Celecoxib

Class: COX-2 selective NSAID

Indications: pain – visceral, inflammatory, pleuritic; pain and inflammation in OA, RA and ankylosing spondylitis; acute pain; primary dysmenorrhoea

Contraindications/cautions: severe heart failure; active peptic ulcer disease; severe renal impairment and not on dialysis; NSAID-induced asthma (contraindicated); mild or moderate renal impairment; previous peptic ulceration, cardiovascular disease (caution)

Adverse reactions: common: nausea, dyspepsia; less common: vomiting, acute kidney injury, oedema, peptic ulceration

Metabolism/clearance: metabolised to inactive metabolites by CYP2C9; negligible renal clearance

Interactions: Increased risk of peptic ulceration with glucocorticoids; increased risk of bleeding with antiplatelets/anticoagulants; increased risk of kidney injury with loop diuretics. Weak inhibitor of CYP2D6

Syringe driver: N/A

Mechanism of action: celecoxib selectively inhibits cyclooxygenase-2 (COX-2) – reducing prostaglandin production resulting in analgesic, anti-inflammatory and anti-pyretic effects. Selective inhibition of COX-2 is associated with less GI-intolerance

Half life: 11 hours

Onset: oral: peak plasma levels 3 hours after oral dose

Notes:

• does not impair clotting
• capsules can be opened, and contents sprinkled onto soft food or administered down a PEG/NG tube
• risk of cardiovascular events with COX-2 inhibitors are usually not a significant contraindication in palliative patients
• consider gastroprotection with a proton-pump inhibitor or H2 antagonist especially if other risk factors
• reduce dose in moderate hepatic impairment; avoid in severe impairment
• avoid if eGFR less than 30 mL/min/1.73m2

Availability:

• capsules 100 mg & 200 mg