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Clinical Pharmacokinetics

, Volume 38, Issue 3, pp 225–242 | Cite as

Clinical Pharmacokinetics and Pharmacodynamics of Celecoxib

A Selective Cyclo-Oxygenase-2 Inhibitor
  • Neal M. DaviesEmail author
  • Andrew J. McLachlan
  • Ric O. Day
  • Kenneth M. Williams
Drug Disposition

Abstract

Celecoxib, a nonsteroidal anti-inflammatory drug (NSAID), is the first specific inhibitor of cyclo-oxygenase-2 (COX-2) approved to treat patients with rheumatism and osteoarthritis. Preliminary data suggest that celecoxib also has analgesic and anticancer properties. The selective inhibition of COX-2 is thought to lead to a reduction in the unwanted effects of NSAIDs. Upper gastrointestinal complication rates in clinical trials are significantly lower for celecoxib than for traditional nonselective NSAIDs (e.g. naproxen, ibuprofen and diclofenac).

The rate of absorption of celexocib is moderate when given orally (peak plasma drug concentration occurs after 2 to 4 hours), although the extent of absorption is not known. Celexocib is extensively protein bound, primarily to plasma albumin, and has an apparent volume of distribution of 455 ± 166L in humans. The area under the plasma concentration-time curve (AUC) of celecoxib increases in proportion to increasing oral doses between 100 and 800mg. Celecoxib is eliminated following biotransformation to carboxylic acid and glucuronide metabolites that are excreted in urine and faeces, with little drug (2%) being eliminated unchanged in the urine. Celecoxib is metabolised primarily by the cytochrome P450 (CYP) 2C9 isoenzyme and has an elimination half-life of about 11 hours in healthy individuals. Racial differences in drug disposition and pharmacokinetic changes in the elderly have been reported for celecoxib.

Plasma concentrations (AUC) of celecoxib appear to be 43% lower in patients with chronic renal insufficiency [glomerular filtration rate 2.1 to 3.6 L/h (35 to 60 ml/min)] compared with individuals with healthy renal function, with a 47% increase in apparent clearance. Compared with healthy controls, it has been reported that the steady-state AUC is increased by approximately 40% and 180% in patients with mild and moderate hepatic impairment, respectively.

Celecoxib does not appear to interact with warfarin, ketoconazole or methotrexate; however, clinically significant drug interactions with fluconazole and lithium have been documented. As celecoxib is metabolised by CYP2C9, increased clinical vigilance is required during the coadministration of other substrates or inhibitors of this enzyme.

Keywords

Celecoxib Naproxen Tolbutamide Nonselective NSAID Traditional NSAID 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

Professor Ric Day is on the Australian advisory board for celecoxib.

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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Neal M. Davies
    • 1
    Email author
  • Andrew J. McLachlan
    • 1
  • Ric O. Day
    • 2
  • Kenneth M. Williams
    • 2
  1. 1.Faculty of PharmacyUniversity of SydneySydneyAustralia
  2. 2.Department of Clinical Pharmacology and ToxicologySt Vincent’s Hospital, University of New South WalesSydneyAustralia

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