Celebrex side effects and how to avoid them

Celebrex side effects | Serious side effects | Allergic reactions | Heart attack | How long do side effects last? | Warnings | Interactions | How to avoid side effects | Resources

Celebrex is a brand-name prescription drug used to reduce pain and swelling caused by osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and other indications that cause acute pain or painful episodes. Celecoxib, the active ingredient in Celebrex, is a nonsteroidal anti-inflammatory drug (NSAID). 

NSAIDs are a family of drugs that includes over-the-counter (OTC) aspirin, ibuprofen, and naproxen. Like these better-known pain relievers, celecoxib reduces pain and swelling by shutting down the body’s ability to produce prostaglandins, a substance critical to the body’s inflammatory process. NSAIDs do this by blocking cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), enzymes that produce prostaglandins. COX-1 activates platelets and protects the stomach lining, so OTC NSAIDs commonly increase the risk of bleeding and stomach pain. However, Celecoxib is specifically a COX-2 inhibitor. This means that it can do its job of reducing pain and swelling without as many gastrointestinal or bleeding side effects. 

As a prescription drug, Celebrex can cause more serious side effects than OTC NSAIDs. Before taking Celebrex, people should familiarize themselves with potential side effects, drug interactions, and pre-existing medical conditions that may cause serious problems before taking this drug.

Related: What is Celebrex?

Common side effects of Celebrex

The most common side effects of Celebrex include:

• Headache
• Diarrhea
• Fever
• Stomach upset
• Infection
• Abdominal pain
• Nausea
• Cough
• Joint pain
• Liver problems
• Vomiting
• Sore throat 
• Stuffy sinuses
• Heartburn
• Swelling of the extremities (peripheral edema)
• Back pain
• Trouble breathing
• Insomnia
• Flatulence
• Rash
• Dizziness
• Stuffy or runny nose
• Constipation
• Delayed ovulation

Serious side effects of Celebrex

The most serious side effects of Celebrex are:

• High blood pressure
• Peptic ulcer and stomach bleeding
• Stroke
• Heart attack
• High potassium
• Gastrointestinal obstruction, bleeding, or perforation
• Kidney problems including kidney failure
• Heart failure
• Blood disorders such as low white or red blood cell counts (anemia)
• Swelling of the linings of the brain (aseptic meningitis)
• Severe allergic reactions

Celebrex allergy

People have had serious allergic reactions including worsening of asthma, airway closure, anaphylaxis, and severe skin reactions when taking Celebrex. Some of these reactions have been fatal. The exact incidence is undetermined, but healthcare professionals consider them to be rare. In 14 clinical studies, the incidence of allergic reactions between people given celecoxib and people taking a placebo pill was the same (2%), so it’s hard to determine how likely these allergic reactions are.

However, celecoxib has a particular structure in its molecule called sulfonamide. About 3% to 6% of people are allergic to antibiotics containing sulfonamide in their molecules, known as “sulfa drugs.” In the same clinical trials, people with sulfa drug allergies were more likely to have allergic-type reactions to celecoxib. However, scientists are unsure if that means that people with sulfa allergies are also allergic to celecoxib.

Because of the catastrophic nature of hypersensitivity reactions, the FDA has chosen a “better safe than sorry” approach to prescribing celecoxib. Celebrex should never be prescribed to people with a history of allergic reactions to NSAIDs, aspirin or aspirin-like drugs (salicylates), or sulfonamide drugs as well as people with aspirin-sensitive asthma. People taking Celebrex should know the warning signs of an allergic reaction. Immediately stop taking Celebrex and talk to a healthcare professional if any symptoms of an allergic reaction are noticed. 

Celebrex and heart attack

Although there was a rumor that Celebrex was taken off the market by the FDA, it is actually the only FDA-approved COX-2 inhibitor on the market. The FDA removed a similar COX-2 inhibitor from the market called Bextra (valdecoxib) and Merck voluntarily withdrew its selective COX-2 inhibitor, Vioxx (rofecoxib). The FDA requires all prescription NSAIDs to include a black box warning about the increased risk of heart attack and adverse cardiovascular events when taking NSAIDs.

All prescription NSAIDs increase the risk for blood clots forming in the heart or blood vessels around the heart, potentially leading to a heart attack or stroke. The risk is greatest in people who have recently experienced a heart attack. It is not clear if Celebrex can increase these problems more than other NSAIDs. Unfortunately, the available evidence is insufficient to determine if one prescription NSAID is more hazardous than another in this regard. 

