Celecoxib

Celecoxib is a selective inhibitor of cyclo-oxygenase-2 (COX-2). It works by inhibiting the activity of this enzyme.

Adult

For pain and inflammation in osteoarthritis: 200 mg daily in 1–2 divided doses, increased if necessary up to 200 mg twice daily. Discontinue if no improvement after 2 weeks on maximum dose. For pain and inflammation in rheumatoid arthritis: 100 mg twice daily, increased if necessary to 200 mg twice daily. Discontinue if no improvement.

Pediatric

Children >2 years: 50 mg (10–25 kg) or 100 mg (>25 kg) 2 times/day.

Renal adjustment

Avoid if possible or use with caution; avoid in moderate to severe impairment. The lowest effective dose should be used for the shortest possible duration.

Hepatic adjustment

Caution in mild to moderate impairment; avoid in hepatic failure. Consider initial dose reduction to 100 mg daily in mild to moderate impairment.

Geriatric

Potentially inappropriate if prescribed with a vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitor in combination (risk of major gastrointestinal bleeding); with concurrent antiplatelet agent(s) without proton pump inhibitor (PPI) prophylaxis (increased risk of peptic ulcer disease); or in patients with a history of peptic ulcer disease or gastrointestinal issues.

Max dose

400 mg daily

• Use with a vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitor in combination (risk of major gastrointestinal bleeding)
• Use with concurrent antiplatelet agent(s) without proton pump inhibitor (PPI) prophylaxis (increased risk of peptic ulcer disease)
• History of peptic ulcer disease or gastrointestinal issues
• Third trimester of pregnancy
• Hepatic failure
• Moderate to severe renal impairment
• Perioperative pain in the setting of CABG surgery
• Should be avoided in patients prone to cardiovascular disease
• Should be avoided in patients prone to cerebrovascular disease
• Loses its GI advantage over other NSAIDs when used in conjunction with aspirin
• patients with history of ischaemic heart disease/hypertension/cardiac failure/cerebrovascular disease
• use in patients at high risk of peptic ulcer, perforation or bleeds (should be administered in the lowest dose for the shortest period of time)