NSAID — Selective COX-2 Inhibitor Pregnancy: Contraindicated in pregnancy and in women who can become pregnant (unless using an effective method of contraception). Studies in rats and rabbits have shown reproductive toxicity including malformations; the potential for human risk in pregnancy is unknown but cannot be excluded, and epidemiological data suggest an increased risk of spontaneous abortion after use of prostaglandin synthesis inhibitors in early pregnancy. Celecoxib may cause uterine inertia and premature closure of the ductus arteriosus during the last trimester, and during the second or third trimester NSAIDs may cause fetal renal dysfunction leading to reduced amniotic fluid volume or oligohydramnios. If a woman becomes pregnant during treatment, celecoxib should be discontinued. Contraindicated in breast-feeding - women who take celecoxib should not breastfeed. Fertility: NSAIDs including celecoxib may delay or prevent rupture of ovarian follicles, associated with reversible infertility in some women.

Celecoxib (Rheumatology)

Brand names: Celebrex

This is celecoxib, a selective COX-2 inhibitor non-steroidal anti-inflammatory drug, used in rheumatology to relieve pain and inflammation in osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Rheumatoid arthritis: initial recommended daily dose 200 mg taken in two divided doses; the dose may, if needed, later be increased to 200 mg twice daily

Route: Oral - may be taken with or without food. For patients who have difficulty swallowing capsules, the capsule contents can be emptied onto a level teaspoon of cool or room temperature applesauce, rice gruel, yogurt or mashed banana and ingested immediately with 240 ml of water

Frequency: Two divided doses daily for rheumatoid arthritis (increased to twice daily 200 mg if needed)

Max: 400 mg daily - 'The maximum recommended daily dose is 400 mg for all indications'

Source: UK SPC (eMC) for Celebrex 100 mg capsule, §4.2 (https://www.medicines.org.uk/emc/product/5533/smpc). The dose above is the SPC's rheumatoid arthritis regimen. OTHER RHEUMATOLOGY INDICATIONS ON THE SAME LABEL - OSTEOARTHRITIS: usual recommended daily dose 200 mg taken once daily or in two divided doses; in some patients with insufficient relief an increased dose of 200 mg twice daily may increase efficacy. ANKYLOSING SPONDYLITIS: recommended daily dose 200 mg taken once daily or in two divided doses; in a few patients with insufficient relief an increased dose of 400 mg once daily or in two divided doses may increase efficacy. REVIEW: for all three indications, in the absence of an increase in therapeutic benefit after two weeks other therapeutic options should be considered. DURATION: as the cardiovascular risks of celecoxib may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used; the patient's need for symptomatic relief and response to therapy should be re-evaluated periodically, especially in patients with osteoarthritis. CONCOMITANT NSAIDs: the concomitant use of celecoxib and a non-aspirin NSAID should be avoided. ELDERLY: as in younger adults, 200 mg per day should be used initially and may if needed later be increased to 200 mg twice daily; particular caution should be exercised in elderly patients with a body weight less than 50 kg. CYP2C9 POOR METABOLISERS: patients known or suspected to be CYP2C9 poor metabolisers should be given celecoxib with caution as the risk of dose-dependent adverse effects is increased - consider reducing the dose to half the lowest recommended dose. HEPATIC IMPAIRMENT: treatment should be initiated at half the recommended dose in patients with established moderate liver impairment with a serum albumin of 25-35 g/l; contraindicated in severe hepatic dysfunction (serum albumin below 25 g/l or Child-Pugh score 10 or above). PAEDIATRIC: the UK SPC states plainly that 'Celecoxib is not indicated for use in children' - no paediatric dose is given, hence paedDose is null. FOR CROSS-REFERENCE ONLY (not UK-licensed, and internally inconsistent in the fetched document - do NOT publish without resolving): the US label approves juvenile rheumatoid arthritis from 2 years of age with weight-band (not per-kg) dosing, but its Highlights section states '50 mg twice daily in patients 10 kg to 25 kg; 100 mg twice daily in patients more than 25 kg' while its §2.4 body text states 'For patients > 10 kg to 25 kg the recommended dose is 100 mg twice daily' - the two statements conflict for the 10-25 kg band and the fetched text gives no figure for the over-25 kg band in §2.4. Verify any under-18 dosing against a children's formulary. US CROSS-CHECK ADULT DOSES (openFDA, celecoxib, A-S Medication Solutions, label date 2023-08-24): osteoarthritis 200 mg per day as a single dose or 100 mg twice daily; rheumatoid arthritis 100 mg to 200 mg twice daily; ankylosing spondylitis 200 mg daily, with a trial of 400 mg daily if no effect after 6 weeks. Note the US RA range (up to 200 mg twice daily) differs in presentation from the UK SPC wording.

