How long for celebrex to work?

It is important for people taking Celebrex to make sure their doctor knows about any heart, high blood pressure, kidney, stomach, esophagus, or intestinal problems so that the doctor can properly assess the risks and benefits of prescribing this medication and can follow their patients accordingly.

The risk of serious side effects to patients taking Celebrex is relatively low, especially in patients that do not also have other risk factors. Though incidents are rare, Celebrex can increase the risk of fatal heart attack or stroke. It can also increase the risk of stomach or intestinal bleeding and other gastrointestinal issues.

We have put together a special guide to help patients learn more about the relative risks of taking NSAIDs like Celebrex compared to common lifestyle risk factors like smoking: NSAIDs & Osteoarthritis: Putting Risks Into Perspective.

Possible side-effects of Celebrex include:

  • Kidney – Patients with kidney problems should be careful when taking Celebrex
  • Blood pressure – Celebrex can cause an increase in blood pressure. Doctors will monitor this. Patients should tell their doctor if they have high blood pressure.
  • Leg swelling – Celebrex can cause swelling of the legs. It can also worsen a condition called congestive heart failure (CHF). Patients should tell their doctor if they have CHF or if they develop leg swelling.
  • Heart attack & stroke – Patients who have had a recent heart attack or stroke or experienced serious chest pain from heart disease should not take Celebrex.
  • Headache – Celebrex can rarely cause a headache or dizziness.
  • Skin rash – Celebrex can rarely cause an allergic rash. Stop the medicine and let your doctor know if you develop a rash, hives, or blisters.
  • Pregnancy & breastfeeding – Celebrex has not been studied in pregnancy. Let your doctor know if you are planning to get pregnant or if you are breastfeeding.

Patients should talk to their doctor if they are concerned about any side effects. It is safe to simply stop taking Celebrex; patients do not need to wean off the medication. Patients should always advise their doctor any time they stop taking a medication or change the dosage on their own.

Surprise! Arthritis Drug Celebrex Shown As Safe As Ibuprofen And Naproxen

In December of 1998, the first of a new class of arthritis pain relievers was approved. Called Celebrex (generic name: celecoxib), this drug was a selective COX-2 inhibitor designed to maintain the pain-reducing properties of traditional non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, but not be burdened with gastrointestinal side effects that plagued the older drugs. A month after Celebrex was jointly launched by Pharmacia and Pfizer, Merck launched its own COX-2 inhibitor, Vioxx, and prescriptions for these two new drugs took off.

However, the COX-2 inhibitors had a potential use beyond pain relief. Celebrex was shown to reduce the formation of polyps in the colon of patients with familial adenomatous polyposis (FAP), a rare disease which if untreated can lead to colon cancer. In fact, the FDA had approved a supplemental NDA for the use of Celebrex in FAP patients. Scientists believed that it was possible that the COX-2 inhibitors could be used as to treat the broader colon cancer population as well. Thus, both Pfizer and Merck launched long-term studies in colon cancer patients to test this hypothesis.

Then, on September 27, 2004, the data safety monitoring board responsible for oversight of Merck’s study, known as APPROVe (“Adenomatous Polyp Prevention on Vioxx”), dropped a bombshell. They recommended that the study be stopped because patients on the drug showed an increased risk of heart attacks and strokes, particularly in those who had been on Vioxx for more than 18 months. Merck immediately withdrew Vioxx from the market. However, the FDA was in a dilemma. Celebrex was still on the market and other COX-2 inhibitors were in late-stage development. Was the increased cardiovascular (CV) risk seen unique to Vioxx, or did all COX-2 inhibitors suffer from adverse CV effects? To help with this problem, the FDA called a joint meeting of their Arthritis Advisory Committee and the Drug Safety & Risk Management Advisory Committee. This meeting lasted three days and consisted of 30 advisors–an unusually high number. It covered the gamut of the properties of COX-2 inhibitors in order to understand the risk-benefit balance that these drugs posed to patients. At the end of these sessions, the joint committee voted to allow Celebrex to stay on the market as it became clear that long-term use of other NSAIDs also posed CV hazards. The FDA agreed with this recommendation. In fact, one of the big outcomes of this meeting was that the non-selective NSAIDs also posed a CV risk. As a result, the FDA made the following change to the Celebrex label:

Celebrex may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction and stroke, which can be fatal. All NSAIDs may have a similar risk. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.

