Celecoxib

Shadrock L. Caparida
 NAME
–Generic Name:
• Celecoxib
–Brand Name:
• Celebrex
–Pregnance risk category C; D in 3rd
trimester
–Drug class:
• NSAIDs
 DOSAGE

• Osteoarthritis
– Adults: 200mg P.O. daily as a single
dose or divided equally b.i.d.
• Rheumatoid arthritis
– Adults: 100-200mg P.O. b.i.d.
• Adjunctive treatment for familial
adenomatous colorectal polyps
– Adults: 400 mg P.O. b.i.d. with food for
up to 6 months
 DOSAGE

• Acute pain and primary

dysmenorrhea.
–Adults: 400 mg P.O., initially,
followed by an additional 200-mg
dose if needed. On subsequent
days, 200mg P.O. b.i.d., p.r.n.
–Elderly: Starts at lowest dosage.
 INDICATION
• Relief from signs and symptoms of
osteoarthritis.
• Relief form signs and symptoms
rheumatoid arthritis .
• Adjunctive treatment for familial
adenomatous colorectal polyps.
• Acute pain and primary
dysmenorrhea.
 CONTRAINDICATION

• Contraindicated in patients
hypersensitive to drug, sulfonamides,
aspirin, or NSAIDs.
• Contraindicated in those with severe
hepatic impairment .
• Contraindicated in women in the
third trimester of pregnancy.
 CONTRAINDICATION
• Adjunctive treatment for familial
adenomatous colorectal polyps
• Use cautiously in patients with history of
ulcer or GI bleeding, advance renal
disease, dehydration, anemia
symptomatic liver disease, hypertension,
edema, heart failure, or asthma and poor
CYP2C9 metabolizers.
• Use cautiously in elderly or debilitated
patients.
 MECHANISM OF ACTION

• Thought to inhibit prostaglandin

synthesis, impending
cyclooxygenase-2 (COX-2), to
produce anti-inflammatory, analgesic
and antipyretic effects.
 DRUG TO DRUG INTERACTION

Drug-Drug; ACE inhibitors: May

decrease antihypertensive effects.
Monitor patient’s blood pressure.
• Aluminum- and magnesium-
containing antacids: may decrease
celecoxib level. Separate doses.
• Aspirin: May increase risk of ulcers; low
aspirin dosages can be used safely to
reduce the risk of CV events. Monitor
patient for signs and symptoms of GI
bleeding.
• Fluconazole: may increase celecoxib to
minimal effective doses.
• Lithium: may increase lithium level.
-Monitor lithium level closely during
treatment
• Warfarin: May increase PT and bleeding
complications. Monitor PT and INR, and
check for signs and symptoms of bleeding.
Drug-herb. Dong quai, feverfew, garlic,
ginger, horse chestnut, red clover: May
increase the risk of bleeding. Discourage
use together.
Drug –lifestyle. Long-term alcohol use,
smoking: may cause GI irritation or
bleeding. Check for signs and symptoms of
bleeding.
 ADVERSE EFFECTS
• CNS: dizziness, headache, insomnia
• CV: peripheral edeman.
• EENT: pharyngitis, rhinitis, sinusitis.
• GI: abdominal pain, diarrhea,
dyspepsia, flatulence, nausea.
• Metablic: hypercholeremia.
• Musculoskeletal: back pain.
• Respiratory: upper repiratory tract
infection
• Skin: rah
• Other: accidental injury
 NURSING RESPONSIBILITIES
• Alert: Patients may be allergic to
drug id they are allergic to or have
anaphylactic reaction to
sulfonamides, aspirin or other
NSAIDs.
• Patient with history of ulcer or GI
bleeding is at higher risk for GI
bleeding while taking NSAIDs such as
celecoxib. Other risk factors for GI
bleeding include treatment with
cortecosteroids or anticoagulants,
longer duration of NSAIDs treatment,
smoking, alcoholism, older age, and
poor overall health.
• Although drug may be used with low
aspirin dosages, the combination may
increase risk of GI bleeding.
• Watch for signs and symptoms of
occult bleeding.
• NSAIDs such as celecoxib can cause
fluid retention; monitor patient with
hypertension, edema or heart failure.
• Drug maybe hepatotoxic; watch for
signs and symptoms of liver toxicity.
• Before starting drug therapy,
rehydrate dehydrated patient.
• Drug can be given without regard to
meals, but food may decrease GI
upset.
• ALERT: Don’t confuse celebrex with
Celebryx or Celexa.