COX-2 Selective NSAID — Perioperative Analgesia Pregnancy: Contraindicated in third trimester; avoid in first and second trimesters

Celecoxib

Brand names: Celebrex

Adult dose

Dose: 200-400 mg orally 1-2 hours pre-operatively; 200 mg twice daily post-operatively

Route: Oral

Frequency: Pre-operative single dose; twice daily post-operatively

Max: 400 mg/day

COX-2 selectivity provides analgesia without platelet inhibition — advantage over non-selective NSAIDs when perioperative bleeding risk is a concern

Paediatric dose

Dose: Seek specialist opinion N/A/kg

Route: Oral

Frequency: Seek specialist opinion

Max: Seek specialist opinion

Not licensed in children under 18 for perioperative analgesia

Dose adjustments

Renal

Avoid if eGFR under 30

Hepatic

Reduce dose to 200 mg/day in moderate hepatic impairment; avoid in severe

Paediatric weight-based calculator

Patient weight (kg)

Not licensed in children under 18 for perioperative analgesia

Clinical pearls

COX-2 selectivity means no platelet inhibition — key advantage over non-selective NSAIDs (diclofenac, ibuprofen) in perioperative setting where bleeding is a concern
MHRA 2013: Celecoxib carries equivalent cardiovascular risk to diclofenac — contraindicated in established cardiovascular disease; both carry similar risk to non-selective NSAIDs
Sulfonamide allergy: celecoxib contains a sulfonamide group — potential cross-reactivity with sulfonamide antibiotics; check allergy history
PROSPECT Guidelines: celecoxib 400 mg pre-operatively is evidence-based for several surgical procedures (colectomy, hysterectomy) — reduces opioid requirements and PONV
GI safety advantage: selective COX-2 inhibition spares prostacyclin-dependent gastric mucosal protection less than non-selective NSAIDs — fewer GI ulcers, though risk not eliminated

Contraindications

Established ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease (MHRA 2013)
Sulfonamide allergy (cross-reactivity)
Active GI ulceration

Side effects

GI effects (less than non-selective NSAIDs)
Cardiovascular events (similar to diclofenac — MHRA 2013)
Renal impairment
Fluid retention

Interactions

Warfarin (increased INR — monitor closely)
ACEi / diuretics (renal risk)
Lithium (increased levels)
Fluconazole (increases celecoxib levels via CYP2C9 inhibition)

Monitoring

Renal function
Blood pressure
Signs of GI bleeding

Reference: BNFc; BNF 90; Celebrex SPC; MHRA Drug Safety Update 2013; PROSPECT Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways