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- this is a non-steroidal anti-inflammatory agent which is a specific inhibitor
of enzyme cyclo-oxygenase 2. Celecoxib is licensed for the symptom relief in rheumatoid
arthritis and osteoarthritis (1)
- the sparing of the COX-1
isoenzyme should, in theory, result in reduced gastrointestinal side-effects and
improves tolerability. However the evidence that COX-2 selectivity reduces the
risk of serious upper gastrointestinal side effects, particularly gastrointestinal
bleeding and ulcer perforation, points towards some reduction of risk but the
advantage over conventional non-steroidal anti-inflammatory drugs appears small
- there is evidence that celecoxib has an anti-inflammatory
effect as potent as diclofenac in the treatment of rheumatoid arthritis (2)
for Prescribers in light of concerns about cardiovascular safety of COX-2 inhibitors
- patients treated with any COX-2 inhibitor who have established
ischaemic heart disease or cerebrovascular disease should be switched to alternative
(non-COX-2 selective) treatments as soon as is convenient.
all patients, alternative treatments should be considered in light of an individual
assessment of risks and benefits of COX-2 inhibitors, in particular cardiovascular,
gastrointestinal and other risk factors.
- prescribers are reminded
that for all NSAIDs (including COX-2 inhibitors), the lowest effective dose should
be used, for the shortest duration necessary.
- for patients switched
to chronic non-selective NSAIDs, consideration should be given to the possible
need for gastro-protective treatments.
and Therapeutics Bulletin (2000); 38 (11):81-86.
- Emery P, Zeidler H,
Kveim TK et al (1999). Celecoxib versus diclofenac in long-term management of
rheumatoid arthritis: randomised double-blind comparison. Lancet; 354:2106-11.
- Medicines and Healthcare products Regulatory Agency (December 2004).
Advice on the use of celecoxib and other selective cox-2 inhibitors in light of
concerns about cardiovascular safety.
Last reviewed 01/2018