Celecoxib

CLASS

  • COX-2 inhibitor

MECHANISM OF ACTION

  • blocks access of arachidonic acid to active site at apex of a hydrophobic channel on COX-2

PHARMACEUTICS

  • tablets

DOSE

  • PO 100 to 400mg BD

INDICATIONS

  • inflammatory pain

ADVERSE EFFECTS

  • hypertension
  • renal failure
  • dyspepsia

PHARMACOKINETICS

  • Absorption –
  • Distribution – 97% protein bound, Vd = 6L/kg
  • Metabolism – hepatic, 3 active metabolites
  • Elimination – t1/2 = 10 hrs

EVIDENCE

Summarized from ANZCA Evidence-based guide to Pain Management

  • COX 2 inhibitors and NSAIDs have similar effects on renal function
  • COX 2 inhibitors don’t produce bronchospasm in aspirin induced respiratory disease
  • COX 2 inhibitors -> no effect of platelet function
  • COX 2 inhibitors -> same peptic ulcer rate as placebo (decreased compared to NSAIDs)
  • COX 2 inhibitors -> don’t give in patients with lots of vascular risk factors
  • parocoxib & valdecoxib DO NOT increase risk of cardiovascular disease after non-cardiac surgery
  • COX 2 inhibitors and NSAIDs are associated with the same rates of adverse CVS effects (MI)
  • short-term use of COX 2 inhibitors do not affect bone healing after spinal fusion
  • VIGOR study looked @ rofecoxib vs naproxen and found significant increase in MI in rofecoxib group (patients on low-dose aspirin were excluded)

CCC Pharmacology Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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