Celecoxib (Celebrex) Uses, Dosage, Side Effects

Celecoxib (cel-e-cox′ib) Celebrex

Classifications: ANALGESIC, NONSTEROIDAL ANTI-INFLAMMMATORY DRUG (NSAID); CYCLOOXYGENASE-2 (COX-2) INHIBITOR; ANTI-INFLAMMATORY

Therapeutic: ANALGESIC, NSAID; COX-2 INHIBITOR; ANTIINFLAMMATORY; ANTIRHEUMATIC

Pregnancy Category: C first and second trimester; D third trimester

AVAILABILITY

Capsule

ACTION & THERAPEUTIC EFFECT

Although an NSAID, unlike ibuprofen celecoxib inhibits prostaglandin synthesis by inhibiting cyclooxygenase- 2 (COX-2), but does not inhibit cyclooxygenase-1 (COX-1). Exhibits anti-inflammatory, analgesic, and antipyretic activities. Reduces or eliminates the pain of rheumatoid and osteoarthritis.

USES

Relief of S&S of osteoarthritis and rheumatoid arthritis. Treatment of acute pain and primary dysmenorrhea; ankylosing spondylitis, juvenile rheumatoid arthritis.

CONTRAINDICATIONS

Hypersensitivity to celecoxib, salicylate, or sulfonamide; asthmatic patients with aspirin triad; GI bleeding; advanced renal disease; development of S&S of renal impairment due to drug; severe hepatic impairment; development of S&S of hepatic impairment due to drug; anemia; pain from CABG surgery; pregnancy (category D third trimester); lactation.

CAUTIOUS USE

Patients who are CYP2C9 poor metabolizers; patients who weigh less than 50 kg; mild or moderate hepatic impairment; elevated LTFs; renal insufficiency; prior history of GI bleeding or peptic ulcer disease; alcoholics; asthmatics; bone marrow suppression; CVA; PVD; fluid retention and/or HF; known risks for cardiovascular disease; kidney disease; hypertension; fluid retention; older adults; pregnancy (category C first and second trimester); children with systemic-onset juvenile rheumatoid arthritis younger than 2 y.

Celecoxib (Celebrex) Uses, Dosage, Side Effects

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ROUTE & DOSAGE

Osteoarthritis/Arthritis/ Ankylosing Spondylitis

Adult: PO 100 mg b.i.d. or 200 mg daily

Rheumatoid Arthritis

Adult: PO 100–200 mg b.i.d.

Acute Pain, Dysmenorrhea

Adult: PO 400 mg 1st dose, then 200 mg same day if needed, then 200 mg b.i.d. prn

FAP

Adult: PO 400 mg b.i.d.

Juvenile Rheumatoid Arthritis

Adolescent/Child (2 y and older, weight greater than 25 kg): PO 100 mg b.i.d. Child (2 y and older, weight 10–25 kg): PO 50 mg b.i.d.

Hepatic Dosage Adjustment

Child-Pugh class B: Reduce dose by 50%

Pharmacogenetic Dosage Adjustment

Poor CYP2C9 metabolizers: Start with ½ normal dose

ADMINISTRATION

Oral

• Give 2 h before/after magnesiumor aluminum-containing antacids.
• Store in tightly closed container and protect from light.

ADVERSE EFFECTS (≥1%)

Body as a Whole: Back pain, peripheral edema. Increased risk of cardiovascular events. GI: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea. CNS: Dizziness, headache, insomnia. Respiratory: Pharyngitis, rhinitis, sinusitis, URI. Skin: Rash.

INTERACTIONS

Drug: May diminish effectiveness of ACE INHIBITORS; fluconazole increases celecoxib concentrations; may increase lithium concentrations; may increase INR in older patients on warfarin.

PHARMACOKINETICS

Peak: 3 h. Distribution: 97% protein bound; crosses placenta. Metabolism: In liver by CYP2C9. Elimination: Primarily in feces (57%), 27% in urine. Half-Life: 11.2 h.

NURSING IMPLICATIONS

Black Box Warning

Celecoxib may increase the risk of serious, potentially fatal thrombosis, (e.g., MI and stroke) and GI adverse events (e.g., bleeding, ulceration, and perforation).

Assessment & Drug Effects

• Monitor for S&S of GI bleeding that may occur suddenly and without warning, especially in older patients.
• Monitor for development of thrombotic events even in those with no prior history of cardiovascular problems.
• Monitor closely lithium levels when the two drugs are given concurrently.
• Monitor closely PT/INR when used concurrently with warfarin.
• Monitor for fluid retention and edema especially in those with a history of hypertension or CHF.
• Monitor lab tests: Periodic Hct and Hgb, LFTs, BUN and creatinine, and serum electrolytes.

Patient & Family Education

• Seek immediate medical attention for any of the following: Chest pain, shortness of breath, sudden weakness, slurring of speech or other S&S of a stroke.
• Promptly report any of the following: Unexplained weight gain, edema, skin rash.
• Stop taking celecoxib and promptly report to prescriber if any of the following occurs: S&S of liver dysfunction including nausea, fatigue, lethargy, itching, jaundice, abdominal pain, and flu-like symptoms; S&S of GI ulceration including black, tarry stools and upper GI distress.
• Avoid using celecoxib during the third trimester of pregnancy.

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Ditulis oleh Unknown pada tanggal Thursday, October 1, 2015