Celecoxib

COX-2 Inhibitor·Analgesia - Simple & NSAIDs

Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, acute pain

Authority requiredPBSNSAIDCelebrex100 mg+2

Max Dose

400 mg/day

Half-life

11 h

GI Bleed

LOWER RISK

CV Risk

MONITOR

Rapid Summary

Overview

Highly selective COX-2 inhibitor ('Coxib'). Designed to provide the anti-inflammatory power of an NSAID while sparing the stomach lining from ulceration.

Maximum Dose

Max 400 mg/day (e.g., 200 mg BD).

Clinical Focus

Much safer for the GI tract, but carries a higher risk of pro-thrombotic cardiovascular events (MI/Stroke) than non-selective agents like Naproxen.

Bottom Line

Celecoxib is a selective COX-2 inhibitor with lower GI bleeding risk than traditional NSAIDs, but carries the same cardiovascular risk and is contraindicated in sulfonamide allergy.

Formulation & Access

Brand Names

Celebrex

Oral Routes

Capsules (100 mg, 200 mg).

Prescribing & PBS

Authority Required (PBS) for chronic arthritis.

Indications & Use

Primary

PBSTGA

Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, acute pain.

Clinical Place

The NSAID of choice for patients with a history of peptic ulcer disease who absolutely require anti-inflammatory therapy.

Quick reference

Class & Role

COX-2 Inhibitor — Highly selective COX-2 inhibitor ('Coxib').

Route / Formulation

Capsules (100 mg, 200 mg). (Celebrex)

Usual Dose & Max

PO 100-200 mg OD or divided BD. Max 400 mg/day (e.g., 200 mg BD).

Key Indication Doses

Osteoarthritis / RA: PO 100-200 mg OD or divided BD. Acute Pain / Dysmenorrhoea: PO 400 mg STAT on Day 1, then 200 mg BD. Renal / Hepatic: Halve dose in moderate hepatic impairment. Avoid entirely if eGFR < 30.

Best Uses

Celecoxib is a selective COX-2 inhibitor with lower GI bleeding risk than traditional NSAIDs, but carries the same cardiovascular risk and is contraindicated in sulfonamide allergy.

Avoid / Cautions

Severe Ischemic Heart Disease, prior stroke/MI, active GI bleeding, severe heart failure. Pregnancy Category B3 (Avoid in 3rd trimester).

Key Risks

Cardiovascular: Increased risk of myocardial infarction, stroke, heart failure, and hypertension. (Selectively blocking COX-2 drops prostacyclin—a vasodilator—while leaving COX-1 thromboxane—a clot promoter—unopposed). Renal: AKI, fluid retention, hyperkalemia. (COX-2 selectivity does NOT protect the kidneys. The renal risk is identical to Ibuprofen). Gastrointestinal: Ulcers and bleeding are significantly reduced compared to standard NSAIDs, but risk is not zero.

Key Interactions

Fluconazole (Inhibits CYP2C9, massively spiking Celecoxib levels. Halve Celecoxib dose). ACEi + Diuretic + Celecoxib = AKI.

Monitoring

Monitor BP regularly. Fluid retention can easily tip an elderly patient into heart failure. Check U&E and eGFR.

Clinical Pearl

Early COX-2 inhibitors (Rofecoxib/Vioxx) were pulled from the market globally because they caused massive fatal heart attacks. Celecoxib survived because its COX-2 selectivity is much weaker. However, the cardiac risk is still very real in high-risk patients.

Access

Authority requiredCelebrex100 mg

Brand: Celebrex
PBS status: Authority required
Formulation: Capsules (100 mg, 200 mg)

Celecoxib

COX-2 Inhibitor·Analgesia - Simple & NSAIDs

Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, acute pain

Authority requiredPBSNSAIDCelebrex100 mg+2

Max Dose

400 mg/day

Half-life

11 h

GI Bleed

LOWER RISK

CV Risk

MONITOR

Rapid Summary

Overview

Highly selective COX-2 inhibitor ('Coxib'). Designed to provide the anti-inflammatory power of an NSAID while sparing the stomach lining from ulceration.

Maximum Dose

Max 400 mg/day (e.g., 200 mg BD).

Clinical Focus

Much safer for the GI tract, but carries a higher risk of pro-thrombotic cardiovascular events (MI/Stroke) than non-selective agents like Naproxen.

Bottom Line

Celecoxib is a selective COX-2 inhibitor with lower GI bleeding risk than traditional NSAIDs, but carries the same cardiovascular risk and is contraindicated in sulfonamide allergy.

Formulation & Access

Brand Names

Celebrex

Oral Routes

Capsules (100 mg, 200 mg).

Prescribing & PBS

Authority Required (PBS) for chronic arthritis.

Indications & Use

Primary

PBSTGA

Osteoarthritis, Rheumatoid arthritis, Ankylosing spondylitis, acute pain.

Clinical Place

The NSAID of choice for patients with a history of peptic ulcer disease who absolutely require anti-inflammatory therapy.

Quick reference

Class & Role

COX-2 Inhibitor — Highly selective COX-2 inhibitor ('Coxib').

Route / Formulation

Capsules (100 mg, 200 mg). (Celebrex)

Usual Dose & Max

PO 100-200 mg OD or divided BD. Max 400 mg/day (e.g., 200 mg BD).

Key Indication Doses

Best Uses

Celecoxib is a selective COX-2 inhibitor with lower GI bleeding risk than traditional NSAIDs, but carries the same cardiovascular risk and is contraindicated in sulfonamide allergy.

Avoid / Cautions

Severe Ischemic Heart Disease, prior stroke/MI, active GI bleeding, severe heart failure. Pregnancy Category B3 (Avoid in 3rd trimester).

Key Risks

Key Interactions

Fluconazole (Inhibits CYP2C9, massively spiking Celecoxib levels. Halve Celecoxib dose). ACEi + Diuretic + Celecoxib = AKI.

Monitoring

Monitor BP regularly. Fluid retention can easily tip an elderly patient into heart failure. Check U&E and eGFR.

Clinical Pearl

Access

Authority requiredCelebrex100 mg

Brand: Celebrex
PBS status: Authority required
Formulation: Capsules (100 mg, 200 mg)