Brand name: Celebrex

Description: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). But it is a newer type than most other NSAIDs. Celecoxib is known as a selective cyclooxygenase-2 (COX-2) inhibitor.

The older NSAIDs include aspirin, ibuprofen, naproxen sodium and diflunisal. These drugs inhibit two enzymes called COX-1 and COX-2. This means that they suppress the normal action of these enzymes in the body. Inhibiting COX-2 is thought to be the way that these drugs relieve pain, reduce fever and lessen swelling and other symptoms of arthritis.

However, older NSAIDs also can cause side effects. These may include ulcers in the stomach and intestines and bleeding. Inhibiting the enzyme COX-1 is thought to cause these side effects.

Celecoxib inhibits COX-2 but not COX-1. Arthritis patients who take it have 50% to 60% fewer stomach and intestinal problems (such as ulcers) than people who take the older NSAIDs.

About 2% of patients who take celecoxib for 6 months to a year have ulcers and bleeding. This rate is 4% to 6% in people who take older NSAIDs for the same amount of time.

Bleeding ulcers can lead to a hospital stay or even death. This is the major reason that rheumatologists (arthritis specialists) and orthopedic surgeons may switch patients to celecoxib.

Dental uses: Celecoxib may be prescribed to treat mild to moderate pain:

• From dental surgery
• From toothache
• In the temporomandibular (jaw) joint

Celecoxib may be preferred over older NSAIDs for some patients. They include people who have long-term pain or osteoarthritis in the jaw joint or face. They may need to take a pain reliever for many weeks or months.

Dosages for dental purposes: The dose of celecoxib for acute pain is 400 milligrams on the first day. Another 200 milligrams may be added on the first day if necessary. Afterward, the dose is 200 milligrams twice a day as needed. For arthritis, the dose is 100 milligrams to 200 milligrams per day.

Concerns and possible side effects: Long-term use (weeks or months) may harm kidney function in some people. This occurs as frequently with celecoxib as with other NSAIDs. Other side effects include:

• Headache
• Diarrhea
• Abdominal pain

The celecoxib label contains "black box" warnings about potential serious side effects. They include the following:

• "NSAIDs are associated with an increased risk of adverse cardiovascular events, including [heart attack], stroke, and new onset or worsening of pre-existing [high blood pressure]."
• "NSAIDs may increase risk of gastrointestinal irritation, ulceration, bleeding, and perforation."

Avoid taking celecoxib if you:

• Are pregnant, especially during the third trimester
• Are allergic to aspirin, other NSAIDs or sulfa drugs — People who are allergic to these drugs also may be allergic to celecoxib. An allergic reaction can be just a mild rash. Or it can lead to a life-threatening closing of the airway and a fall in blood pressure.
• Have asthma and are sensitive to aspirin or NSAIDs — For a small percentage of people with asthma, these drugs may cause life-threatening asthma attacks.
• Have significant kidney or liver disease

People who have had ulcers in the stomach or small intestine should use celecoxib only with extreme caution. If you take celecoxib regularly, avoid drinking alcohol. It can increase the risk of stomach irritation or ulcers. If you take celecoxib or ibuprofen, have your blood pressure tested often.

Celecoxib may interact in a harmful way with other medicines. For example:

• Lithium (Eskalith), a drug for bipolar disorder, can reach toxic levels if taken with celecoxib.
• The combination of celecoxib and warfarin (Coumadin) or other anticoagulants can lead to bleeding.
• Some high blood pressure medicines may actually raise blood pressure when combined with celecoxib. These include beta blockers (such as propranolol, brand name Inderal), ACE inhibitors (such as enalopril, brand name Vasotec) and diuretics (such as hydrochlorothiazide).
• Fluconazole (Diflucan) use may significantly increase blood levels of celecoxib.
• Aspirin use with celecoxib can increase the risk of stomach or intestinal problems.

These interactions can be serious. Therefore, you should tell your dentist about all medicines you are taking. Celecoxib should be prescribed only after your doctor or dentist considers:

• Your medical history
• Use of other medicines
• Any potential drug interactions