HIGHLIGHTS OF PRESCRIBING INFORMATION ----------------------- WARNINGS AND PRECAUTIONS ----------------------­ These highlights do not include all the information needed to use • Hepatotoxicity: Inform patients of warning signs and symptoms of CELEBREX safely and effectively. See full prescribing information hepatotoxicity. Discontinue if abnormal liver tests persist or worsen or if for CELEBREX. clinical signs and symptoms of liver disease develop (5.3) • Hypertension: Patients taking some antihypertensive medications may CELEBREX ® (celecoxib) capsules, for oral use have impaired response to these therapies when taking NSAIDs. Initial U.S. Approval: 1998 Monitor blood pressure (5.4, 7) WARNING: RISK OF SERIOUS CARDIOVASCULAR AND • Heart Failure and Edema: Avoid use of CELEBREX in patients with GASTROINTESTINAL EVENTS severe heart failure unless benefits are expected to outweigh risk of See full prescribing information for complete boxed warning. worsening heart failure (5.5) • Renal Toxicity: Monitor renal function in patients with renal or hepatic • Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an impairment, heart failure, dehydration, or hypovolemia. Avoid use of increased risk of serious cardiovascular thrombotic events, CELEBREX in patients with advanced renal disease unless benefits including myocardial infarction and stroke, which can be fatal. are expected to outweigh risk of worsening renal function (5.6) This risk may occur early in the treatment and may increase with duration of use. (5.1) • Anaphylactic Reactions: Seek emergency help if an anaphylactic • CELEBREX is contraindicated in the setting of coronary artery reaction occurs (5.7) bypass graft (CABG) surgery. (4, 5.1) • Exacerbation of Asthma Related to Aspirin Sensitivity: CELEBREX is contraindicated in patients with aspirin-sensitive asthma. Monitor • NSAIDs cause an increased risk of serious gastrointestinal patients with preexisting asthma (without aspirin sensitivity) (5.8) (GI) adverse events including bleeding, ulceration, and • Serious Skin Reactions: Discontinue CELEBREX at first appearance of perforation of the stomach or intestines, which can be fatal. skin rash or other signs of hypersensitivity (5.9) These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior • Premature Closure of Fetal Ductus Arteriosus: Avoid use in pregnant history of peptic ulcer disease and/or GI bleeding are at women starting at 30 weeks of gestation (5.10, 8.1) greater risk for serious GI events. (5.2) • Hematologic Toxicity: Monitor hemoglobin or hematocrit in patients with any signs or symptoms of anemia (5.11, 7) ---------------------------RECENT MAJOR CHANGES -------------------------­ ------------------------------ ADVERSE REACTIONS -----------------------------­ Warnings and Precautions (5.1, 5.4) 6/2018 Most common adverse reactions in arthritis trials (>2% and >placebo) Warnings and Precautions (5.2) 5/2019 are: abdominal pain, diarrhea, dyspepsia, flatulence, peripheral edema, accidental injury, dizziness, pharyngitis, rhinitis, sinusitis, upper --------------------------- INDICATIONS AND USAGE --------------------------­ respiratory tract infection, rash (6.1). CELEBREX is a nonsteroidal anti-inflammatory drug indicated for: • Osteoarthritis (OA) (1.1) To report SUSPECTED ADVERSE REACTIONS, contact • Rheumatoid Arthritis (RA) (1.2) Pfizer at 1-800-438-1985 or FDA at 1-800-FDA-1088 or • Juvenile Rheumatoid Arthritis (JRA) in patients 2 years and older (1.3) www.fda.gov/medwatch • Ankylosing Spondylitis (AS) (1.4) • Acute Pain (AP) (1.5) ------------------------------ DRUG INTERACTIONS -----------------------------­ • Primary Dysmenorrhea (PD) (1.6) • Drugs that Interfere with Hemostasis (e.g., warfarin, aspirin, selective serotonin reuptake inhibitors [SSRIs]/serotonin norepinephrine ----------------------- DOSAGE AND ADMINISTRATION ----------------------­ reuptake inhibitors [SNRIs]): Monitor patients for bleeding who are • Use the lowest effective dosage for shortest duration consistent concomitantly taking CELEBREX with drugs that interfere with with individual patient treatment goals (2.1) hemostasis. Concomitant use of CELEBREX and analgesic doses of • OA: 200 mg once daily or 100 mg twice daily (2.2, 14.1) aspirin is not generally recommended (7) • RA: 100 mg to 200 mg twice daily (2.3, 14.2) • Angiotensin Converting Enzyme (ACE) Inhibitors, Angiotensin Receptor • JRA: 50 mg twice daily in patients 10 kg to 25 kg. 100 mg twice daily Blockers (ARB), or Beta-Blockers: Concomitant use with CELEBREX in patients more than 25 kg (2.4, 14.3) may diminish the antihypertensive effect of these drugs. Monitor blood • AS: 200 mg once daily single dose or 