COX-2 inhibitors are the newest type of non-steroidal anti-inflammatory drugs (NSAIDs) to be approved by the U.S. Food and Drug Administration (FDA). Like the older (also called traditional) NSAIDs (such as ibuprofen and naproxen), COX-2 inhibitors are effective at relieving pain and inflammation associated with arthritis.

COX-2 inhibitors work by blocking only one type of an enzyme known as cyclooxygenase-2 (COX-2). The traditional NSAIDs block both types of cyclooxygenase enzymes (COX-1 and COX-2). COX-1 is involved in many body functions including protection of the gastrointestinal (GI) tract and some kidney processes. COX-2 is primarily involved in inflammation. Therefore, COX-2 inhibitors generally relieve pain and inflammation as effectively as traditional NSAIDs but may cause fewer GI side effects.

Drugs in this Class
Celecoxib Capsules (Celebrex)

Summarizing the Evidence

• Celebrex was approved in 1998. It is the only COX-2 inhibitor currently available in the U.S. Clinical studies have shown that Celebrex is effective in reducing inflammation and relieving pain from arthritis.
• Many of the trials comparing COX-2 inhibitors for the treatment of arthritis were conducted with the first approved drug in the class, Vioxx (rofecoxib), or with a second-generation COX-2 inhibitor, Bextra (valdecoxib). More than three years after its approval, Vioxx was withdrawn from the market due to dangerous side effects, including heart attacks and strokes, which possibly were associated with its use. In April 2005, U.S. sales of Bextra, which was FDA-approved in November 2001, were also suspended.
• One small study compared Celebrex, Vioxx, and a placebo (inactive sugar pill) in 182 adult patients with osteoarthritis (OA) of the knee. The study found that both drugs were similarly effective in relieving OA pain.
• Two other studies of Celebrex, Vioxx, and placebo involved over 800 patients with OA of the knee. During the 6 weeks that the identical studies lasted, both Celebrex 200 mg and Vioxx 12.5 mg were more effective than placebo, showing approximately equal relief of OA pain.
• Another study compared Celebrex, Vioxx, and acetaminophen (Tylenol) in 400 adults with OA. The study showed slightly better results with Vioxx compared to Celebrex and acetaminophen for relieving pain and morning stiffness. However, this study was funded and carried out in part by the pharmaceutical company that makes Vioxx, and the results may have been influenced by that funding source.
• A larger study (1578 OA patients) comparing Celebrex, two doses of Vioxx, and acetaminophen showed similar results. This study found that 200 mg of Celebrex, 12.5 mg of Vioxx, and 25 mg of Vioxx per day all relieved OA pain more effectively than 4,000 mg of acetaminophen per day. Relief from the higher dose of Vioxx was somewhat faster and slightly greater than with Celebrex or with the lower dose of Vioxx.
• Two related 6-week studies also measured the ability of Celebrex, Vioxx, and placebo to alleviate pain at night for patients with OA of the knees, hips, or both. Although one study found that patients taking Vioxx had slightly less pain than those taking Celebrex, the second study found no difference between Vioxx and Celebrex.
• Although not currently available, two other selective COX-2 inhibitors (lumiracoxib and etoricoxib) are being studied for their potential use in the future.

Dosing and Administration

Celebrex can be taken either once daily or twice daily for treating arthritis.

Cautions

Taking a COX-2 inhibitor may increase the risk of having an adverse cardiovascular event such as a heart attack or a stroke. Vioxx was associated with more reported cases of such serious adverse events than other COX-2 inhibitors. Many of the adverse events happened within a few months of beginning treatment with the COX-2 inhibitor. Additionally, the risk appears to increase as the dose of COX-2 inhibitor increases. More studies are needed to determine whether all COX-2 inhibitors (including Celebrex) increase cardiovascular risk.

Rarely, taking Celebrex has been associated with an allergic reaction (usually a skin rash) for patients who are also allergic to salicylate drugs, such as aspirin.

Generic Availability

Currently, Celebrex is not available generically. However, many traditional NSAIDs are available not only as generics, but also as non-prescription (also called over-the-counter or OTC) products. For many arthritis patients, a generic traditional NSAID may be an effective, more affordable treatment option than Celebrex.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

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Last Updated: August 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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