Dose adjustments

Renal

Experience with celecoxib in patients with mild or moderate renal impairment is limited, so such patients should be treated with caution. Contraindicated in patients with an estimated creatinine clearance below 30 ml/min.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients; known hypersensitivity to sulfonamides
Active peptic ulceration or gastrointestinal (GI) bleeding
Patients who have experienced asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic-type reactions after taking aspirin or other NSAIDs including COX-2 inhibitors
Pregnancy, and women of childbearing potential unless using an effective method of contraception; breast-feeding
Severe hepatic dysfunction (serum albumin below 25 g/l or Child-Pugh score 10 or above)
Estimated creatinine clearance below 30 ml/min
Inflammatory bowel disease
Congestive heart failure (NYHA II-IV)
Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease
(US label additionally) In the setting of coronary artery bypass graft (CABG) surgery

Side effects

Gastrointestinal - abdominal pain, diarrhoea, dyspepsia, flatulence and nausea (common); upper and lower GI complications (perforations, ulcers or bleeds), some fatal, have occurred
Cardiovascular - peripheral oedema and fluid retention, hypertension; an increased number of serious cardiovascular events, mainly myocardial infarction, was found at doses of 200 mg twice daily and 400 mg twice daily in a long-term placebo-controlled study
Infections - sinusitis, upper respiratory tract infection, pharyngitis, urinary tract infection (common)
Nervous system - dizziness, hypertonia and headache (common); paraesthesia and somnolence (uncommon); cerebral infarction (uncommon)
Hypersensitivity and skin reactions - hypersensitivity (uncommon); anaphylactic shock and anaphylactic reaction (very rare); rash and serious skin reactions
Haematological - anaemia (uncommon); leukopenia and thrombocytopenia (rare); pancytopenia (very rare). Hyperkalaemia also reported (uncommon)

Interactions

Anticoagulants such as warfarin - synergistic effect on bleeding; concomitant use carries an increased risk of serious bleeding compared with either drug alone; monitor for signs of bleeding (US label Table 3)
Antiplatelet drugs (e.g. aspirin), SSRIs and SNRIs - drugs that interfere with haemostasis or serotonin reuptake may potentiate bleeding risk more than an NSAID alone; monitor for signs of bleeding (US label Table 3)
Aspirin - concomitant use with NSAIDs produces no greater therapeutic effect but was associated with a significantly increased incidence of gastrointestinal adverse reactions; there is a further increase in the risk of gastrointestinal ulceration or other complications when celecoxib is taken with aspirin even at low doses (UK SPC §4.4; US label Table 3)
Antihypertensive medications - patients may have an impaired response to these therapies when taking NSAIDs; monitor blood pressure (US label §5.4, §7)
Non-aspirin NSAIDs including other COX-2 selective inhibitors - concomitant use with celecoxib should be avoided (UK SPC §4.4)
Interactions are taken from the US prescribing information and UK §4.4 because the fetched eMC bundle contains no §4.5 section, and the US Table 3 is truncated at the source-fetch limit (CYP2C9 and other entries were not retrieved) - verify against the full UK SPC §4.5

Clinical monograph

How it works

It selectively inhibits cyclo-oxygenase-2, reducing prostaglandin-mediated inflammation and pain while sparing COX-1, which lessens gastrointestinal mucosal injury.

Prescribing in practice

Like other NSAIDs it carries cardiovascular thrombotic risk and is contraindicated in established ischaemic heart disease, cerebrovascular and peripheral arterial disease, so it is used at the lowest effective dose for the shortest period.
It is contraindicated in sulfonamide allergy and used with caution with renal impairment, hypertension and heart failure.
Although gastrointestinal-sparing relative to non-selective NSAIDs, serious gastrointestinal events can still occur, particularly in older patients or with concomitant antithrombotics.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal or cardiovascular symptoms, particularly with prolonged use or in at-risk patients.

Counselling the patient

Report indigestion, black stools, breathlessness or ankle swelling.
Take with food and use the lowest effective dose for the shortest time.

Evidence & guidelines

Efficacy and the relative gastrointestinal profile are supported by randomised controlled trials, with NICE and MHRA guidance on cardiovascular risk.

Reference: CONDOR Trial (Lancet 2010); PRECISION Trial (NEJM 2016); NICE TA27 (COX-2 inhibitors); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways