Celecoxib

Celecoxib is a prescription medication used to treat pain, arthritis, and painful menstrual periods. Celecoxib belongs to a group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These work by blocking chemicals in the body that cause pain and inflammation.

Celecoxib comes in capsule form and is taken by mouth, once or twice daily, with or without food.

Common side effects include stomach pain, upset stomach, and diarrhea.

CYP2C9 is a protein in your body that is involved in the elimination of celecoxib and other drugs from your body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2C9 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2C9 testing is done to determine whether you are a poor metabolizer. If you are a poor metabolizer, the levels of celecoxib in your blood can become too high. As a result you may be at an increased risk of having more side effects from celecoxib.

Your doctor may adjust your dose of celecoxib if you are a poor metabolizer.

Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) available by prescription only. It is used for relief of the signs and symptoms of:

• osteoarthritis (OA)
• rheumatoid arthritis (RA)
• juvenile rheumatoid arthritis (JRA)
• ankylosing spondylitis (AS)
• short-term pain (acute pain) in adults
• painful menstruation

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Celecoxib may be found in some form under the following brand names:

• Celebrex

Celecoxib can cause serious side effects. See "Drug Precautions" section.

Common celecoxib side effects include:

• abdominal pain
• diarrhea
• upset stomach
• gas or bloating
• nausea
• cough
• upper respiratory infection

This is not a complete list of celecoxib side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• warfarin (Coumadin) and other "blood thinners" or anticoagulants
• aspirin
• other NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
• amiodarone (Cordarone, Pacerone)
• angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)
• angiotensin II receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eposartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan)
• certain antidepressants (mood elevators)
• atazanavir (Reyataz)
• oral steroids
• clopidogrel (Plavix)
• codeine (in some cough medications and some pain medications)
• dextromethorphan (in some cough medications)
• diuretics ('water pills')
• efavirenz (Sustiva)
• fluconazole (Diflucan)
• fluvastatin (Lescol)
• lithium (Eskalith, Lithobid)
• certain medications for mental illness
• metoprolol (Lopressor, Toprol XL)
• metronidazole (Flagyl)
• mexiletine (Mexitil)
• ondansetron (Zofran)
• propafenone (Rhythmol)
• ritonavir (Norvir, in Kaletra)
• sulfamethoxazole (Bactrim, Septra)
• sulfinpyrazone (Anturane)
• tamoxifen (Nolvadex)
• timolol (Blocadren, Timolide, in some eye drops)
• tramadol (Ultram)
• zafirlukast (Accolate)

This is not a complete list of celecoxib drug interactions. Ask your doctor or pharmacist for more information.

Celecoxib may cause serious side effects including:

• heart attack
• stroke
• high blood pressure
• heart failure from body swelling (fluid retention)
• kidney problems including kidney failure
• bleeding and ulcers in the stomach and intestine
• low red blood cells (anemia)
• life-threatening skin reactions
• life-threatening allergic reactions
• liver problems including liver failure
• asthma attacks in people who have asthma

Get emergency help right away if you have any of the following symptoms:

• shortness of breath or trouble breathing
• chest pain
• weakness in one part or side of your body
• slurred speech
• swelling of the face or throat

Stop taking celecoxib and call your healthcare provider right away if you have any of the following symptoms:

• nausea
• more tired or weaker than usual
• itching
• your skin or eyes look yellow
• stomach pain
• flu-like symptoms
• vomit blood
• there is blood in your bowel movement or it is black and sticky like tar
• skin rash or blisters with fever
• unusual weight gain
• swelling of the arms and legs, hands and feet

Celecoxib and other NSAID medicines should only be used:

• exactly as prescribed
• at the lowest dose possible for your treatment
• for the shortest time needed

Do not take an NSAID medicine:

• if you had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine
• for pain right before or after heart bypass surgery

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of celecoxib there are no specific foods that you must exclude from your diet when receiving celecoxib.

Before receiving celecoxib, tell your healthcare provider:

• about all of your medical conditions.
• about all of the medicines you take. NSAIDs and some other medicines can interact with each other and cause serious side effects. Keep a list of your medicines to show to your healthcare provider and pharmacist.
• if you are pregnant. NSAID medicines should not be used by pregnant women late in their pregnancy.
• if you are breastfeeding. Talk to your doctor.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.
 
This medication falls into category C, then category D from 30 weeks of gestation onward. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child. In addition, use of celecoxib during the third trimester of pregnancy should be avoided.

Tell your doctor if you are breastfeeding or plan to breastfeed. Celecoxib may be excreted in human milk in low amounts. The manufacturer recommends breastfeeding women use caution when taking celecoxib. You and your doctor will need to decide it is safe for you to take celecoxib while breastfeeding.

• Take celecoxib capsules by mouth at the same time each day.
• Celecoxib is usually taken once or twice daily.
• This medication can be taken with or without food. 
• Swallow celecoxib capsules whole. Do not break, chew, or crush capsules.
• For people who have difficulty swallowing capsules, the contents of a celecoxib capsule can be added to applesauce. Carefully empty the entire capsule contents onto a level teaspoon of cool or room temperature applesauce and swallow right away with water.
• To get the most benefit from celecoxib, take it exactly as prescribed by your doctor.
• Do not stop taking celecoxib without discussing it with your doctor.

Osteoarthritis

If you take too much celecoxib call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If celecoxib is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store this medication in the original, tightly sealed container. Keep celecoxib at room temperature, away from excess heat and moisture.
• Keep this and all medications out of the reach of children.

WARNING: CARDIOVASCULAR AND GASTROINTESTINAL RISKS

Cardiovascular Risk