | 200 mg/day | 400 mg/day (trial if no effect at 6 wk) |
| Acute pain / primary dysmenorrhea | Adult | 400 mg once, then 200 mg once if needed (day 1) | 200 mg BID PRN |
Renal Not recommended in severe renal insufficiency; avoid in advanced renal disease unless benefit outweighs risk
Hepatic Moderate (Child-Pugh B): reduce dose 50%; severe: not recommended
Instructions
- May be given without regard to meals
- Difficulty swallowing (incl. JRA): sprinkle capsule contents onto applesauce, ingest immediately with water
- CYP2C9 poor metabolizers: start at half the lowest recommended dose (consider alternatives for JRA)
Available strengths
- cap 50, 100, 200, 400 mg
- sol 25 mg/mL
- susp 10 mg/mL
Contraindications
- History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs
- Setting of CABG surgery
- Demonstrated allergic-type reactions to sulfonamides
Cautions
- CV thrombotic events (MI, stroke)
- GI bleeding, ulceration, perforation
- Hepatotoxicity
- Hypertension; heart failure and edema
- Renal toxicity/hyperkalemia
- Anaphylaxis; aspirin-sensitive asthma (contraindicated)
- Serious skin reactions (SJS/TEN)/DRESS
- Fetal toxicity 20-30 wk gestation
- Anemia/hematologic toxicity
Adverse reactions
- Abdominal pain
- Diarrhea
- Dyspepsia
- Flatulence
- Peripheral edema
- Dizziness
- Headache
- Upper respiratory infection
- Rash
Pregnancy Avoid at >=30 wk (premature ductus arteriosus closure); limit 20-30 wk (oligohydramnios/fetal renal dysfunction)
Lactation Low levels in breast milk (<1% weight-based infant dose); caution advised
Cost
Generic entry2014
Open Celecoxib in the interactive console ↗
Memory aids: interaction avatars
Open Celecoxib in the interactive console ↗
Self-check
- Which metabolism changes raise celecoxib exposure?
CYP2C9 poor metabolism or inhibition. - What platelet enzyme does celecoxib largely spare?
COX-1.