•  Arthritis

Manufacturer : G.D. Searle, a division of Monsanto (no generics) Looks like : white capsules with a blue or gold band Available doses : 100 milligrams (blue band), 200 mg (gold band)

Celebrex is a medicine approved for treating the inflammation of arthritis. It's a specialized type of nonsteroidal anti-inflammatory drug (NSAID). This class of medications includes aspirin and ibuprofen, but Celebrex works in a more targeted way than most anti-inflammatory medications. Since its introduction in February 1999, it has become one of the best-selling drugs on the market.

Celebrex is approved for people with rheumatoid arthritis (in which the immune system attacks tissues in and around joints) or osteoarthritis (in which the body's repair system for joint damage is thought to be faulty). It irritates the stomach's lining less than other anti-inflammatory drugs, so it can help people with arthritis who have indigestion and other symptoms from their current medication. Also, it doesn't prevent platelet clumping the way aspirin does, so it may be useful for people who need to avoid clot-busting drugs.

You can either take a full day's worth at once or in two separate doses, depending on what your doctor prescribes. Although you can take it anytime, mealtimes may be best because Celebrex dissolves more thoroughly in fat than in water. Its concentration in the bloodstream peaks about three hours after you've taken it, so that's when you'll feel the effect most. If you eat a very fatty meal before taking it, the drug's absorption is slower but more of the dose gets into your bloodstream. If you take antacids containing aluminum or magnesium with your meals, they will limit your absorption of the drug and you may not feel the full effect.

Arthritis is marked by damage to cartilage, the tough, slippery material that cushions joints. As the condition worsens, other types of tissues in and around joints also wear down, sometimes leading to a painful grinding of bone against bone. The body's response to this kind of injury is inflammation; visible signs of inflammation include fever, swelling, and pain.

Anti-inflammatory medications such as aspirin interrupt the body's natural inflammation response by blocking an enzyme called COX. This enzyme controls the production of prostaglandins, chemicals with a range of effects in the body. Recently scientists discovered there are two kinds of COX, and each does something a little different. COX-1 regulates prostaglandins that protect the mucous lining of the stomach (so that the acids you use to digest food don't break down your stomach as well). COX-2 produces the prostaglandins that cause the inflammation associated with arthritis. Most NSAIDs block both types of COX, which is why aspirin is harsh on the stomach.

Celebrex is the first of a new class of drugs called COX-2 inhibitors, often promoted as "super-aspirins." By selectively blocking only COX-2, they are somewhat easier on the stomach than most anti-inflammatory medications.

There is growing concern that COX-2 inhibitors can cause heart problems and gastrointestinal bleeding. In June 2005, the U.S. Food and Drug Administration called for stronger warnings drug labels to alert users to the potential life-threatening risks associated with these types of drugs.

In September 2004, the manufacturer of Vioxx, a popular COX-2 inhibitor, voluntarily removed the drug from the market after reports that it caused increased risk of stroke and heart attack in some people. A study by researchers at Vanderbilt University found that people on higher doses (50 mg) of Vioxx, were almost twice as likely to develop heart disease or suffer heart attacks when compared to those taking other NSAIDs or 25 mg doses of Vioxx. According to the FDA, further studies bore out the evidence of increased cardiovascular risks.

In December 2004, the manufacturer of Celebrex halted studies of the drug's effectiveness against cancer when participants in one of the studies experienced an increased risk of heart problems. Participants in the cancer studies were given 400 to 800 milligrams of Celebrex, while arthritis patients are usually prescribed anywhere from 100 to 400 milligrams. Another COX-2 inhibitor, Bextra, was removed from the market by the manufacturer due to concerns about serious skin reactions in some patients.

The Arthritis Foundation supports the strengthened warnings on Celebrex packaging but also believes that COX-2 inhibitors are valuable drugs for people with arthritis, and each person should work with his or her doctor to make the best decision about whether or not to use the drug. In fact, the Arthritis Foundation would like to see the FDA and Merck reconsider putting Vioxx and Bextra back on the market.

Meanwhile in London, the European Medicines Agency is reviewing the safety of all drugs of this class.

To be on the safe side, scientists at the Food and Drug Administration are assuming that Celebrex can have the full range of side effects that other NSAIDs have, including indigestion and headaches. Compared with other NSAIDs, though, it causes abdominal pain in only half as many people (4 percent versus 9 percent).

Based on how COX-2 works in the body, Celebrex and other COX-2 inhibitors may have additional side effects. Since COX-2 is involved in fighting ulcers, Celebrex could cause ulcers or prevent them from healing. COX-2 is also present in the kidneys, so the drug could cause fluid retention or worsen hypertension. While none of these effects has been proven, doctors are advising patients on Celebrex to keep an eye out for symptoms related to ulcers and kidney problems, including blood in stools and general swelling. As with any medication, Celebrex could trigger an allergic reaction.

You shouldn't take Celebrex if you have asthma or have had other allergic reactions to aspirin or other NSAIDs. You should also skip it if you're allergic to sulfa drugs. If you're pregnant, steer clear of Celebrex unless your physician believes that the benefit to you outweighs the possible risk to your baby. In studies on pregnant rats, a dose equivalent to double the daily human dose caused certain birth defects, and higher doses increased the chances of miscarriage.

It's possible that Celebrex interacts with certain drugs, including diuretics, corticosteroids, and blood pressure medicines. Ask your doctor or pharmacist to see if there's a chance of an interaction with your current medications. Also, double-check with a pharmacist before taking over-the-counter pain and fever relievers such as aspirin and ibuprofen because they have many of the same effects as Celebrex.

Talk to your doctor to find out if Celebrex has advantages over your current medication, whether that's a nonsteroidal drug or a steroid medication (which is more powerful).

Before you leave the pharmacy, it's a good idea to verify that you actually received Celebrex and not something else. The nonprofit Institute for Safe Medication Practices is calling on Searle to rename Celebrex because it's easy to confuse it with two similar-sounding drugs: Celexa (citalopram hydrobromide), an antidepressant from Forest Laboratories and Cerebyx (fosphenytoin), a drug for seizure disorders made by Parke-Davis. In the first two weeks after it became available, there were more than 40 documented cases of errors in filling prescriptions for Celebrex.

Also keep in mind that exercise, proper posture, and physical therapy (including heat treatment and massage) are important in controlling arthritis; medications are just one component in treating the condition.

References

First published July 14, 1999
Last updated November 12, 2007
Copyright © 1999 Consumer Health Interactive

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