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COX-2 Inhibitor (NSAID) Pregnancy: C (first/second trimester) — D (third trimester)

Celecoxib

Brand names: Celebrex

Adult dose

Dose: 100–200mg twice daily
Route: Oral
Frequency: Twice daily with food
OA: 200mg OD. RA: 100–200mg BD. Familial adenomatous polyposis: 400mg BD (adjunctive). Max 400mg/day.

Clinical pearls

  • GI advantages over non-selective NSAIDs (CLASS trial) but NOT in those on aspirin
  • Cardiovascular risk similar to other NSAIDs — AVOID in established CVD
  • Sulfonamide structural component — allergy history to sulfonamides relevant
  • Useful in patients with high GI bleed risk who need NSAID therapy
  • Does not affect platelet aggregation — does not replace aspirin for CV protection

Contraindications

  • Established ischaemic heart disease
  • Cerebrovascular disease
  • Peripheral arterial disease
  • Sulfonamide allergy (cross-reactivity)
  • Active PUD
  • Severe hepatic impairment

Side effects

  • Hypertension
  • Fluid retention
  • Oedema
  • GI upset (less than non-selective NSAIDs)
  • Hepatotoxicity

Interactions

  • Warfarin — increased INR
  • ACE inhibitors — blunted antihypertensive effect
  • Lithium — increased levels
  • Fluconazole — increases celecoxib levels

Monitoring

  • Blood pressure
  • Renal function (prolonged use)
  • LFTs
  • Cardiovascular symptoms

Reference: CLASS trial; EMA NSAID Safety Review; BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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