Makindo Medical Notes

💊 Celecoxib is a highly selective COX-2 inhibitor. ⚠️ It theoretically reduces gastric side effects (e.g. ulceration) compared with traditional NSAIDs, but may increase cardiovascular risk (MI, stroke) — evidence still under investigation. Always check the BNF link here before prescribing.

📖 About

• 🎯 Highly selective COX-2 inhibitor.
• ⬇️ Lower risk of peptic ulceration than NSAIDs (main selling point).
• ⚠️ No platelet effect and ❌ no cardioprotection (unlike aspirin).
• ⬆️ Evidence of prothrombotic tendency (cardiovascular caution).

🧪 Properties

• Contains a sulphonamide group → may cause hypersensitivity rash.
• Does not inhibit platelet aggregation.

⚙️ Action

• COX-1 → “housekeeping” enzyme: gastric mucosal protection, renal blood flow, thromboxane production.
• COX-2 → induced during inflammation: prostaglandins mediating pain, fever, swelling.
• Celecoxib inhibits COX-2 activity ~10–20× more than COX-1.

💉 Indications / Dose

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis.
• Dysmenorrhoea (menstrual pain).
• Familial adenomatous polyposis → reduces polyp burden (specialist use).
• Dose: 100–200 mg PO twice daily. ⚠️ Always use the lowest effective dose for the shortest duration.

🔄 Interactions

• 🩸 Aspirin offsets gastroprotection.
• ⬆️ Methotrexate toxicity risk.
• ⚠️ Risk of renal impairment if combined with ACE inhibitors, ARBs, ciclosporin, or diuretics.

⚠️ Cautions

• ⬆️ May cause a prothrombotic state → use with caution in IHD, cerebrovascular disease, peripheral vascular disease.
• 💧 Risk of renal toxicity and fluid retention → may worsen cardiac failure or hypertension.
• Monitor renal function and blood pressure if used long term.

⛔ Contraindications

• Severe renal or hepatic impairment.
• Active GI ulceration or bleeding.
• Established cardiovascular disease (MI, stroke, severe HF).
• Hypersensitivity (esp. to sulphonamides).

💥 Side Effects

• ⚠️ Prothrombotic risk: MI, stroke, angina.
• 💧 Oedema, hypertension, fluid retention.
• 🤢 GI upset: diarrhoea, dyspepsia, abdominal pain (though less ulcer risk than NSAIDs).
• 🌡️ Rash, cough, headache.

📚 References

• Celecoxib in BNF