While this solved the immediate problem, the FDA now had a bigger issue. Patients with arthritis tend to be older, heavier and not easily able to exercise due to joint pain–the very patients that are prone to heart disease. How should physicians be advised as to best treat arthritis pain in this population? The FDA asked Pfizer to sponsor a study to answer that question. Known as PRECISION (“Prospective Randomized Evaluation of Celebrex Integrated Safety vs. Ibuprofen or Naproxen”), the study was led by the esteemed cardiologist Dr. Steven Nissen of the Cleveland Clinic and involved 24,081 patients, a third of whom were randomly assigned to Celebrex, a third each to prescription doses of ibuprofen and naproxen. The key inclusion criteria for the trial were that patients had established CV disease or increased risk for the development of CV disease. The primary outcome measured was death from CV causes, including hemorrhagic death, nonfatal myocardial infarction and non-fatal stroke.

The PRECISION results are now available. They were presented yesterday by Dr. Nissen at the ongoing American Heart Association meeting with simultaneous publication of the results in the New England Journal of Medicine. It is safe to say that what the PRECISION investigators found would have startled those attendees at the FDA Advisory Committee meetings held back in 2004. There were 188 deaths (2.3%) from CV causes for the Celebrex patients, 201 deaths (2.5%) for those on naproxen and 218 (2.7%) for the ibuprofen patients. In the NEJM article, the authors state that “the PRECISION trial provides statistically strong evidence that the cardiovascular risk associated with moderate doses of celecoxib is not greater than that associated with non-selective NSAIDs.” They go on to say that “the trial results do not support the widely advocated belief that naproxen treatment, as compared to other NSAIDs, results in better cardiovascular outcomes.”

Furthermore, the PRECISION results provided other revelations. While the primary purpose of the trial was to assess CV outcomes, GI and renal outcomes were looked at as secondary endpoints. It is no surprise that the Celebrex had significantly fewer GI safety issues–after all, that’s why these drugs were first developed. But the rates of renal adverse events and hospitalizations for high blood pressure were also significantly lower for Celebrex compared to ibuprofen (although Celebrex and naproxen were no different on this effect.)

The study investigators acknowledged that PRECISION had limitations:

Adherence and retention were lower than in most trials that assess cardiovascular outcomes, which reflects the challenges of long-term treatment of a painful condition in patients who frequently experience frustration with unrelieved symptoms and switch therapies or leave the trial. Low levels of adherence have also been found in previous pain studies.

The events that surrounded the withdrawal of Vioxx from the market led to a slew of attacks on the pharmaceutical industry. The industry, specifically Pfizer and Merck, were looked at as profiteers, committed not to patients but to profits. It was alleged that the COX-2 inhibitors were drugs that weren’t necessary and which actually harmed patients. The PRECISION results show that this isn’t the case. Celebrex is an important drug for physicians to use in treating arthritis patients in significant pain. It is safer to use from a GI perspective than non-selective NSAIDs and, in patients with kidney function issues, it is safer than ibuprofen.

PRECISION was a long and expensive trial. I would guess that it cost Pfizer more than $500 million. Furthermore, Pfizer will benefit little from these results. Celebrex is now generically available as celecoxib. If anything, generic drug makers will benefit from these results, as it is likely that more celecoxib will be prescribed as a result of PRECISION. Finally, it must be noted that only a pharmaceutical company of Pfizer’s size could have funded such a study. From a budgeting standpoint, it would have been crippling for an agency like the NIH to have paid for this.

PRECISION has helped physicians and patients better understand the risks and benefits of the drugs used to treat arthritis pain. They have Pfizer to thank for that.

(The author is the former head of Pfizer Global R&D.)

About Celebrex (Celecoxib), a COX-2 Inhibitor

Celecoxib is a prescription nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed for many types of joint pain and inflammation.

See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

The medication is sold under the brand name Celebrex, or in generic form. Celecoxib is a type of medication known as a COX-2 inhibitor because of the way it works in the body.

