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COX-2 Selective NSAID — Perioperative Analgesia Pregnancy: Contraindicated. UK SPC §4.3/§4.6: 'Celecoxib is contraindicated in pregnancy and in women who can become pregnant... If a woman becomes pregnant during treatment, celecoxib should be discontinued.' Animal studies (rats and rabbits) showed reproductive toxicity including malformations; epidemiological data suggest an increased risk of spontaneous abortion after prostaglandin synthesis inhibitors in early pregnancy. Celecoxib 'may cause uterine inertia and premature closure of the ductus arteriosus during the last trimester', and in the second or third trimester NSAIDs 'may cause fetal renal dysfunction which may result in reduction of amniotic fluid volume or oligohydramnios in severe cases'. Breast-feeding is also contraindicated: 'Women who take Celebrex should not breastfeed.'

Celecoxib

Brand names: Celebrex

Celecoxib is a selective COX-2 inhibitor non-steroidal anti-inflammatory drug used for pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute postoperative pain.

Adult dose

Dose: 400 mg initially, followed by an additional 200 mg dose if needed on the first day; then 200 mg twice daily as needed on subsequent days
Route: Oral
Frequency: Day 1: 400 mg then 200 mg if required. Subsequent days: twice daily as needed
SCOPE: this is the ACUTE PAIN regimen only, and it is taken from the US FDA label, not the UK SPC. US label §2.6: 'For management of Acute Pain and Treatment of Primary Dysmenorrhea, the dosage is 400 mg initially, followed by an additional 200 mg dose if needed on the first day. On subsequent days, the recommended dose is 200 mg twice daily as needed.' The UK SPC in this bundle licenses celecoxib only for osteoarthritis, rheumatoid arthritis and ankylosing spondylitis and states 'The maximum recommended daily dose is 400 mg for all indications' — so the day-1 total above exceeds the UK ceiling and perioperative/acute-pain use is unlicensed in the UK. No source in this bundle gives a pre-operative timing (e.g. '1-2 hours before surgery') or a distinct post-operative regimen. Both labels state the lowest effective dose should be used for the shortest duration possible. UK SPC: 'Celebrex may be taken with or without food.' Elderly (UK SPC §4.2): 'As in younger adults, 200 mg per day should be used initially... Particular caution should be exercised in elderly with a body weight less than 50 kg.' CYP2C9 poor metabolisers (UK SPC §4.2): 'Consider reducing the dose to half the lowest recommended dose.'

Dose adjustments

Renal

Contraindicated in 'Patients with estimated creatinine clearance <30 ml/min' (UK SPC §4.3). UK SPC §4.2: 'Experience with celecoxib in patients with mild or moderate renal impairment is limited, therefore such patients should be treated with caution.' US label §5.6: 'Monitor renal function in patients with renal or hepatic impairment, heart failure, dehydration, or hypovolemia. Avoid use of celecoxib in patients with advanced renal disease unless benefits are expected to outweigh risk of worsening renal function.'

Hepatic

UK SPC §4.2: '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 <25 g/l or Child-Pugh score ≥10)' (UK SPC §4.3). US label §2.7: 'In patients with moderate hepatic impairment (Child-Pugh Class B), reduce the dose by 50%. The use of celecoxib in patients with severe hepatic impairment is not recommended.'

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. 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 acetylsalicylic acid (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 <25 g/l or Child-Pugh score ≥10)
  • Estimated creatinine clearance <30 ml/min
  • Inflammatory bowel disease
  • Congestive heart failure (NYHA II-IV)
  • Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease

Side effects

  • Sinusitis, upper respiratory tract infection, pharyngitis, urinary tract infection
  • Dizziness, hypertonia, headache
  • Insomnia; anxiety, depression, fatigue, confusional state, hallucinations
  • Anaemia; leukopenia, thrombocytopenia; pancytopenia
  • Hypersensitivity; anaphylactic shock and anaphylactic reaction
  • Hyperkalaemia
  • Vision blurred, conjunctivitis; eye haemorrhage; retinal artery or vein occlusion
  • Tinnitus, hypoacusis
  • Cerebral infarction, paraesthesia, somnolence; intracranial haemorrhage (including fatal), aseptic meningitis, epilepsy (including aggravated epilepsy)
  • Ataxia, dysgeusia, ageusia, anosmia
  • US label, most common in arthritis trials (>2% and > placebo): abdominal pain, diarrhoea, dyspepsia, flatulence, peripheral oedema, accidental injury, dizziness, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection, rash
  • Serious class effects flagged on both labels: cardiovascular thrombotic events; GI bleeding, ulceration and perforation (some fatal); hepatotoxicity; hypertension; heart failure and oedema; renal toxicity; serious skin reactions and DRESS

Monitoring

  • Blood pressure — US label §5.4: 'Patients taking some antihypertensive medications may have impaired response to these therapies when taking NSAIDs. Monitor blood pressure.'
  • Renal function — US label §5.6: 'Monitor renal function in patients with renal or hepatic impairment, heart failure, dehydration, or hypovolemia.'
  • Liver tests — US label §5.3: 'Discontinue if abnormal liver tests persist or worsen or if clinical signs and symptoms of liver disease develop.'
  • Signs and symptoms of GI perforation, ulceration or bleeding, particularly in the elderly and in patients on concomitant aspirin, other NSAIDs, antiplatelets, glucocorticoids or alcohol (UK SPC §4.4)
  • Fluid retention and oedema, especially with a history of cardiac failure, left ventricular dysfunction or hypertension (UK SPC §4.4)
  • Skin — US label §5.9: 'Discontinue celecoxib at first appearance of skin rash or other signs of hypersensitivity.'
  • Re-evaluate the need for symptomatic relief and the response to therapy periodically (UK SPC §4.4)

Clinical monograph

How it works

It selectively inhibits the COX-2 enzyme, reducing prostaglandin-mediated inflammation and pain while largely sparing COX-1.

Prescribing in practice

  • Like other NSAIDs it carries cardiovascular thrombotic risk, so it should be used at the lowest effective dose for the shortest duration and avoided in established ischaemic heart disease, cerebrovascular or peripheral arterial disease, and significant heart failure.
  • It is contraindicated in patients with sulfonamide hypersensitivity and in those who have had asthma, urticaria, or allergic reactions to aspirin or other NSAIDs.
  • Although COX-2 selectivity reduces gastrointestinal injury, ulceration and bleeding can still occur, and renal function and blood pressure may be adversely affected.

Monitoring

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

Counselling the patient

  • Take it with food and use the lowest dose that controls your symptoms.
  • Report any indigestion, black stools, or signs of bleeding.
  • Seek urgent help for chest pain, breathlessness, or sudden weakness.

Evidence & guidelines

Celecoxib's analgesic and anti-inflammatory efficacy is supported by trials, with cardiovascular and gastrointestinal safety considerations reflected in MHRA advice.

Reference: Celebrex SPC; MHRA Drug Safety Update 2013; PROSPECT Guidelines; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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