Celebrex

What is Celebrex?

Celebrex is a medication that belongs to the class of non-steroidal anti-inflammatory drugs (NSAIDs), specifically selective COX-2 inhibitors. It is a prescription medication used to treat the signs and symptoms of arthritis, acute pain (mild or moderate), and inflammation.¹

Celebrex inhibits the enzyme that produces prostaglandins, which cause pain in high concentrations. By lowering prostaglandin levels, inflammation and pain decrease. 

Celebrex has US Food and Drug Administration (FDA) boxed warnings. Taking NSAIDs increases your risk of serious gastrointestinal problems, including bleeding, ulceration, and perforation. In some cases, gastrointestinal problems triggered by NSAID use occur without warning signs and can be fatal. The risk of serious outcomes is highest among older adults and people with a history of peptic ulcer disease or gastrointestinal bleeding.²

NSAIDs also increase the risk of severe (and potentially fatal) cardiovascular thrombotic events, including heart attack and stroke.

Finally, Celebrex is contraindicated in the setting of coronary artery bypass graft (CABG) surgery due to evidence of increased heart attack and stroke risk.

What is Celebrex’s generic name?

Celecoxib is the generic name of Celebrex. It is available in capsule form in 50mg, 100mg, 200mg, and 400mg strengths.

What does Celebrex treat?

Celebrex is indicated for the treatment of:²

• Osteoarthritis

• Rheumatoid arthritis

• Juvenile rheumatoid arthritis in patients two years and older

• Ankylosing spondylitis

• Primary dysmenorrhea (menstrual cramps)

• Acute pain

Off-label uses (uses for which FDA approval has not yet been granted) include:

• Familial adenomatous polyposis³

• Gout⁴

How do you take Celebrex?

Celebrex is taken orally. Usually, the lowest effective dose should be given for the shortest period possible. Typical dosage recommendations are as follows:²

• For osteoarthritis: 100mg twice daily or 200mg once a day

• For rheumatoid arthritis: 100–200mg twice daily

• For ankylosing spondylitis: 200mg daily taken as one dose or divided (maximum 400mg per day)

• For juvenile rheumatoid arthritis: Celebrex is only intended for children two and older, and the dose depends on their weight

  • For children 12–25kg, the recommended dose is 50mg twice daily

  • For children over 25kg, the dose can be as high as 100mg twice daily

• For acute pain or menstrual cramps: 400mg once on the first day with an additional 200mg if needed, then 200mg twice the next day, if required

Your doctor will prescribe the lowest dose that effectively manages your condition. You can take Celebrex with or without food. However, doses higher than 400mg twice daily should be taken with food to enhance absorption.

People who struggle with swallowing pills can break open the capsules and mix the contents into a tablespoon of applesauce. The mixture should be consumed right away along with water.⁵

Seeing results

Celebrex significantly improves pain and inflammation in arthritis, but it doesn’t stop the disease from progressing. Celebrex has been shown to improve function in patients with osteoarthritis, but it only provides pain relief when used to treat rheumatoid arthritis.⁶ ⁷

Clinical studies assessing the effectiveness of Celebrex produced the following results:²

• Patients with osteoarthritis saw significant reductions in pain within 24 to 48 hours when taking Celebrex during a flare

• Patients with osteoarthritis, rheumatoid arthritis, juvenile arthritis, and ankylosing spondylosis saw benefits when assessed at predetermined points during the study period (12 weeks or 24 weeks after initiating treatment)

• Patients with acute pain related to oral surgery, orthopedic surgery, and primary dysmenorrhea reported pain relief from a single dose of Celebrex within 60 minutes

It may take some time to see the results of Celebrex. Continue taking the medication as prescribed, even if it doesn’t seem to be helping with your symptoms. If you’ve been taking Celebrex for a couple of weeks and are concerned about a lack of apparent benefit, discuss your concerns with your doctor.

Potential side effects of Celebrex

Celebrex is associated with side effects that range from common and mild to rare and fatal.²

Common side effects of Celebrex are typically mild and include

• Headaches

• Dizziness

• Elevated blood pressure³

• Upper respiratory tract infections

• Sinusitis

• Indigestion or gas

• Diarrhea

• Abdominal pain

• Nausea and vomiting

• Back, body, and joint pain

• Insomnia

• Rash

As well as other gastrointestinal, nervous system, psychiatric, respiratory, and whole-body issues.

Less common side effects may be mild or severe and include the following:

• Gastrointestinal issues, including constipation, difficulty swallowing, vomiting, and gastritis, esophagitis, or gastroesophageal reflux

• Cardiovascular issues, including high blood pressure, cardiac chest pain, heart attack, and coronary artery disease

• Infectious issues, including bacterial, viral, and fungal infections, as well as herpes simplex and zoster infections

• Nervous system issues, such as loss of sensation, migraine, and nerve pain

• Musculoskeletal effects, such as leg cramps, muscle aches, and joint pain

• Reproductive concerns, including painful periods and other menstrual disorders, fibrocystic breasts, vaginitis, and prostate issues

• Ear and hearing troubles, including ringing in the ears, earaches, and deafness

• Heart rate and rhythm irregularities, such as fast heart rate and palpitations

• Liver and biliary abnormalities, including abnormal function and increased liver enzymes

• Psychiatric concerns, including anxiety and depression

• Skin-related problems, such as rash, hair loss, and increased sweating

• Blood-related problems, including platelet irregularities and anemia

And various other metabolic, musculoskeletal, respiratory, skin, urinary tract, and eye health concerns.

Rare and severe adverse effects associated with Celebrex include the following:

• Angioedema (allergic swelling of the face, throat, or tongue) 

• Anaphylaxis (whole-body allergic reaction)

• Hepatitis or liver failure

• Gallstones

• Ulcers and bleeding (sometimes fatal) requiring hospitalization

• Congestive heart failure

• Intestinal obstruction or perforation

• Ataxia (loss of balance)

• Suicidal thoughts or behaviors

• Acute kidney failure

• Sepsis

And a range of other severe and life-threatening conditions related to the cardiovascular, gastrointestinal, hepatic, metabolic, nervous, and renal systems.

Seek emergency medical attention if you experience any of the following:

• Signs of an allergic reaction: hives, a blistering or peeling rash, swelling of your face, tongue, or throat, difficulty breathing, fever, or burning eyes

• Signs of a heart attack or stroke: chest pain spreading to your shoulder or jaw, shortness of breath, sudden numbness or weakness on one side of the body, difficulty speaking, or leg swelling

• Signs of gastrointestinal bleeding or perforation: nausea, abdominal pain, vomit that contains blood or looks like coffee grounds, black or tarry stool, fast heart rate, fever, or low blood pressure

Who should not take Celebrex?

Celebrex is a commonly-prescribed drug, but it’s not suitable for everyone.²

People with any history of the following conditions should use Celebrex cautiously and only if their doctor decides the benefits outweigh the risks:

• Hypertension

• Fluid retention

• Heart attack or heart failure

• Peptic ulcer disease or gastrointestinal bleeding

• Stroke

• Kidney disease

• Liver disease

• Blood platelet issues

• Asthma

Celebrex is contraindicated in people with the following conditions:

• Hypersensitivity to celecoxib

• Allergic reactions to sulfonamides

• Asthma or allergic reactions after taking aspirin or other NSAIDs

• Those undergoing CABG surgery

Additionally, people taking certain drugs should be aware of possible interactions with Celebrex. Drug interactions are detailed in the section Interactions with other drugs below.

Long-term use of Celebrex

Celecoxib oral capsules may be used for short- or long-term treatment, depending on the condition being treated. It can raise the risk of heart attacks and strokes for older people and those with heart conditions. Your doctor will advise you if you can safely use it long-term.

Missed doses

If you miss a dose, take it as soon as you remember. However, if it’s nearly time for your next dose, skip the missed one and resume your normal schedule. Don’t double your dose to make up for a missed one.

Overdoses

Before taking any over-the-counter medications for pain, fever, swelling, or cold and flu symptoms while on Celebrex, see your doctor or pharmacist to be sure it’s safe and learn the appropriate dose for you.

Aspirin, ibuprofen, and other anti-inflammatory drugs are similar to celecoxib and belong to the same family, so taking two or more of these medications together could result in an overdose. Overdose signs and symptoms may include any of the following:

• Blurred vision

• Ringing in the ears

• Rash

• Sweating

• Chills

• Severe stomach pain

• Nausea

• Gastrointestinal bleeding

• Vomiting

• A change in your urine volume

• Severe headache

• High blood pressure

• Agitation and incoherence

• Slow or shallow breathing

• Loss of consciousness or coma

A Celebrex overdose is a medical emergency. If you suspect you (or someone in your care) have taken too much Celebrex, call the National Poison Control helpline and seek immediate emergency care. 

What to discuss with your doctor before taking Celebrex

Tell your doctor if you are allergic to celecoxib, aspirin, other NSAIDs (such as ibuprofen), other COX-2 inhibitors, or anything else (drugs or otherwise). This product might include inactive ingredients that could trigger an allergic reaction.

Tell your doctor or pharmacist about any medical conditions you have, including:

• Asthma

• Liver disease

• Kidney disease

• Heart disease

• High blood pressure

• Stroke

• Blood disorders

• Gastrointestinal bleeding or ulcer disease

• Nasal polyps

If your child takes Celebrex for systemic-onset juvenile rheumatoid arthritis, they may be at an elevated risk of life-threatening bleeding or clotting problems. Speak with your doctor about steps you can take to minimize the risk and remain vigilant for signs of complications.²

Stopping Celebrex

Stop taking Celebrex if your doctor recommends it. Your doctor may instruct you to taper off the medication for a few days before stopping it entirely.

Stop using Celebrex and contact your doctor immediately if you have:

• Any sign of a skin rash, even if it’s mild

• A reaction affecting many parts of your body, including a widespread skin rash, swollen glands, fever, severe muscle aches or weakness, unusual bruising, or yellowing skin or eyes

• Signs of internal bleeding, including tarry or bloody stools, vomit that looks like coffee grounds, or coughing up blood

• Signs of heart problems, such as swelling, shortness of breath, or rapid weight gain

• Signs of kidney dysfunction, including little to no urination, shortness of breath, fatigue, or swelling in your feet or ankles

• Signs of liver problems, such as abdominal pain (upper right side), nausea, itching, dark urine, tiredness, or yellowing skin or eyes

• Signs of anemia, including pale skin, cold hands and feet, unusual tiredness, lightheadedness, or shortness of breath

Celebrex and pregnancy

You must speak with your doctor before taking NSAIDs, including Celebrex, during pregnancy. The US FDA warns against taking NSAIDs from the 20th week of gestation.⁸

During the initial approval phase, Celebrex was designated a pregnancy category C drug up to 30 weeks gestation by the FDA. Category C means animal studies have shown harm to the fetus, but there have not been enough good-quality human studies to determine its risk in humans. Based on its pregnancy category, doctors would only recommend Celebrex during this stage of pregnancy if the benefits outweighed the potential risks.

The FDA subsequently designated Celebrex a category D drug from 30 weeks gestation and beyond. Category D means that studies in pregnant women at this stage have demonstrated risks to the fetus. Researchers concluded that taking NSAIDs during the third trimester increases the risk of a severe cardiovascular problem called premature closure of the fetal ductus arteriosus.² ³

The current guidance reflects an update provided by the FDA in 2020. Through a review of relevant literature and reports filed through the FDA Adverse Event Reporting System (FAERS) database, the organization identified cases of severely low amniotic fluid levels and kidney problems in the fetus when the mother had taken NSAIDs after 20 weeks. 

Thus, the FDA advises against taking any form of NSAIDs, including Celebrex, from the 20th week of gestation in an effort to prevent these fetal adverse effects. Ask your doctor for guidance if you are pregnant or trying to conceive.

Celebrex is excreted in breast milk, but there is limited data on its implications for the baby. Speak with your doctor about the risk of adverse effects to you and your baby before taking Celebrex if you’re breastfeeding or planning to breastfeed.

Interactions with other drugs and alcohol²

A variety of drugs are known to interact with Celebrex. A drug interaction can have severe (sometimes fatal) consequences when one or both drugs involved act differently than intended.

Other NSAIDs and salicylates

Other NSAIDs (such as ibuprofen and naproxen) and salicylates (including aspirin) may interact with Celebrex. This interaction increases the risk of stomach and intestinal ulcers, perforation, and bleeding. Thus, it is important to avoid over-the-counter NSAIDs such as Aleve, Motrin, Advil, Bufferin, and Excedrin and instead, let your doctor know that you need another type of medicine for your pain. 

Alcohol

You should avoid consuming alcohol while taking any NSAIDs, as this increases the risk of stomach ulcers, bleeding, and perforation, which could be fatal.

Blood pressure medications

NSAIDs may diminish the effects of blood pressure-lowering medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers, as prostaglandins have a role in blood pressure regulation.

Drugs interfering with hemostasis

Those taking blood thinners (such as warfarin) and anti-platelet drugs (including aspirin) are at risk of severe bleeding events while also on Celebrex. Therefore, doctors will closely monitor them for signs of bleeding. Doctors may also recommend blood testing, especially in the first few days of starting the medication or with any dose changes.

Similarly, people taking drugs that influence serotonin reuptake may face a higher risk of bleeding and require monitoring.

Diuretics

NSAIDs may reduce the effectiveness of both loop (Lasix, Bumex) and thiazide (Zaroxolyn, Microzide, Diuril) diuretics. Doctors will monitor people taking these drugs alongside Celebrex for signs of worsening kidney function and diuretic inefficacy.

Digoxin

Celebrex increases digoxin (Lanoxin) levels in the blood and prolongs its half-life, meaning more of the drug stays in the body for longer, so a dosage adjustment may be required. The drugs may be used concurrently with routine monitoring of digoxin serum concentration.

Methotrexate

Taking NSAIDs, including Celebrex, alongside methotrexate may increase the risk of methotrexate toxicity. Doctors will monitor methotrexate levels in patients taking both medications.

Cyclosporine

Kidney toxicity is among the known severe side effects associated with cyclosporine use. Taking Celebrex increases the risk, and patients taking both drugs must undergo routine monitoring for signs of deteriorating kidney function.

Lithium

Celebrex raises the level of lithium in the blood, which could cause lithium toxicity in those taking lithium concurrently.

Pemetrexed

Taking Celebrex alongside pemetrexed (Alimta) increases the risk of severe side effects associated with pemetrexed, including bone marrow suppression and toxicity within the kidney and gastrointestinal systems.

Corticosteroids

Using Celebrex and corticosteroids concurrently may increase the risk of gastrointestinal ulcers and bleeding. Therefore, patients taking both drugs must remain vigilant in monitoring for signs of adverse reactions within the gastrointestinal system.

Drugs affecting CYP2C9 enzymes

Medications that inhibit CYP2C9, including the antifungal fluconazole, may increase the risk of Celebrex toxicity. In contrast, medications that induce CYP2C9, such as rifampin, may impair Celebrex’s effectiveness.

CYP2D6 substrates

Celebrex inhibits the enzyme CYP2D6 and may affect concentrations of drugs metabolized by the enzyme, including atomoxetine (Strattera). 

Allergy information

Celebrex rarely causes a serious allergic reaction. But if you detect any signs of a severe allergic response, seek medical treatment immediately.

Signs of a drug allergy may include:

• Itching

• Rash, hives

• Swelling (particularly of the face, tongue, and throat)

• Extreme dizziness

• Vomiting

• Difficulty breathing

• Loss of consciousness

Drug approval history

• 1998: The US FDA approves Celebrex for treating the symptoms of rheumatoid arthritis and osteoarthritis⁹

• 1999: The US FDA approves Celebrex for polyp reduction in familial adenomatous polyposis¹⁰

• 2006: The US FDA approves Celebrex for treating the symptoms of juvenile rheumatoid arthritis in patients two years and older¹¹

• 2012: The US FDA withdraws approval of Celebrex for polyp reduction in familial adenomatous polyposis because a postmarketing study on effectiveness required as part of the drug’s approval was not completed (the withdrawal was not linked to any new data indicating lack of effectiveness or safety)¹²

• 2014: The US FDA approves the first generic versions of celecoxib¹³

Tips and advice for taking Celebrex

The following tips can help you stay safe while taking Celebrex:

• Do not give Celebrex to a child unless a doctor has prescribed it.

• Store Celebrex at room temperature and out of the reach of children.

• Use UV-protective clothing and broad-spectrum SPF 30+ sunscreen if you have to be in the sun, as Celebrex may make your skin more sensitive to sun exposure.¹⁴

• Monitor for signs of weight gain as unexplained weight increases may be linked to fluid retention, which might point to other health concerns.