Celecoxib

Drug Category:

COX-2 inhibitor NSAID (non-steroidal anti-inflammatory drug)

Prescription:Yes

Cox-2 inhibitor drugs (e.g. Celebrex Vioxx) have come under increased scrutiny in recent years. In fact Vioxx was taken off the market in September 2004 over concerns of heightened risks of heart attacks and strokes among those who have taken it for extended periods. Although Vioxx and Celebrex belong to the same drug category we cannot assume that Celebrex is associated with the same problems. Health Canada is assessing the safety of Celebrex and continues to release information regarding how this medication should be prescribed.

Celecoxib better known by the brand name Celebrex is prescribed to treat pain stiffness and inflammation from osteoarthritis and rheumatoid arthritis. It is also sometimes prescribed for the short-term (one week or less) management of moderate to severe pain in adults caused by conditions such as muscle sprains or strains pain and swelling after orthopaedic surgery or tooth extractions. Some doctors prescribe Celebrex for short-term relief of painful conditions such as gout headaches or menstrual pains.

Is there any reason not to take this drug?

You should not take this drug if you are allergic to celecoxib or sulfonamide drugs.

You should not take Celebrex if you experienced asthma skin hives or an allergic reaction to aspirin (ASA/Acetylsalicylic Acid) or other NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) e.g. ibuprofen diclofenac naproxen rofecoxib

CELEBREX should not be used before or after heart surgery. Patients who took a drug in the same category as CELEBREX after a type of heart surgery (coronary artery bypass grafting (CABG)) were more likely to have heart attacks strokes blood clots in the leg(s) or lung(s) and infections and/or other complications than those who did not take that drug.

As noted by Health Canada in 2005 if you are already at risk of a heart attack or stroke taking Celebrex may increase this risk. Factors that increase the risk of heart attack and stroke include high blood pressure (treated or untreated) high blood cholesterol diabetes and smoking. If you have any of these risk factors and have been prescribed Celebrex consult with your doctor.

If you have a history of any of the following conditions talk to your doctor about whether or not you should be taking Celebrex:

  • Angina (serious chest pain related to heart disease)
  • Circulation problems or heart disease
  • Heart failure
  • Heart attack
  • Stroke or mini-strokes
  • Loss of vison
  • H.Pylori infection (presence of H.Pylori bacteria increases risk of stomach ulcers)

Do not take CELEBREX if you have or have ever had any of the following:

  • an ulcer or any bleeding from the stomach
  • high levels of potassium in your blood
  • inflammatory bowel disease e.g. Crohn's disease ulcerative colitis
  • active or serious liver disease
  • poor or worsening kidney function

CELEBREX should not be used during the later stage of pregnancy (after 28 weeks) or by patients who are breastfeeding or plan to breastfeed.

What about possible side effects?

The most common side effects are diarrhea stomach pain nausea gas heartburn. These side effects may be related to the dose and may go away with time. Ask your doctor or pharmacist to suggest ways to minimize these side effects.

STOP taking Celebrex and tell your doctor or another health care provider immediately if you experience any of the following side effects:

  • confusion
  • depression
  • diarrhea
  • pain or difficulty urinating
  • dizziness or feeling lightheaded
  • fatigue
  • yellowing of the skin or eyes
  • loss of appetite
  • nausea
  • swollen feet or lower legs
  • vomiting

STOP taking Celebrex and get emergency medical treatment immediately if you experience any of the following potentially serious side effects:

  • bloody or black tarry stools
  • blurred vision or other changes in vision
  • changes in the amount or color of your urine especially if urine appears dark red or brown
  • hearing problems
  • skin rash hives swelling or itching
  • tightness in the chest
  • trouble breathing
  • wheezing
  • pain. Sudden discomfort or pain that does not go away with rest. Pain that may be in the chest neck jaw shoulder arms or back. Pain that may feel like burning squeezing heaviness tightness or pressure. In women the pain may be more vague
  • sudden weakness numbness or tingling in the face arm or leg
  • sudden temporary loss of speech or trouble understanding speech
  • sudden severe and unusual headache

This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or may change the safety or effectiveness of either drug.