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Conditions Treated with Celecoxib

Common conditions that Celebrex may treat include:

  • Osteoarthritis. Joint stiffness, pain, and swelling—especially following inactivity—are frequent symptoms of osteoarthritis that may be relieved by celecoxib. By easing these symptoms, the medication allows an individual to exercise more, which is critical to keep osteoarthritis from progressing. Some medical research has also found celecoxib helpful in slowing joint damage in osteoarthritis.1
  • See Osteoarthritis of the Spine

  • Rheumatoid arthritis. The swelling and inflammation of joints that characterize rheumatoid arthritis can often be alleviated with celecoxib. Unlike disease-modifying anti-rheumatic drugs (DMARDs) used for rheumatoid arthritis, celecoxib does not address the disease itself. Alleviating these symptoms enables people to be more physically active, which has been shown to improve range of motion and reduce disability.
  • See Rheumatoid Arthritis in the Spine

  • Juvenile rheumatoid arthritis. Inflammation, stiffness, tenderness, swelling, and pain in the joints, as well as rashes and fever, are often experienced with juvenile rheumatoid arthritis. Celecoxib or another NSAID are often the only medications needed for this disease. Celecoxib can relieve all but the rash symptoms. It can be taken by children age 2 and older. As when celecoxib is used for arthritis in adults, the relief of symptoms allows greater participation in physical activities, which can improve daily functioning.
  • Ankylosing spondylitis. Early morning stiffness, sacroiliac pain and inflammation, and pain in the lower back, hip, or buttock are typical with this type of arthritis. Celecoxib treats the pain, inflammation, and stiffness.
  • See Ankylosing Spondylitis

  • Acute pain in the back, neck, and elsewhere. Celecoxib’s ability to reduce pain and inflammation makes it helpful in treating strains, sprains, headaches, menstrual pain, and aches and pains caused by overexertion. It also treats the aches and pains of the flu and other illnesses.
  • Watch Video: What is Acute Neck Pain?

  • Post-surgical pain. Celecoxib can be helpful when taken by itself or in combination with other medications to relieve pain following surgery, including joint replacement surgery.
  • See Getting Adequate Pain Control After Back Surgery

  • Chronic low back pain. Symptoms of this common condition include inflammation as well as pain. Both can be relieved with celecoxib.
  • See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

  • Gout. Celecoxib is commonly prescribed “off-label” to treat acute gout. Off-label use means the medication is not specifically approved by the U.S. Food and Drug Administration for the condition or symptoms. An off-label medication is typically prescribed if the doctor thinks it will be more helpful than other options for an individual.

Taking celecoxib 30 minutes before physical activity is advised for those with osteoarthritis, rheumatoid arthritis, or juvenile rheumatoid arthritis. People with arthritis may need to take the medication for up to two weeks to get the maximum benefit.

See Osteoarthritis Medications

Those taking celecoxib on an as-needed basis, rather than on a schedule, usually get the best pain relief by taking the medication at the first sign of pain.

In This Article:

  • About Celebrex (Celecoxib), a COX-2 Inhibitor
  • Potential Risks and Complications of Celecoxib
  • Anti-Inflammatory Medications for Back Pain Relief Video

How Celecoxib Works

As a COX-2 inhibitor, celecoxib blocks an inflammation-promoting enzyme called COX-2. Medications known as COX-2 inhibitors were developed to work as well as traditional NSAIDs but with fewer stomach problems.

See Safe Use of COX-2 Inhibitors and Other NSAIDs

However, many reports of heart attacks and stroke prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Two drugs in this class were taken off the U.S. market following reports of heart attacks in people who took them.

See Understanding COX-2 Inhibitor Side Effects

Celebrex is still available, but with strong warnings, as are required for all NSAID medications. The risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke, are black box warnings—the strictest issued by the FDA—and outlined in black on the medication label. This risk may occur early in the treatment and may increase with duration of use.

See Potential Risks and Complications of NSAIDs

The FDA also advises that celecoxib be prescribed at the lowest possible dose for the shortest time possible.

The decreased risk for gastrointestinal problems is a significant selling point for celecoxib because many people are unable to take NSAIDs such as ibuprofen due to the risk of gastrointestinal bleeding.

