Brand name: Celebrex

Description: Currently the largest-selling prescription drug in the United States, celecoxib was the first FDA-approved nonsteroidal anti-inflammatory drug (NSAID) that is marketed as a selective cyclooxygenase—2 (COX-2) inhibitor.

Older NSAIDs like aspirin, ibuprofen, naproxen sodium and diflunisal inhibit both COX-1 and COX-2. An inhibition of COX-2 is thought to be responsible for the ability of these drugs to relieve pain, reduce fever and lessen swelling and other symptoms of arthritis.

However, the inhibition of COX-1 is thought to be responsible for the tendency of these drugs to cause stomach and intestinal ulcers and bleeding. As a selective COX-2 inhibitor, celecoxib does not inhibit COX-1, which has resulted in about a 50-percent reduction in ulcer occurrence in arthritis patients taking it. The drug was associated with ulcers and bleeding in 2 percent of patients taking it for six months to a year, compared to a 4-percent incidence in patients taking more traditional NSAIDs, such as ibuprofen or naproxen sodium, for the same amount of time.

Bleeding ulcers can lead to hospitalization and even death. This is the major reason why many rheumatologists (arthritis specialists) and orthopedic surgeons have switched their patients to a COX-2 inhibitor.

Dental Uses: In dentistry, this lower incidence of stomach and intestinal ulcers with the long-term use of selective COX-2 inhibitors should be beneficial for patients with chronic pain of the temporomandibular joint and other types of chronic facial pain who would need to be on the drug for many weeks or months.

Currently, celecoxib is not approved for the short-term treatment of acute pain such as pain after dental surgery or toothache pain. In studies of pain after oral surgery, celecoxib 200 milligrams was an inferior pain reliever when compared to ibuprofen 400 milligrams.

Dosages for Dental Purposes: The dose of celecoxib for this use would be 100 milligrams to 200 milligrams twice each day (the same dose as for arthritis sufferers).

Concerns and Possible Side Effects: With chronic use (weeks or months), impairment of kidney function still occurs as frequently as with other NSAIDs. Abdominal pain (without ulcers) also can occur.

Patients allergic to aspirin or other NSAIDs (ibuprofen, naproxen sodium, diflunisal and many others) should not take celecoxib. In addition, patients allergic to sulfonamide drugs may also be allergic to celecoxib and should thus not take it.

Allergic reactions can range from a mild rash to life-threatening closure of the airway and a fall in blood pressure.In addition, about 5 percent to 10 percent of patients with asthma cannot tolerate aspirin, related NSAIDs or COX-2 inhibitors (including celecoxib); these drugs precipitate life-threatening asthma attacks in these so-called aspirin- or NSAID-sensitive asthmatics.

Celecoxib must be used with extreme caution in patients with a history of ulcers of the stomach or the small intestine. Patients should avoid alcohol consumption during celecoxib therapy because alcohol increases the risk of stomach ulcers and bleeding.

Other drugs with which celecoxib may adversely interact include:

• The manic-depression drug lithium (Eskalith), which when combined can lead to lithium toxicity
• Warfarin (Coumadin) and other anticoagulants, which can lead to bleeding Oral drugs for diabetes (ie, Diabinase and Orinase), which can lead to low blood sugar
• Some high blood pressure medications, including beta blockers (propranolol, brand name Inderal), ACE inhibitors (enalopril, brand name Vasotec), and diuretics (hydrochlorothiazide, brand name Hydrodiurul). Combining any of these with celecoxib may cause elevations in blood pressure.

These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.