How long do side effects last?

Most common side effects of Celebrex go away when Celebrex is discontinued. However, with a half-life of 11 hours, Celebrex stays in the body longer than other NSAIDs. It could take one or two days for common side effects like headache, stomach upset, diarrhea, and fever to clear up.

Serious side effects such as peptic ulcers, gastrointestinal bleeding, and severe allergic reactions may take days or weeks to improve, even with medical treatment. Extremely rare but catastrophic side effects such as heart attack, stroke, or aseptic meningitis could have lifelong complications.

Celebrex contraindications & warnings

Abuse and dependence

The U.S. Food and Drug Administration (FDA) does not consider celecoxib to be a drug with the potential for abuse or physical dependence.

Overdose

An overdose of Celebrex will require immediate medical help. Taking more Celebrex than prescribed increases the risk for side effects. An excessive overdose may cause severe gastrointestinal bleeding, high blood pressure, kidney failure, respiratory depression, or death. If an overdose is suspected, look for symptoms such as drowsiness, lethargy, stomach pain, nausea, and vomiting. 

Restrictions

Celebrex has some severe side effects that may make the drug too hazardous to take. Some of these side effects are listed by the FDA in a black box warning on the drug information sheet. 

As a result, there are several pre-existing medical conditions that are contraindications for Celebrex:

• Allergic reactions to celecoxib or any of the inactive ingredients in Celebrex
• Sulfonamide drug allergies
• Any history of allergic reactions to any other type of NSAID
• Salicylate allergies
• Aspirin-sensitive asthma
• Severe kidney disease
• Gastrointestinal bleeding
• Coronary artery bypass graft (CABG) surgery

People with other pre-existing conditions may be given Celebrex, but they’re at an increased risk for severe side effects. Some may require a dose reduction, but most will require close monitoring for problems.

• Liver problems: Celecoxib is broken down by the liver. People with moderate hepatic impairment should take half of a regular dose. People with severe liver disease should avoid Celebrex if possible.
• Poor metabolizers: Some people are born with a reduced ability to break down celecoxib in the liver because they are “poor CYP2C9 metabolizers. CYP2C9 is the liver enzyme that breaks down celecoxib. This population should be given half the regular dose.
• Gastrointestinal problems: Celebrex has been associated with serious GI problems such as swelling, bleeding, ulcers, obstruction, and perforation. These issues are more likely to happen in people who already have a history of gastrointestinal bleeding. Gastrointestinal bleeding is also more of a risk in people who have bleeding disorders, drink alcohol excessively, or smoke.
• Kidney problems: All NSAIDs can harm the kidneys, so Celebrex treatment will require extra monitoring when given to people with mild to moderate kidney dysfunction. 
• Dehydration: Celebrex is also more likely to cause kidney problems in people who are dehydrated.
• Cardiovascular disease: NSAID use is associated with an increased risk of heart attack, so Celebrex is used only with extra monitoring in people with cardiovascular disease or risk factors for cardiovascular disease such as high blood pressure or fluid retention. 
• Congestive heart failure: NSAIDs like Celebrex can worsen heart failure and increase the risk of heart attack, hospitalization, or death in heart failure patients. Healthcare providers should avoid using Celebrex in people with heart failure.
• Risk factors for bleeding: Unlike other prescription NSAIDs, celecoxib only has a minor effect on bleeding. However, people with risk factors for bleeding or bleeding disorders will require more careful monitoring.
• Hypertension: Celebrex can worsen high blood pressure, particularly in people whose blood pressure is controlled by blood pressure medications. 

Pregnancy and nursing

Because of the risk to the fetus, women who are pregnant will not be given Celebrex or any other NSAID beyond 30 weeks. Though not prohibited, healthcare providers generally avoid prescribing Celebrex and other NSAIDs between 20 and 29 weeks of pregnancy. NSAIDs can cause problems with a fetus’ cardiovascular development and kidney function as well as reduce the fluid in the amniotic sac, a complication that could be fatal to an unborn baby. 

Women who are breastfeeding can take Celebrex. Very small amounts of celecoxib are secreted into the breast milk. There are no reports of adverse reactions in nursing babies.

