Celecoxib
Celecoxib
Celebrex (oral capsules), Elyxyb (oral solution, for acute migraine)
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Summary
Common uses
Osteoarthritis (FDA)0, Rheumatoid arthritis (FDA)0, Juvenile rheumatoid arthritis (FDA, ≥2 years)0, Ankylosing spondylitis (FDA)0, Acute musculoskeletal pain (FDA)0, Primary dysmenorrhea (FDA)0, Familial adenomatous polyposis (FDA, adjunct to surgery and surveillance)0, Acute migraine (Elyxyb oral solution, FDA)0
Pharmacy
Starting dose
Osteoarthritis: 200 mg PO once daily or 100 mg BID. Rheumatoid arthritis: 100-200 mg PO BID. Acute pain: 400 mg loading, then 200 mg every 12 hours
Preparations
Capsules 50, 100, 200, 400 mg; Elyxyb oral solution 25 mg/mL
US FDA Max
400 mg/day for chronic indications; higher for short-term acute pain
Pharmacology
Routes
Oral
Onset
30-60 minutes
Duration
12-24 hours
Half-life
~11 hours[1]
Bioavailability
~99% (oral)[1]
Pregnancy
Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning (fetal renal dysfunction, oligohydramnios); contraindicated from 30 weeks (risk of premature ductus arteriosus closure)[1]
Legal status
Rx-only in US
Purported mechanism
Selective COX-2 inhibitor, the only such NSAID in widespread US use after the withdrawals of rofecoxib (Vioxx, 2004) and valdecoxib (Bextra, 2005). COX-2 selectivity reduces gastrointestinal mucosal injury compared to non-selective NSAIDs, the principal pharmacological selling point, while the PRECISION trial (2016) demonstrated cardiovascular non-inferiority versus ibuprofen and naproxen, validating continued use.0 CYP2C9 substrate; CYP2C9 poor metabolizers may have higher exposure and benefit from a lower starting dose. Contains a sulfonamide moiety that has historically prompted caution in patients with sulfa antibiotic allergy, though the chemistry differs from antimicrobial sulfonamides and cross-reactivity is debated[1].
References
- ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Celebrex (celecoxib), Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020998s053lbl.pdf