Celecoxib

celecoxib (sell ah cocks' ib) Celebrex Pregnancy Category C Pregnancy Category D (third trimester) Drug classes

NSAID Analgesic (nonopioid) Specific COX-2 enzyme blocker Therapeutic actions

Analgesic and anti-inflammatory activities related to inhibition of the COX-2 enzyme, which is activated in inflammation to cause the signs and symptoms associated with inflammation; does not affect the COX-1 enzyme, which protects the lining of the GI tract and has blood clotting and renal functions. Indications

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Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis Reduction of the number of colorectal polyps in familial adenomatous polyposis (FAP) Management of acute pain Treatment of primary dysmenorrhea

Contraindications and cautions

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Contraindicated with allergies to sulfonamides, celecoxib, NSAIDs, or aspirin; significant renal impairment; pregnancy; lactation. Use cautiously with impaired hearing, hepatic and cardiovascular conditions.

Available forms

Capsules—100, 200 mg Dosages ADULTS

Initially, 100 mg PO bid; may increase to 200 mg/day PO bid as needed. • Acute pain, dysmenorrhea: 400 mg, then 200 mg PO bid. • FAP: 400 mg PO bid. PEDIATRIC PATIENTS

Safety and efficacy have not been established. PATIENTS WITH HEPATIC IMPAIRMENT

Reduce dosage by 50%. Pharmacokinetics Route Oral

Onset Slow

Peak 3 hr

Metabolism: Hepatic; T1/2: 11 hours Distribution: Crosses placenta; may enter breast milk Excretion: Urine and bile Adverse effects

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CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthamologic effects Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis GI: Nausea, abdominal pain, dyspepsia, flatulence, GI bleed Hematologic: Neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased hemoglobin or hematocrit, bone marrow depression, menorrhagia Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock

Interactions

Drug-drug • Increased risk of bleeding if taken concurrently with warfarin. Monitor patient closely and reduce warfarin dose as appropriate Nursing considerations CLINICAL ALERT!

Name confusion has occurred between Celebrex (celecoxib), Celexa (citalopram), Xanax (alprazolam), and Cerebyx (fosphenytoin); use caution. Assessment

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History: Renal impairment, impaired hearing, allergies, hepatic and CV conditions, lactation Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC, renal and liver function tests; serum electrolytes

Interventions

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Administer drug with food or after meals if GI upset occurs. Establish safety measures if CNS, visual disturbances occur. Arrange for periodic ophthalmologic examination during long-term therapy. If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy. Provide further comfort measures to reduce pain (eg positioning, environmental control), and to reduce inflammation (eg warmth, positioning, rest).

Teaching points

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Take drug with food or meals if GI upset occurs. Take only the prescribed dosage.

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These side effects may occur: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while using this drug). Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision.

Adverse effects in Italic are most common; those in Bold are life-threatening.