Children

Celebrex is FDA-approved as safe and effective to treat juvenile rheumatoid arthritis in children as young as 2 years of age. Children who are poor metabolizers, however, are put on alternative medicine.

Seniors

People older than 65 years are at a higher risk of serious side effects when taking Celebrex. They will typically be started at the lowest possible dose and be monitored more carefully for problems.

Celebrex interactions

Prescription NSAIDs such as Celebrex have some potentially hazardous drug interactions. Doctors, pharmacists, and other healthcare professionals are familiar with these interactions, so they may avoid certain drugs, adjust doses, or watch patients closely for adverse reactions when prescribing Celebrex. Medications that interact with Celebrex include:

• Drugs that affect bleeding: Anticoagulants (blood thinners such as warfarin), aspirin, SSRIs, and SNRIs may increase bleeding risk when taken with Celebrex.
• Drugs that reduce blood pressure: Since Celebrex increases blood pressure, it may counteract the effects of angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), and thiazide diuretics. 
• Drugs that are metabolized by the liver: Other medications that are metabolized through the liver, specifically the CYP2C9 pathway, may increase or decrease the rate of elimination for Celebrex.
• NSAIDs: Taking multiple NSAIDs at the same time will increase side effects. Ketorolac, a prescription NSAID, is never prescribed with celecoxib.
• Drugs that damage the kidneys: Aminoglycoside antibiotics, platinum-based cancer drugs, lithium, methotrexate, and many other medications may increase the risk of kidney damage from NSAIDs.
• Drugs that increase the risk of gastrointestinal bleeding: Gastrointestinal bleeding is more likely when Celebrex is taken with corticosteroids (such as prednisone), certain types of osteoporosis drugs, and some anticancer drugs. 

How to avoid Celebrex side effects

Celebrex may have a more worrisome reputation than it deserves, but it is a good idea to be aware of some side effects. Here are a few tips that can help fend off possible problems.

1. Take Celebrex as directed

Take Celebrex as prescribed. Don’t increase or decrease the dose. If a dose is missed, don’t take the dose if it’s almost time for the next dose and do not take a double dose to compensate. 

2. Make sure the healthcare provider has a complete medical history

Pre-existing conditions are often the main cause of drug side effects. Make sure the prescriber has a complete medical history or all medical conditions, particularly:

• Heart problems including heart disease, heart failure, or heart attack
• Liver problems
• Kidney problems
• Asthma
• Ulcers or gastrointestinal bleeding
• Fluid retention
• Allergies to NSAIDs
• Pregnancy or plans to become pregnant
• Breastfeeding or plans to breastfeed

Also, tell the prescribing healthcare provider about all the drugs and supplements being taken. Many side effects are due to drug interactions.

3. Avoid taking other NSAIDs

Popular OTC pain relievers like aspirin and ibuprofen are NSAIDs like Celebrex. They can cause similar side effects and add to Celebrex’s side effects. Other NSAIDs should be avoided when taking Celebrex. Talk to a healthcare provider about alternative drugs. 

4. Avoid taking Celebrex over the long term

Side effects, particularly serious side effects, are more likely when Celebrex is taken for a long time. The optimal treatment is to take the lowest possible dose for the shortest time possible. If Celebrex is being prescribed for a chronic condition, talk to the healthcare provider about alternatives to long-term NSAID treatment.

5. Watch for signs of allergic reactions

Some people may have serious hypersensitivity reactions to Celebrex, so immediately contact a healthcare provider if even minor signs of an allergic reaction are noticed such as:

• Hives
• Skin rash
• Blisters or peeling skin
• Skin pain
• Burning eyes
• Skin discoloration
• Fever
• Trouble breathing
• Swelling of the face, mouth, or throat

6. Know when to get help

Celecoxib can also cause severe side effects such as heart attack, stroke, heart failure, gastrointestinal bleeding, and liver problems. Some people are more at risk than others. Stop taking Celebrex and get medical attention at any sign of a potentially serious problem such as:

• Chest pain
• Shortness of breath
• Weakness
• Slurred speech
• Weakness on one side of the body
• Unexplained weight gain
• Swelling
• Abdominal pain
• Bloody, black, or tarry stools
• Blood or blood clots (“coffee grounds”) in the vomit
• Diarrhea
• Yellowing of the eyes or skin
• Flu-like symptoms
• Dark urine
• Tiredness
• Low energy