See Types of NSAIDs

One medical study showed a significantly lower incidence of gastric ulcers in people with rheumatoid arthritis or osteoarthritis who were prescribed celecoxib rather than diclofenac, another NSAID.2 (Diclofenac has a black box warning citing the risk of fatal gastrointestinal bleeding, ulceration, and perforation of the stomach and intestines.)

Another benefit of the COX-2 inhibitor celecoxib is that—unlike other NSAIDs—it does not hamper blood clotting. This can make celecoxib an option for some people on blood-thinning medications such as warfarin (brand name Coumadin).

How Celecoxib Is Taken

Celecoxib is available in 50 mg, 100 mg, 200 mg, and 400 mg capsules, and should be taken with food or milk to avoid an upset stomach. Typical doses range from 200 to 400 mg daily, but the dose for acute gout is up to 800 mg once, followed by 400 mg on the first day, then 400 mg twice daily for a week. Taking the lowest effective dose is recommended.

People who have trouble swallowing a capsule—a condition called dysphagia—may empty the contents of the capsule onto a teaspoon of cool or room-temperature applesauce and administer immediately with water. Patients are advised to avoid lying down for 30 minutes after taking celecoxib.

See Treatments for Dysphagia

  • 1.Cho H, Walker A, Williams J, Hasty KA. Study of osteoarthritis treatment with anti-inflammatory drugs: cyclooxygenase-2 inhibitor and steroids. Biomed Res Int. 2015;2015:595273.
  • 2.Cheung R, Cheng TT, Dong Y, et al. Incidence of gastroduodenal ulcers during treatment with celecoxib or diclofenac: pooled results from three 12-week trials in Chinese patients with osteoarthritis or rheumatoid arthritis. Int J Rheum Dis. 2010;13(2):151-7.

What is Celecoxib (Celebrex®)?

Celecoxib is commonly known by the brand name Celebrex®. Celecoxib (Sell-e-COX-eb) is used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.

How do I take it?

Celecoxib is taken once or twice a day. The pills are100 or 200mg. each. The usual dose is 200 to 400-mg. per day. This drug is used for both rheumatoid arthritis and osteoarthritis. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine may be taken with or without food.

What else should I know?

Celecoxib is less likely to cause stomach upset and ulcers than NSAIDS. However, in some cases patients have complained of upset stomachs, indigestion, or diarrhea. Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. IF YOU HAVE A KNOWN ALLERGY TO SULFA DRUGS, DO NOT TAKE THIS MEDICINE UNTIL YOU TALK TO YOUR DOCTOR.

What about other medications?

When you are taking Celecoxib, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.

Celecoxib can be taken with other medications, however it is best to have your doctor’s advice before adding another drug to your daily routine.

Effectiveness and Safety of Celecoxib for the Treatment of Rheumatoid Arthritis

Practice Pointers

RA is a common type of inflammatory arthritis. Although disease-modifying antirheumatic drugs (DMARDs) are first-line therapy to minimize pain and swelling, NSAIDs are commonly used for arthritis analgesia. The authors of this review sought to assess whether celecoxib is an effective and safe agent for treating symptoms of RA.1

This review included eight double-blind, randomized, parallel-group trials with 3,988 participants who had been diagnosed with RA for an average of nine years.1 Most patients (73%) were women. Participants in the intervention arms received celecoxib in a dosage of 200 or 400 mg per day. Outcomes were based on American College of Rheumatology 20% improvement criteria (ACR20), as well as self-reported pain and physical function.

Compared with placebo, celecoxib improved clinical symptoms (15% improvement on ACR20; 95% confidence interval , 7% to 25%; NNT = 7 ). Celecoxib also improved self-reported pain (i.e., 11-point reduction on a 100-point visual analog scale over 12 weeks; 95% CI, 8 to 14; NNT = 4 ). Despite these findings, celecoxib did not improve joint function as defined by the Health Assessment Questionnaire Disability Index scale, which assesses activities of daily living in patients with RA. Although the reviewers looked for reports of cardiovascular events, none were noted in the celecoxib vs. placebo comparison. Short-term serious adverse events, such as headache, dyspepsia, diarrhea, and abdominal pain, and total withdrawals or discontinuation rates were evaluated; there was no difference in the rates of short-term serious adverse events between celecoxib and placebo.

