What Is the Best Way to Take Celecoxib (Celebrex)?

A panel of outside advisers to the FDA recently voted on the cardiovascular safety of Celebrex. These experts concluded that people who take celecoxib (Celebrex) to ease arthritis pain are at no greater risk for cardiovascular complications than people who take NSAIDs like ibuprofen or naproxen.

A lot of news organizations took this news to mean that Celebrex was safe. For example, NPR carried a headline on its website:

“FDA Panel Affirms Safety of Painkiller Celebrex.”

Other headlines stated:

“FDA Panel Gives Celecoxib Positive CV [cardiovascular] Safety Grade”

“FDA Advisers Say Celebrex Painkiller Safe for Heart”

Can You Trust Headlines?

We think such headlines are totally misleading. In point of fact, the advisory panel concluded that celecoxib is roughly comparable to ibuprofen and naproxen when it comes to cardiovascular safety. Since all these NSAIDs have been linked to heart attacks and strokes, the fact that people who take celecoxib (Celebrex) are equally vulnerable to NSAID-induced cardiovascular problems does not make the drug safe for the heart.

You can learn more about the side effects of NSAIDs in general and celecoxib in particular at this link:

FDA warning About NSAIDs in General:

“The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.

“The risk appears greater at higher doses.

“It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.

“NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.

“In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.

“Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.

“There is an increased risk of heart failure with NSAID use.”

If you would like to get the inside details on the PRECISION trial that was just presented to the FDA’s expert advisory panel, take a few minutes to listen to the lead author. Steve Nissen, MD, was a guest on our syndicated radio show.  He revealed some fascinating details about NSAIDS and Celebrex in this important study at this link. You can stream the audio by clicking on the green arrow or downloading the free MP3 file.

How To Take Celecoxib (Celebrex)?

This reader was not specifically asking about the safety of celecoxib, but implicit in the question is a concern about the risks associated with NSAIDs.

Q. Does Celebrex need to be taken every day to work? Can you take it as you would take ibuprofen, meaning as needed when you are experiencing pain?

I have gotten conflicting answers from my doctor and my pharmacist. One says it needs to build up in your system via a daily dose to be effective and the other says take it only when you’re hurting. I don’t want to take such a powerful drug daily if it is not necessary.

A. You can take Celecoxib (Celebrex) as needed for acute pain, such as after an accident or surgery. The analgesic effect usually kicks in within an hour. The peak blood levels occur within three hours (Pharmacogenetics and Genomics, April, 2012)

For people with osteoarthritis pain, the recommended dose is either 100 mg twice a day or 200 mg once a day.

We see no reason why you couldn’t take Celebrex when you experience pain. This approach might reduce the risk of side effects.