Celecoxib (Celebrex)

Antiinflammatory (NSAID, COX-2 inhibitor, decreases prostaglandins)

  • Bipolar depression3
  • Treatment resistant depression3
  • inflammatory depression2
  • postpartum depression3

Features

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Handout

Dosing

200 mg bid in depression (start 100 mg qd)

INTERACTIONS: Raises lithium (usually 30%, but can double levels; lower dose and check levels more frequently.

Take with a proton-pump inhibitor to prevent ulceration/GI bleed (pantoprazole 40 mg qd, or omeprazole, lansoprazole, dexlansoprazole, esomeprazole, rabeprazole).

Management

Best-studied anti-inflammatory med in depression. One of few meds that worked in treatment-resistant bipolar depression, and may work better when hs-CRP is ≥ 3. May redice manic symptoms (does not cause them).

Main risks are long-term so best to give for 6 months to get them better and then try to stop.

TOLERABILITY: No problems.

RISKS: Gastric ulcer, thrombosis (heart attacks, stroke), hypertension, heart failure, hepatotoxicity (1%), renal toxicity, asthma, hepatitis, and anemia (0.2%) Avoid if allergies to sulfa or aspirin (can cause Stevens-Johnson Syndrome, anaphylaxis, and asthma). Avoid in pregnancy.

EMR Text

Depression

Celecoxib use based on multiple randomized controlled trials in depression (Wang Z et al,World J Clin Cases. 2022;10(22):7872-7882).

Celecoxib risks, including ulcer, thrombosis, cardiac, liver, kidneys, and anemia, reviewed with patient.

Bipolar

Celecoxib use based on small randomized controlled trials in bipolar disorder, where it improved treatment resistant depression and mixed/manic symptoms (Bavaresco DV et al, CNS Neurol Disord Drug Targets. 2019;18(1):19-28).

Celecoxib risks, including ulcer, thrombosis, cardiac, liver, kidneys, and anemia, reviewed with patient.

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