Celecoxib and traditional NSAIDs were equally effective at reducing pain and improving clinical symptoms. Moderate-quality evidence showed that celecoxib caused fewer gastroduodenal ulcers (at least 3 mm in size) than traditional NSAIDs (absolute change = 12%; 95% CI, 11% to 13%; NNH = 9 ). No differences were noted in the number of short-term serious adverse events between patients treated with celecoxib and traditional NSAIDs. There were also no differences in cardiovascular events between patients treated with celecoxib and those treated with traditional NSAIDs. Finally, fewer patients discontinued celecoxib therapy (7%) than traditional NSAID therapy (14%; absolute change = 7%; 95% CI, 4% to 9%; NNH = 14 ).

Of note, five out of eight studies in the review were funded by pharmaceutical companies; seven studies were rated as being at high or unclear risk of attrition bias.

There is currently no cure for RA. Although U.S. and Canadian guidelines support the use of DMARDs, they do not discuss the role of NSAIDs for RA. This review suggests there may be a role for the use of celecoxib in the care of RA.2

Low back pain is a part of life—common across sexes, age groups, and countries, it’s something that almost all people experience at some point. Treatment for low back pain often includes a combination of medication and non-medication options. What should you start with? What treatments have the best evidence? And more importantly . . . what’s coming our way for low back pain treatment?

To start #OldSchool—the best evidence exists for these three treatments:

  • Non-steroidal anti-inflammatory drugs (NSAIDS). Which NSAID? Ibuprofen (Motrin, Advil), naproxen (Aleve), and celecoxib (Celebrex) are common examples. There does not appear to be a “best” NSAID for low back pain from the evidence. Start with low doses and go higher if needed, aiming for short term use. If you can’t take NSAIDS (stomach issues, kidney problems) take acetaminophen (Tylenol) instead.
  • Muscle relaxants. Adding a muscle relaxant to an NSAID improves low back pain. Start with one that doesn’t make you tired like methocarbamol (Robaxin) or metaxalone (Skelaxin). See my previous blog here for full discussion on muscle relaxants for low back pain.
  • Heat. Superficial heat for low back pain has been shown to help. There is moderate evidence from a small number of studies that heat wrap therapy provides short-term reduction in pain and disability in those with acute or sub-acute low-back pain (less than 12 weeks). When using heat wraps, use them only for 15-20 minutes at a time. Don’t fall asleep with them on.

Ok, then what’s next for back pain?

  • Physical therapist or chiropractor. To sum up the evidence here: for low back pain, physical therapy and chiropractic manipulation have similar effects on symptoms, function, satisfaction with care, disability, recurrences of back pain, and subsequent visits for back pain. So think of them as being equally effective. I’d pick whichever one is more convenient and covered more by your insurance.
  • Other exercise therapy. For example,yoga, tai chi or qigong. There is fair evidence that yoga and movement therapies will help for your back pain. Pursue them on your own and stick with one that interests you the most and is the most convenient.
  • Other alternative therapies. Mindfulness stress reduction (meditation + yoga) and cognitive behavioral therapy outperformed NSAIDS in a recent study. Both are worth a try for sure if you are struggling with low back pain. Acupuncture, though—not so much. In the last two years a review of scientific evidence found the practice of acupuncture was no better than placebo in treating those living with low back pain and sciatica. Gua sha is another alternative therapy that may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.

What’s next for those with chronic, neuropathic (nerve-like) low back pain?

  • Gabapentin (Neurontin) or duloxetine (Cymbalta) have the best evidence in addition to the above listed options for nerve-like pain in your low back that may radiate down your buttock or leg. Tramadol (Ultram) may also be added to your regimen at this point.
  • The hot-button issue: Opioids for low back pain. Opioids are no more effective than NSAIDS for low back pain and have a high rate of adverse effects (the understatement of the year). Avoid opioids at all costs for low back pain.

