Drug - Celebrex (celecoxib)
Therapeutic area - NSAIDs
Patient has tried and failed at least 3 different traditional NSAIDs, one of which must be meloxicam (Mobic)
Patient is on warfarin and prescriber is aware of the cardiovascular and cerebrovascular risks associated with Celebrex.
Patient is at high risk for GI complications. GI complications are defined as:
- Past complicated ulcers (perforation, obstruction, bleeding) OR
- 3 or more of the following risk factors:
- Concurrent multiple NSAIDs
- Concurrent high dose NSAIDs
- Concurrent anticoagulant/antiplatelet
- Past uncomplicated ulcer
- Age >70 years
- Concomitant steroids
- Chan FKL, Hung LCT, Suen BY, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med. 2002;347(26):2104-2110.
- Chan FK, Hung L, Suen B, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology. 2004;127:1038-1043.
- McDonagh MS. Oregon Evidence Based Practice Center. Oregon Health & Science University. Drug Effectiveness Review Project. Non Steroidal Anti-inflammatory Drugs final report. January 2004. May be accessed at http://www.ohsu.edu/drugeffectiveness/reports/final.cfm. Accessed on November 10, 2004.
- Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal Toxicity with celecoxib vs Nonsteroidal anti-inflammatory drugs for osteoarthristis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. JAMA. 2000;284(10):1247-1255.
- Lu HL. Celecoxib Statistical Reviewer Briefing Document for the Advisory Committee. May be accessed at http://www.fda.gov/ohrms/dockets/ac/01/briefing/3677b1_04_stats.pdf. Accessed November 12, 2004.
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