100 mg twice daily. If no effect is pressure (7) observed after 6 weeks, a trial of 400 mg (single or divided doses) may be of benefit (2.5, 14.4) • ACE Inhibitors and ARBs: Concomitant use with CELEBREX in • AP and PD: 400 mg initially, followed by 200 mg dose if needed on first elderly, volume depleted, or those with renal impairment may result in day. On subsequent days, 200 mg twice daily as needed (2.6, 14.5) deterioration of renal function. In such high risk patients, monitor for signs of worsening renal function (7) Hepatic Impairment: Reduce daily dose by 50% in patients with • Diuretics: NSAIDs can reduce natriuretic effect of furosemide and moderate hepatic impairment (Child-Pugh Class B). (2.7, 8.6, 12.3) thiazide diuretics. Monitor patients to assure diuretic efficacy including antihypertensive effects (7) Poor Metabolizers of CYP2C9 Substrates: Consider a dose reduction by 50% (or alternative management for JRA) in patients who are known or • Digoxin: Concomitant use with CELEBREX can increase serum suspected to be CYP2C9 poor metabolizers, (2.7, 8.8, 12.3). concentration and prolong half-life of digoxin. Monitor serum digoxin levels (7) --------------------- DOSAGE FORMS AND STRENGTHS -------------------­ CELEBREX (celecoxib) capsules: 50 mg, 100 mg, 200 mg and 400 mg (3) ---------------------- USE IN SPECIFIC POPULATIONS ----------------------­ • Pregnancy: Use of NSAIDs during the third trimester of pregnancy ------------------------------ CONTRAINDICATIONS -----------------------------­ increases the risk of premature closure of the fetal ductus arteriosus. • Known hypersensitivity to celecoxib, or any components of the drug Avoid use of NSAIDs in pregnant women starting at 30 weeks of product or sulfonamides (4) gestation (5.10, 8.1) • History of asthma, urticaria, or other allergic-type reactions after • Infertility: NSAIDs are associated with reversible infertility. Consider taking aspirin or other NSAIDs (4) withdrawal of CELEBREX in women who have difficulties conceiving • In the setting of CABG surgery (4) (8.3) See 17 for PATIENT COUNSELING INFORMATION and Medication Guide. Revised: 5/2019 Reference ID: 4428693 FULL PRESCRIBING INFORMATION: CONTENTS* WARNING: RISK OF SERIOUS CARDIOVASCULAR AND 6. ADVERSE REACTIONS GASTROINTESTINAL EVENTS 6.1 Clinical Trials Experience 1. INDICATIONS AND USAGE 6.2 Postmarketing Experience 1.1 Osteoarthritis 7. DRUG INTERACTIONS 1.2 Rheumatoid Arthritis 8. USE IN SPECIFIC POPULATIONS 1.3 Juvenile Rheumatoid Arthritis 8.1 Pregnancy 1.4 Ankylosing Spondylitis 8.2 Lactation 1.5 Acute Pain 8.3 Females and Males of Reproductive Potential 1.6 Primary Dysmenorrhea 8.4 Pediatric Use 2. DOSAGE AND ADMINISTRATION 8.5 Geriatric Use 2.1 General Dosing Instructions 8.6 Hepatic Insufficiency 2.2 Osteoarthritis 8.7 Renal Insufficiency 2.3 Rheumatoid Arthritis 8.8 Poor Metabolizers of CYP2C9 Substrates 2.4 Juvenile Rheumatoid Arthritis 10. OVERDOSAGE 2.5 Ankylosing Spondylitis 11. DESCRIPTION 2.6 Management of Acute Pain and Treatment of Primary 12. CLINICAL PHARMACOLOGY Dysmenorrhea 12.1 Mechanism of Action 2.7 Special Populations 12.2 Pharmacodynamics 3. DOSAGE FORMS AND STRENGTHS 12.3 Pharmacokinetics 4. CONTRAINDICATIONS 12.5 Pharmacogenomics 5. WARNINGS AND PRECAUTIONS 13. NONCLINICAL TOXICOLOGY 5.1 Cardiovascular Thrombotic Events 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.2 Gastrointestinal Bleeding, Ulceration, and Perforation 13.2 Animal Toxicology 5.3 Hepatotoxicity 14. CLINICAL STUDIES 5.4 Hypertension 14.1 Osteoarthritis 5.5 Heart Failure and Edema 14.2 Rheumatoid Arthritis 5.6 Renal Toxicity and Hyperkalemia 14.3 Juvenile Rheumatoid Arthritis 5.7 Anaphylactic Reactions 14.4 Ankylosing Spondylitis 5.8 Exacerbation of Asthma Related to Aspirin Sensitivity 14.5 Analgesia, Including Primary Dysmenorrhea 5.9 Serious Skin Reactions 14.6 Cardiovascular Outcomes Trial 5.10 Premature Closure of Fetal Ductus Arteriosus 14.7 Special Studies 5.11 Hematologic Toxicity 16. HOW SUPPLIED/STORAGE AND HANDLING 5.12 Masking of Inflammation and Fever 17. PATIENT COUNSELING INFORMATION 5.13 Laboratory Monitoring * Sections or subsections omitted from the full prescribing information 5.14 Disseminated Intravascular Coagulation (DIC) are not listed. Reference ID: 4428693 FULL PRESCRIBING INFORMATION WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS Cardiovascular Thrombotic Events • Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction, and stroke, which can be fatal. This risk may occur early in the treatment and may increase with duration of use. [see Warnings and Precautions (5.1)] • CELEBREX is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. [see Contraindications