Moving on—invasive procedures:

  • Epidural steroid injections. Steroid injections in the lumbar spine are performed by pain management or interventional radiologists, and they do work. Epidural injections done with several approaches (interlaminar, caudal, or transforaminal) have been shown to reduce pain and disability short term (usually at 2 weeks) and help delay the need for surgical intervention. Epidural steroid injections may provide relief for a period of time and additional repeat injections are an option if pain recurs.

The future—and beyond:

  • Radiofrequency denervation aka radiofrequency ablation (RFA) was the rising star, but a recent large study revealed disappointing results. RFA is a medical procedure where the nerve is ablated (the nerve endings are deadened) using high frequency alternating current. But does it work for chronic low back pain? Not so well. A recent study (JAMA July 4; 318(1):68-81) found radiofrequency denervation added to a standardized exercise program for chronic low back pain resulted in either no improvement or no clinically important improvement compared with a standardized exercise program alone. To sum it up: the findings do not support the use of radiofrequency denervation to treat chronic low back pain originating in the facet joints, sacroiliac joints, or intervertebral disks. Disappointing.
  • Platelet rich plasma. Platelet rich plasma (PRP) has shown promising results when injected into the intervertebral disc and is currently being studied. PRP is high in growth factors, which is why it’s being studied, yet there are no active studies for low back pain being done. Will PRP help for low back pain? We don’t know yet, and won’t for a while.
  • Stem cell therapy to regenerate cells and increase disc matrix production (the gel- like central part of the disc) is also currently being researched. This may be coming our way for low back pain, but no results yet.
  • Cannabis. Studies on cannabis/medical marijuana are limited because it is still illegal under federal law, but several trials have evaluated the effectiveness of cannabis for patients with neuropathic pain. Patients with nerve pain from spinal stenosis or degenerative disc disease show a 30% improvement in chronic pain score following cannabis therapy. Pain relief provided by cannabis is dose-dependent, with higher THC content producing more pronounced pain relief. Know this: the strains of cannabis containing high levels of CBD (cannabidiol) generally make patients feel less high, since CBD acts as an antagonist to the psychoactive effect of THC. Consider starting with high-CBD, low-THC strains if you are concerned about feeling high.

What has helped for you?

Dr O.

  • Potential Risks and Complications of Celecoxib

    It is recommended that patients consider the increased risk of major cardiovascular, gastrointestinal, kidney, and liver complications before taking celecoxib. Celecoxib is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

    Celecoxib Safety Debated

    The safety of the COX-2 inhibitor celecoxib (brand name Celebrex) came under scrutiny when the other COX-2 inhibitors were taken off the market more than a decade ago.

    The medical literature includes studies showing an increased risk of serious cardiovascular problems with celecoxib, as well as other NSAIDs.1-3

    See Safe Use of COX-2 Inhibitors and Other NSAIDs

    The Food and Drug Administration (FDA) position is that the risk for certain patients is worth the benefit of celecoxib. Taking the lowest effective dose of celecoxib, for the shortest time possible, is advised by the FDA, and prominent warnings are required on packages for all nonsteroidal anti-inflammatory (NSAIDS), including celecoxib, highlighting the risks.4

    See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

    Results of a long-term, multinational clinical trial that began in 2006 to assess and compare the risk of celecoxib with other common NSAIDs have not yet been released.5

    See Common NSAIDs for Back and Neck Pain

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    Heart-Related Risk Factors

    The FDA has revised its warnings for people taking prescription NSAIDs, which include celecoxib, to include these findings:

    • The added risk of a heart attack or stroke is not limited to long-term use. The risk can increase even during the first weeks of using an NSAID.
    • People with heart disease or its risk factors have a higher rate of heart attack or stroke, but there is also an elevated risk for those without heart problems or heart disease risk factors.
    • Research indicates that the risk goes up as the dose increases.
    • The risk of heart failure also increases in people using NSAIDs.

    Keeping the doctor informed of any medication prescribed by another doctor for the patient is always advised, but it is particularly important for those with heart problems.

    Who Should Not Take Celecoxib

    Celecoxib is not recommended for people:

    • With stomach or intestinal bleeding
    • Who have had an asthma attack or other allergic reaction to aspirin or to any other NSAID or sulfa drug
    • Have had a coronary artery bypass graft (CABG) recently

    Caution is recommended when considering celecoxib for a child with systemic onset juvenile rheumatoid arthritis. This could increase the risk of a serious bleeding/clotting condition known as disseminated intravascular coagulation.