Tell your doctor specifically if you are taking any of these drugs as he/she may need to make changes or monitor you more closely:

  • ACE (angiotension converting enzyme) inhibitors e.g. enalapril lisinopril perindopril ramipril quinapril benazapril trandolapril - taking Celebrex may reduce how well these drugs work to lower blood pressure and control the symptoms of heart failure may also increase risk of the body having high potassium levels.
  • NSAIDs e.g. ASA/Aspirin (more than 325mg per day) diclofenac ibuprofen indomethacin ketorolac meloxicam naproxen rofecoxib valdecoxib oxaprozin etodolac nabumetone - these drugs have the same effects so you don't need to take both plus there is a higher risk of related side effects
  • Low dose aspirin (81-325mg per day) for heart protection - can be taken together safely but there is a higher risk of stomach problems which can occur months after taking both drugs
  • Blood pressure medications e.g. atenolol metoprolol amlodipine nifedipine verapamil felodpine hydralazine - Celebrex can increase blood pressure interfering with how well these medications control your blood pressure. Your doctor may monitor your blood pressure more frequently.
  • Bile acid sequestrants e.g. cholestyramine colestipol - these drugs reduce the effects of Celebrex. Try separating times of administration by 2 hours.
  • blood thinners and anti-clotting medications e.g. warfarin ticlopidine clopidogrel Aggrenox - increased risk of bleeding problems
  • herbal products with blood thinning effects e.g. ginkgo biloba garlic ginger licorice ginseng feverfew evening primrose oil omega-3 fatty acids - may increase risk of bleeding problems
  • water pills e.g. furosemide hydrochlorothiazide metolazone triamterene amiloride - Celebrex may cause your body to keep more fluid interfering with how well the water pills work
  • cyclosporine - possible high levels of cyclosporine in the body or kidney problems
  • corticosteroids e.g. prednisone - very often used together safely but watch for stomach problems
  • fluconazole - may reduce how your body processes Celebrex resulting in higher than expected levels in the body
  • lithium - - adding Celebrex or a dose increase can increase lithium levels in the body while stopping Celebrex or lowering the dose can lower levels. Monitor closely during any of these changes
  • potassium supplements triamterene spironolactone amiloride - may increase the risk of having high potassium levels in the body

This is not a complete list of drug interactions. Ask your doctor or pharmacist to review your list of medications.

Other information

Call your doctor IMMEDIATELY if you develop chills fever muscle aches or pains or other flu-like symptoms occur especially if they occur before or together with a skin rash. These symptoms may be the first signs of a SERIOUS ALLERGIC REACTION to this medication.

CELEBREX may cause you to become more sensitive to sunlight. Any exposure to sunlight or sunlamps may cause sunburn skin blisters skin rash redness itching or discoloration or vision changes. If you have a reaction from the sun tell your doctor. To lower your risk minimize time spent in the sun or under a sunlamp and when outdoors wear sunblock and protective clothing ( e.g. wide brimmed hat sunglasses long-sleeved breathable cotton shirts)

Children: Not recommended under the age of 18. Safety not established.

Seniors: may be more sensitive to the side effects so your doctor may choose to start you on a lower dose.

Pregnancy: Do not use in the later stage of pregnancy (after 28 weeks) because it can prolong labour and may have an effect on the baby's heart. Even in earlier stages of pregnancy talk to your doctor about alternatives.

Women who are nursing: Not recommended. Talk to your doctor.

People who drive or operate machinery: Before trying these activities see how Celebrex affects you especially your balance level of pain body movement control and ability to concentrate. Only proceed if you can do so safely.

Alcohol: Do not drink as alcohol can increase risks of stomach problems.

Overdose: If you experience any unusual reactions or if you seriously exceed the recommended dosage call your doctor or 911.

Stopping the drug: CELEBREX should be prescribed and used at the lowest effective dose and for the shortest possible duration. Celebrex relieves symptoms while it is taken - these symptoms may return after stopping

If you miss a dose: your symptoms may return. Take it as soon as you remember then follow your prescription bottle directions starting with that dose. Never double dose Storage conditions: Closed container; cool dry location away from excess moisture (not in the bathroom) always out of reach of children.

Dietary precautions: Take with food or milk to reduce stomach upset.

Drugs in the NSAID family have been associated with a depletion of folic acid. While Celebrex is an NSAID it has not been directly linked to folic acid depletion. It is important to maintain a healthy diet including green leafy vegetables and grain products which are rich in folic acid. Among other things low folic acid is associated with an increase in risk of heart disease. Do not take folic acid supplements unless recommended by your doctor.