Celecoxib

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.