    See Rheumatoid Arthritis in the Spine

    Celecoxib use should be avoided in patients with advanced renal disease and used with caution in patients with moderate hepatic (liver) impairment; dosage adjustment is recommended.

    The long-term use of NSAIDs in women of reproductive age may be associated with infertility that is reversible upon discontinuation of the medication.

    See Potential Risks and Complications of NSAIDs

    In This Article:

    • About Celebrex (Celecoxib), a COX-2 Inhibitor
    • Potential Risks and Complications of Celecoxib
    • Anti-Inflammatory Medications for Back Pain Relief Video

    Celecoxib Side Effects

    In addition to heart-related risks such as heart attack and stroke, these side effects may be experienced:

    • Serious skin reactions
    • Serious liver problems
    • Kidney problems, particularly if the patient becomes dehydrated
    • Gastrointestinal problems. Diarrhea, gastroesophageal reflux disease (GERD), nausea, and vomiting are the most common gastrointestinal side effects. Stomach bleeding and ulcers can also occur. While celecoxib is generally less irritating to the stomach than other NSAIDs in the short term, the long-term effect is unclear. Gastrointestinal problems tend to occur more often when the person drinks alcohol while taking the medication.
    • Hypertension, or high blood pressure
    • Dysphagia (difficulty swallowing)
    • Dizziness
    • Difficulty breathing or shortness of breath, also called dyspnea
    • Sinusitis and upper respiratory infections

    See Understanding COX-2 Inhibitor Side Effects

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    Among those with juvenile idiopathic arthritis, the most common adverse reactions—affecting 5% or more of patients—are abdominal pain, arthralgia (joint pain), cough, diarrhea, fever, headache, upper respiratory infection, nausea, upper abdominal pain, and vomiting.

    It is best to let the doctor know about any side effects that occur. The doctor may conduct lab tests regularly to monitor the effects of the medication.

    Considerations When Taking Celecoxib

    It may be helpful to take these other health factors into account:

    • Pregnancy. Women who are pregnant or breastfeeding—or planning to get pregnant soon—are advised to discuss their medical history and current status with the doctor before celecoxib is prescribed. Medical studies have shown the medication poses a risk of harm to the baby when taken late in pregnancy, and risk or safety earlier in pregnancy has not been established.6 Celecoxib is rated a Category C for pregnancy safety prior to 30 weeks’ gestation and Category D from 30 weeks’ gestation onward, under the FDA’s ratings for medication safety during pregnancy. The ratings run from A through X, with A being the safest.
    • Age. Older adults are more prone to side effects in general, and are more likely than young adults to experience age-related kidney or stomach difficulties.
    • Drug interactions. Medications including blood thinners, diuretics (water pills), blood pressure medication, and steroids may interfere with celecoxib’s effectiveness. Taking other NSAIDs or acetaminophen at the same time as celecoxib may harm the liver.
    • See Acetaminophen for Back Pain

    • Planned surgery or medical tests. Celecoxib may need to be stopped prior to surgery or medical tests. Checking with the surgeon in advance is advised.
    • Liver impairment. A dosage reduction should be considered in patients with moderate hepatic impairment and celecoxib use in not recommended in patient with severe hepatic impairment.

    This is not a comprehensive list of potential risks and complications associated with celecoxib. Patients should communicate with their doctor and pharmacist to determine their specific situation.

    Individual Needs Assessed

    Working with the doctor to find the safest and most effective medication options is the recommended approach. The doctor can evaluate each patient’s individual risk factors (e.g. the patient’s likelihood for developing certain health problems, including heart attack, stroke, and gastrointestinal problems) and health needs to determine the safest and most effective treatment options. The physician will also take into consideration the patient’s previous experience with NSAIDs.

    In addition to discussing celecoxib with the doctor, keeping the doctor up-to-date on all other medications being taken—both prescription and over-the-counter—as well as vitamins and nutritional supplements is the best course of action.

    See Research on Glucosamine and Chondroitin Sulfate Supplements

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