Celebrex vs. Mobic

• Celebrex (celecoxib) and Mobic (meloxicam) are nonsteroidal anti-inflammatory drugs (NSAIDs) used for the relief of pain, fever, swelling, and tenderness caused by arthritis.
• Celebrex is also used for familial FAP, acute pain, and menstrual cramps.
• Celebrex is different from Mobic and other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with short-term use) and does not interfere with the clotting of blood.
• Side effects of Celebrex and Mobic that are similar include upset stomach, diarrhea, nausea, bloating, gas, headache, nervousness, runny or stuffy nose, sore throat, skin rash, and dizziness.
• Side effects of Celebrex that are different from Mobic include abdominal pain, indigestion, and insomnia.
• Side effects of Mobic that are different from Celebrex include drowsiness.
• Celebrex and Mobic may interact with aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), other cold/allergy/pain medicine that contains NSAIDs, ACE inhibitors, blood thinners, and diuretics (water pills).
• Celebrex may also interact with antidepressants, fluconazole, lithium, and heart or blood pressure medications.
• Mobic may also interact with cyclosporine, lithium, glyburide, methotrexate, and steroids.

Celebrex (celecoxib) and Mobic (meloxicam) are nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to treat arthritis, pain, menstrual cramps, and colonic polyps. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis that causes pain, fever, swelling and tenderness. Celebrex and Mobic block the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling and tenderness are reduced.

Celebrex

The most common adverse effects are:

• headache,
• abdominal pain,
• indigestion
• (dyspepsia),
• diarrhea,
• nausea,
• flatulence, and
• insomnia.

Other side effects include:

• fainting,
• kidney failure,
• heart failure,
• aggravation of hypertension,
• chest pain,
• ringing in the ears,
• deafness,
• stomach and intestinal ulcers,
• bleeding,
• blurred vision,
• anxiety,
• photosensitivity,
• weight gain,
• water retention,
• flu-like symptoms,
• drowsiness and
• weakness.

Celecoxib, like other NSAIDs may cause serious stomach and intestinal ulcers that may occur at any time during treatment. Celecoxib does not interfere with the function of the blood platelets and, as a result, does not reduce clotting and lead to increased bleeding time like other NSAIDs.

Allergic reactions can occur with celecoxib. Individuals who have developed allergic reactions (rash, itching, difficulty breathing) from sulfonamides (for example, sulfamethoxazole and trimethoprim [Bactrim]), aspirin or other NSAIDs may experience an allergic reaction to celecoxib and should not take celecoxib.

NSAIDs (except for low-dose aspirin) may increase the risk of heart attacks, stroke, and related conditions, which can be fatal. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel conditions. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

NSAIDs cause an increased risk of serious, even fatal, stomach and intestinal adverse reactions such as bleeding, ulcers, and perforation of the stomach or intestines. These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these types of reactions.

Mobic

WARNING

• Individuals who are allergic to NSAIDs may experience shortness of breath when given an NSAID. People with asthma also are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
• New onset or worsening of high blood pressure (hypertension) may occur. Blood pressure should be monitored closely during treatment.
• Meloxicam may cause fluid retention and swelling (edema). It should be used cautiously in people with heart failure.
• Meloxicam may reduce kidney function. Therefore, it should not be used in people with severe kidney failure. It should be used cautiously in the elderly, people with heart failure, liver dysfunction, and those taking diuretics, ACE-inhibitors, or angiotensin II antagonists.
• Serious skin reactions such as exfoliative dermatitis, Stevens- Johnson syndrome, and toxic epidermal necrolysis (TEN) may occur without warning.
• NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
• Central nervous system effects including drowsiness, dizziness, and blurred vision may occur in patients who are taking an NSAIDs.

Celebrex

The lowest effective dose should be used for each patient.

• For the management of osteoarthritis, the dose usually is 100 mg twice daily or 200 mg as a single dose.
• For rheumatoid arthritis, the dose usually is 200 mg twice daily.
• For acute pain or menstrual cramps, the dose is 400 mg as a single dose on the first day followed by an additional 200 mg if needed, then 200 mg twice daily as needed.
• For FAP, the recommended dose is 400 mg twice daily.

Mobic

The lowest effective dose should be used for each patient. Meloxicam therapy usually is started at 7.5 mg daily. Some patients require a dose of 15 mg daily, but this larger dose should be taken only under the direction of a physician. Juvenile rheumatoid arthritis is treated with 0.125 mg/kg daily up to 7.5 mg per day. Meloxicam may be taken with or without food.

Celebrex

Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin.

Fluconazole (Diflucan) increases the concentration of celecoxib in the body by preventing the elimination of celecoxib in the liver. Therefore, treatment with celecoxib should be initiated at the lowest recommended doses in patients who are taking fluconazole.

Celecoxib increases the concentration of lithium (Eskalith, Lithobid) in the blood by 17% and may promote lithium toxicity. Therefore, lithium therapy should be closely monitored during and after therapy with celecoxib.

Persons taking the anticoagulant (blood thinner) warfarin (Coumadin) should have their blood tested when initiating or changing celecoxib treatment, particularly in the first few days, for any changes in the effects of the anticoagulant.

NSAIDs may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.

People who drink more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs, and this also may be true with celecoxib.

Mobic

Meloxicam may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

Meloxicam may reduce the blood pressure-lowering effects of drugs given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.

When meloxicam is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.

Meloxicam increases the negative effect of cyclosporine on kidney function and reduces the effect of furosemide (Lasix) and thiazide diuretics because of prostaglandin inhibition.

Individuals taking oral blood thinners, for example, warfarin (Coumadin), should avoid meloxicam because meloxicam also thins the blood, and excessive blood thinning may lead to bleeding.

Meloxicam should be avoided by patients with a history of asthma attacks, hives, or other allergic reactions to aspirin or other NSAIDs. If aspirin is taken with meloxicam there may be an increased risk for developing a gastrointestinal ulcer.

People who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking meloxicam or other NSAIDs. Cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol) may decrease the effectiveness of meloxicam by preventing its absorption from the intestine.

Meloxicam oral suspension contains sorbitol. Combining sodium polystyrene sulfonate (Kayexalate) with sorbitol may cause fatal intestinal necrosis. Therefore, meloxicam oral solution should not be combined with Kayexalate.

Celebrex

Celecoxib has not been studied in pregnant women. In animal studies, doses that were twice the maximally recommended dose were harmful to the fetus. It should not be used in late pregnancy because there is a risk of heart defects in the newborn. Celecoxib should only be used in pregnant women when the benefits outweigh the potential risk to the fetus.

Available evidence suggests that celecoxib is secreted in breast milk. Nursing mothers should avoid celecoxib or discontinue breastfeeding.

Mobic

There have been no studies of meloxicam therapy in pregnant women.. Meloxicam generally should be avoided during the first and second trimester of pregnancy. Because meloxicam may cause a fetal birth defect called ductus arteriosus (early closure of two major blood vessels of the heart and lung) in the third trimester of pregnancy, meloxicam also should be avoided during this last part of pregnancy.

There have been no studies in humans to determine if meloxicam is excreted in breast milk.