celecoxib
(sell ah cocks' ib)
Celebrex
Pregnancy Category C (first and second trimester)
Pregnancy Category D (third trimester)
Drug classes
NSAID
Analgesic (nonopioid)
Specific COX-2 enzyme blocker
Therapeutic actions
Analgesic and anti-inflammatory activities related to inhibition of the COX-2 enzyme, which is activated in inflammation to cause the signs and symptoms associated with inflammation; does not affect the COX-1 enzyme, which protects the lining of the GI tract and has blood clotting and renal functions.
Indications
· Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis
· Reduction of the number of colorectal polyps in familial adenomatous polyposis (FAP)
· Management of acute pain
· Treatment of primary dysmenorrhea
· Relief of signs and symptoms of anklylosing spondylitis
Contraindications and cautions
· Contraindicated with allergies to sulfonamides, celecoxib, NSAIDs, or aspirin; significant renal impairment; pregnancy (third trimester); lactation.
· Use cautiously with impaired hearing, hepatic, and CV conditions.
Available forms
Capsules—100, 200 mg
Dosages
ADULTS
Initially, 100 mg PO bid; may increase to 200 mg/day PO bid as needed.
· Acute pain, dysmenorrhea: 400 mg, then 200 mg PO bid.
· Ankylosing spondylitis: 200 mg/day PO, if no effect is seen after 6 wks, a trial of 400 mg/day PO may be started. If no effect is seen after 6 wks at 400 mg/day, an alternate therapy should be considered.
· FAP: 400 mg PO bid.
PEDIATRIC PATIENTS
Safety and efficacy have not been established.
PATIENTS WITH HEPATIC IMPAIRMENT
Reduce dosage by 50%.
Pharmacokinetics
| Route | Onset | Peak |
| Oral | Slow | 3 hr |
Metabolism: Hepatic; T1/2: 11 hours
Distribution: Crosses placenta; may enter breast milk
Excretion: Bile, urine
Adverse effects
· CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthamologic effects
· CV: MI, CVA
· Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
· GI: Nausea, abdominal pain, dyspepsia, flatulence, GI bleed
· Hematologic: Neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia
· Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock
Interactions
Drug-drug
· Increased risk of bleeding if taken concurrently with warfarin. Monitor patient closely and reduce warfarin dose as appropriate
· Increased lithium levels and toxicity
· Increased risk of GI bleeding with long-term alcohol use, smoking
Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Celebrex (celecoxib), Celexa (citalopram), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution.
Assessment
· History: Renal impairment, impaired hearing, allergies, hepatic and CV conditions, lactation, pregnancy
· Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC, LFTs, renal function tests; serum electrolytes
Interventions
· Administer drug with food or after meals if GI upset occurs.
· Establish safety measures if CNS, visual disturbances occur.
· Arrange for periodic ophthalmologic examination during long-term therapy.
· WARNING: If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy.
· Provide further comfort measures to reduce pain (eg, positioning, environmental control), and to reduce inflammation (eg, warmth, positioning, rest).
Teaching points
· Take drug with food or meals if GI upset occurs.
· Take only the prescribed dosage.
· You may experience these side effects: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while taking this drug).
· Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision.
Adverse effects in Italic are most common; those in Bold are life-threatening.
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