CELECOXIB- celecoxib capsule
Proficient Rx LP
WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS
Cardiovascular Thrombotic Events
- Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction, and stroke, which can be fatal. This risk may occur early in the treatment and may increase with duration of use. [ see Warnings and Precautions (5.1) ]
- Celecoxib is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. [ see Contraindications (4) and Warnings and Precautions (5.1)]
Gastrointestinal Bleeding, Ulceration, and Perforation
- NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events. [ see Warnings and Precautions (5.2) ]
1. INDICATIONS AND USAGE
Celecoxib is indicated
For the management of the signs and symptoms of OA [ see Clinical Studies (14.1) ]
1.2 Rheumatoid Arthritis (RA)
For the management of the signs and symptoms of RA [ see Clinical Studies (14.2) ]
1.3 Juvenile Rheumatoid Arthritis (JRA)
For the management of the signs and symptoms of JRA in patients 2 years and older [ see Clinical Studies (14.3) ]
1.4 Ankylosing Spondylitis (AS)
For the management of the signs and symptoms of AS [ see Clinical Studies (14.4) ]
1.5 Acute Pain
For the management of acute pain in adults [ see Clinical Studies (14.5) ]
1.6 Primary Dysmenorrhea
For the management of primary dysmenorrhea [ see Clinical Studies (14.5) ]
2. DOSAGE AND ADMINISTRATION
2.1 General Dosing Instructions
Carefully consider the potential benefits and risks of celecoxib and other treatment options before deciding to use celecoxib. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [ see Warnings and Precautions (5) ].
These doses can be given without regard to timing of meals.
For OA, the dosage is 200 mg per day administered as a single dose or as 100 mg twice daily.
2.3 Rheumatoid Arthritis
For RA, the dosage is 100 mg to 200 mg twice daily.
2.4 Juvenile Rheumatoid Arthritis
For JRA, the dosage for pediatric patients (age 2 years and older) is based on weight. For patients >10 kg to <25 kg the recommended dose is 50 mg twice daily. For patients >25 kg the recommended dose is 100 mg twice daily.
For patients who have difficulty swallowing capsules, the contents of a celecoxib capsule can be added to applesauce. The entire capsule contents are carefully emptied onto a level teaspoon of cool or room temperature applesauce and ingested immediately with water. The sprinkled capsule contents on applesauce are stable for up to 6 hours under refrigerated conditions (2°C to 8°C/ 35°F to 45°F).
2.5 Ankylosing Spondylitis
For AS, the dosage of celecoxib capsules is 200 mg daily in single (once per day) or divided (twice per day) doses. If no effect is observed after 6 weeks, a trial of 400 mg daily may be worthwhile. If no effect is observed after 6 weeks on 400 mg daily, a response is not likely and consideration should be given to alternate treatment options.
2.6 Management of Acute Pain and Treatment of Primary Dysmenorrhea
For management of Acute Pain and Treatment of Primary Dysmenorrhea, the dosage is 400 mg initially, followed by an additional 200 mg dose if needed on the first day. On subsequent days, the recommended dose is 200 mg twice daily as needed.
2.7 Special Populations
In patients with moderate hepatic impairment (Child-Pugh Class B), reduce the dose by 50%. The use of celecoxib in patients with severe hepatic impairment is not recommended [ see Warnings and Precautions (5.3), Use in Specific Populations (8.6), and Clinical Pharmacology (12.3)].
Poor Metabolizers of CYP2C9 Substrates
In adult patients who are known or suspected to be poor CYP2C9 metabolizers based on genotype or previous history/experience with other CYP2C9 substrates (such as warfarin, phenytoin), initiate treatment with half of the lowest recommended dose.
In patients with JRA who are known or suspected to be poor CYP2C9 metabolizers, consider using alternative treatments [ see Use in Specific populations (8.8), and Clinical Pharmacology (12.5)].
3. DOSAGE FORMS AND STRENGTHS
50 mg white to off-white powder filled in size “4” hard gelatin white capsules, with reverse printed white on red band with markings SG on cap and 156 on body.
100 mg white to off-white powder filled in size “4” hard gelatin white capsules, with reverse printed white on blue band with markings SG on cap and 157 on body.
200 mg white to off-white powder filled in size “2” hard gelatin white capsules, with reverse printed white on gold band with markings SG on cap and 158 on body.
400 mg white to off-white powder filled in size “0” hard gelatin white capsules, with reverse printed white on green band with markings SG on cap and 159 on body.
Celecoxib capsules are contraindicated in the following patients:
- Known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to celecoxib, any components of the drug product [ see Warnings and Precautions (5.7, 5.9)].
- History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs, have been reported in such patients [ see Warnings and Precautions (5.7, 5.8) ].
- In the setting of CABG surgery [ see Warnings and Precautions (5.1) ].
- In patients who have demonstrated allergic-type reactions to sulfonamides [ see Warnings and Precautions (5.7) ].
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