COX-2 Inhibitor (NSAID) Pregnancy: Contraindicated in pregnancy and in women who can become pregnant. Animal studies show reproductive toxicity including malformations; the potential for human risk cannot be excluded. May cause uterine inertia and premature closure of the ductus arteriosus during the last trimester, and fetal renal dysfunction with reduced amniotic fluid or oligohydramnios during the second or third trimester. Discontinue if a woman becomes pregnant during treatment. Women taking celecoxib should not breastfeed.

Celecoxib

Brand names: Celebrex

Celecoxib is a COX-2-selective non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation, including in osteoarthritis and rheumatoid arthritis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 200 mg daily

Route: Oral (with or without food)

Frequency: Once daily or in two divided doses (osteoarthritis, ankylosing spondylitis); rheumatoid arthritis: initial 200 mg daily taken in two divided doses. May be increased to 200 mg twice daily if symptom relief is insufficient

Max: 400 mg daily (the maximum recommended daily dose for all indications)

As the cardiovascular risks of celecoxib may increase with dose and duration of exposure, the shortest possible duration and the lowest effective daily dose should be used, and the need for symptomatic relief re-evaluated periodically. Osteoarthritis: usual recommended daily dose 200 mg once daily or in two divided doses; an increased dose of 200 mg twice daily may increase efficacy in some patients. Rheumatoid arthritis: initial 200 mg daily in two divided doses, increased if needed to 200 mg twice daily. Ankylosing spondylitis: 200 mg once daily or in two divided doses; in a few patients 400 mg once daily or in two divided doses may increase efficacy. In the absence of an increase in therapeutic benefit after two weeks, other therapeutic options should be considered. Elderly: 200 mg per day initially as in younger adults, may be increased to 200 mg twice daily; particular caution in the elderly with a body weight below 50 kg. CYP2C9 poor metabolisers: administer with caution and consider reducing the dose to half the lowest recommended dose. Moderate hepatic impairment (serum albumin 25-35 g/L): initiate treatment at half the recommended dose. For patients who have difficulty swallowing capsules, the capsule contents may be sprinkled onto a level teaspoon of cool or room-temperature applesauce, rice gruel, yogurt or mashed banana and ingested immediately with 240 mL of water. Paediatric: the SPC states celecoxib is not indicated for use in children.

Dose adjustments

Renal

Experience in patients with mild or moderate renal impairment is limited - treat with caution. Contraindicated in patients with estimated creatinine clearance below 30 mL/min.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. ( 2.1 ) OA: 200 mg once daily or 100 mg twice daily. ( 2.2 , 14.1 ) RA: 100 mg to 200 mg twice daily. ( 2.3 , 14.2 ) JRA: 50 mg twice daily in patients 10 kg to 25 kg. 100 mg twice daily in patients more than 25 kg. ( 2.4 , 14.3 ) AS: 200 mg once daily single dose or 100 mg twice daily. If no effect is observed after 6 weeks, a trial of 400 mg (single or divided doses) may be of benefit. ( 2.5 , 14.4 ) AP and PD: 400 mg initially, followed by 200 mg dose if needed on first day. On subsequent days, 200 mg twice daily as needed. ( 2.6 , 14.5 ) Hepatic Impairment: Reduce daily dose by 50% …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-08-24. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients; known hypersensitivity to sulfonamides
Active peptic ulceration or gastrointestinal bleeding
Patients who have experienced asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic-type reactions after taking aspirin or other NSAIDs including COX-2 inhibitors
Pregnancy and women of childbearing potential unless using an effective method of contraception; breast-feeding
Severe hepatic dysfunction (serum albumin below 25 g/L or Child-Pugh score 10 or more)
Estimated creatinine clearance below 30 mL/min
Inflammatory bowel disease
Congestive heart failure (NYHA II-IV)
Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease

Side effects

Sinusitis, upper respiratory tract infection, pharyngitis, urinary tract infection
Dizziness, hypertonia, headache; insomnia; anxiety, depression, fatigue
Anaemia; leukopenia, thrombocytopenia; pancytopenia
Hypersensitivity; anaphylactic reaction and anaphylactic shock
Hyperkalaemia; vision blurred, conjunctivitis; tinnitus, hypoacusis; cerebral infarction

Interactions

The concomitant use of celecoxib and a non-aspirin NSAID should be avoided
Concomitant acetylsalicylic acid, even at low doses, further increases the risk of gastrointestinal ulceration and other gastrointestinal complications
Increased risk of gastrointestinal complications with concomitant antiplatelet drugs or glucocorticoids, in the elderly, in patients using alcohol and in those with prior gastrointestinal disease
COX-2 selective inhibitors are not a substitute for acetylsalicylic acid for cardiovascular thrombo-embolic prophylaxis - antiplatelet therapy should not be discontinued
(US labelling) Monitor for signs of bleeding when used with anticoagulants such as warfarin, antiplatelet drugs, SSRIs and SNRIs

Clinical monograph

How it works

It selectively inhibits cyclo-oxygenase-2, reducing prostaglandin-mediated inflammation with relatively less effect on COX-1 (and so less gastrointestinal injury than non-selective NSAIDs).

Prescribing in practice

Lower gastrointestinal risk than non-selective NSAIDs does not remove cardiovascular and renal risk — avoid in established cardiovascular disease and significant renal impairment, and use the lowest effective dose for the shortest time.
It does not provide the antiplatelet protection of aspirin.
It is a sulfonamide — use caution in sulfonamide allergy.

Monitoring

With longer use or in at-risk patients monitor renal function and blood pressure.

Counselling the patient

Report indigestion, black stools or reduced urine output.
Avoid combining it with other NSAIDs.

Evidence & guidelines

A COX-2-selective NSAID with lower gastrointestinal risk, balanced against cardiovascular risk and used selectively (NICE osteoarthritis/RA guidance).

Reference: CLASS trial; EMA NSAID Safety Review; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways