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Undertaking aadministration of instrument orto multiple ideasIn fact, the ultimate novicesToward the Best in the Academy�bridging’ betweenve factor that comes into play in the learning cycle:youted conceptual framework. And,review. In some cases, you may need to introduce newinformation that immediately bB. Conclusions. Refer to lit review.C. Need for the research. Who will benefit?ven idea, first discusslesson. Even better is to build inconsecutive.) Plan on completing one small subshat point on learning seems to consist mostly of creating new, efficient neural15. It is customary to provide your chair and committee(pathways.”the structure will change a bit as you move along through the thesis. But having the detailed
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A turn for the better: Clay Schnose making progress every day

<h1>A turn for the better: Clay Schnose making progress every day</h1>

A turn for the better: Clay Schnose making progress every day

Savanna Simmons
January 17, 2019 Prior to last June, Clay Schnose, a junior at Hot Springs High School, was an average teenage boy, a rodeo kid, avid fisherman, and deer hunter. He worked for his uncle, Tom Schnose, on his ranch, as well as helped him with his pipeline business. After work hours, he devoted himself to rodeo practice, where he would work on techniques for his recent love, calf roping, as well as his old love, team roping. That all came to a sliding stop last September.[Text Wrapping Break]After fighting canker sores on and off all summer—not an uncommon occurrence for Clay, but never to that magnitude, according to his mother—a doctor’s appointment was scheduled in late July. Clay had been severely fatigued, ran low-grade fevers, and could hardly eat due to the pain from the canker sores. The first doctors visit resulted in a prescription for Acyclovir and a mouthwash to numb the pain. Not noticing any improvements, three more future visits to different providers in the area yielded no more than, “It’s a virus, it just needs to run its course,” said Kimberly Schnose, Clay’s mother.[Text Wrapping Break]On Sept. 4, Clay came home from school early with an excruciating headache. He was having a hard time gripping his pencil with his right hand well enough to keep up with taking notes, and he was fatigued. The next day, he was taken into their local clinic to be seen by their family provider Fall River Health Services in Hot Springs, South Dakota, and was treated for severe dehydration. After receiving IV fluids, and he seemed to perk up. The next day, his mom noticed the right side of his mouth had started to droop when he smiled. Thinking maybe it was just due to possibly swelling of the sores in his mouth, she disregarded it until the morning of Sept. 8. A fever, coupled with the slurred speech and right-side weakness, meant a return to the clinic in Hot Springs, and as they were walking into the building, Kim noticed Clay was dragging his right foot, almost stumbling a couple times before getting in the building. When the nurse came to do the evaluation, she weighed Clay, and they learned he had lost about 20 to 25 pounds since his symptoms had appeared. Again, the medical professionals felt he was suffering from dehydration and started him on IV fluids. At the end of the third liter of fluid, Clay hadn’t shown any marked improvement, so he was sent to the ER. Once there, Dr. Bender, the doctor on rotation that day, had a CT scan done on Clay’s head. Results concluded Clay had swelling on the brain and several lesions. He suspected Clay was also suffering from meningitis, but the best way to determine that was a lumbar puncture. “He said, ‘I think you need to get him to Rapid City; I think he has meningitis,'” Kim said. Recommended Stories For You Clay was immediately loaded into an ambulance headed for Rapid City where a lumbar puncture was performed to withdraw spinal fluid for testing. The test confirmed meningitis, and with the noted encephalitis from the CT scan, the ER pediatrician on call recommended being flown to a facility with a pediatric neurologist; the closest in South Dakota being at Sanford Children’s Hospital in Sioux Falls. They were received at 1:30 a.m. Central Time by an ER doctor, concerned that Clay was presenting signs of going septic.[Text Wrapping Break]”That’s when I thought, ‘Holy cow, I could lose him,'” Kimberly said. “Five years ago, I lost my husband to colon cancer; it was just scary to do this alone. It was a couple of days before my nerves were calm again.”[Text Wrapping Break]Sanford Children’s Hospital was Clay’s home for a week, and while he was surrounded by loved ones, including close friends from Minnesota with whom he hunts and fishes annually, very little progress was witnessed. Of all the tests performed that week, the only disease that came back positive was mycoplasma, but the positive reading wasn’t a high enough percentage to cause the problems he was experiencing, according to his Infectious Disease doctors at both Sioux Falls, and later, Denver. At this time, Clays diagnosis was Meningoencephalitis.[Text Wrapping Break]”They administered high doses of IV Vancomycin and Acyclovir to get his symptoms controlled, and then, when he discharged, I took care of administering the Acyclovir through his PICC line using a gravity flow pump that I had to connect and disconnect twice a day for two weeks,” Kim said. “We were home for a week, and he started exhibiting neurological changes again. So back to the hospital and again he was life flighted back to Sioux Falls, where he was treated for another week.” This time the diagnosis became Auto Immune Encephalitis.[Text Wrapping Break]Clay was able to return back home to Oelrichs for only nine days before his next life flight occurred. He had a clinical follow up, so his mom took him back to Hot Springs. Unbeknownst to either Kim or Clay, when the nurse did the prescreening evaluation, Clay’s blood pressure was elevated, and he was running a moderate temperature. Given Clay’s history, and still taking antibiotics, these symptoms an issue needing to be addressed. Their family provider recommended the University of Colorado Children’s Hospital in Aurora, Colorado. “They had two shots in Sioux Falls, and he wasn’t getting better,” Kimberly said.[Text Wrapping Break]The children’s hospital collected him by life flight within a couple hours, and Kim followed down the next morning. A multitude of tests—a third spinal tap, another MRI, an unknown number of labs, a brain biopsy— all came back negative. No clear solution could be found for the most-disconcerting symptom, inflammation in the brain, so his became Auto Immune Inflammatory Brain Disease. “The team of doctors, consisting of Rheumatology, Neurology, Infectious Disease, and several other specialties, determined it was time to begin treating the symptoms in hopes of stopping anymore progression,” Kim said. “Given the symptoms, they decided to begin a high dose, 1,000 mg IV, of Prednisone over a five-day period to tackle the inflammation. Along with the prednisone Clay was also receiving a couple of intravenous immune globulin, IVIG, treatments to boost his immune system, a few antibiotics, and medications to protect his organs from the potential damage the antibiotics could do.” As his condition finally took a turn for the better, rehabilitation medicine entered the equation to regain strength in his right side. By the time he left Colorado, three weeks later, he was walking without a noticeable deficiency. Clay was home for 12 days—over deer season—before displaying neurological changes; he began dragging his right leg again, slurring his words more, exhibiting mental confusion and emotional outbursts more than usual. He was admitted to Rapid City Regional this time, and after collaborating with the on-call neurologist in Aurora, Rapid City administered another round of high-dose steroids. One the third day, just after Thanksgiving, Clay’s symptoms failed to improve enough to consider his symptoms controlled, and the provider in Aurora was prepared to life flight Clay back to Children’s Hospital, but a blizzard blanketed the entire Rocky Mountain region and extended north to the Black Hills. The life flight crew from Rapid City declined transport, so Children’s Hospital crew took the risk. With a collaborative effort with the ground ambulance, the flight crew was on the ground for less than 20 minutes and headed back to Aurora with Clay. Kim followed after the snow had subsided and roads were cleared. Once Clay arrived in Aurora, another MRI was completed on him, this time on his head and upper body. The results showed new lesions on his spine, explaining the changes in his physical abilities and indicating the disease was able to progress despite the prescribed prednisone, antibiotics, and other treatments. A PET scan was performed to rule out any other new lesions elsewhere, which came back negative. This new discovery of lesions on his spine now changed his formal diagnosis to Auto Immune Inflammatory Central Nervous System Disorder, and it was time to get more aggressive. Following the recommended protocol of a Canadian institute that specializes in inflammatory brain disease, Clay participated in a series of five plasmapheresis treatments, which clean his blood of any antibodies to give his body a fresh start, three more IVIG treatments, and begin the first of seven infusions of a drug called Cytoxan. “Although Cytoxan is classified as a chemotherapy drug, cancer was ruled out for Clay through the MRI and PET scan completed. The dosage Clay would receive is very low, with minimal side effects,” Kim said. “This combination proved to be effective, and we were able to come home Dec. 9; the longest we had been home since discovering Clay’s ailments in September.” The location of his lesions on the brain affect his behavior and emotions, so Kimberly was advised to monitor her son’s impulsive tendencies. His emotional outbursts are lessening each day, and his impulsivity is nearly nil. Clay started back to school Jan. 7, four months after his last attendance, and to start it was just for an hour a day. After his first day back and seeing how well he tolerated it, the school increased his class load to a full morning schedule. “He has a full load in the morning, and he’s handling that pretty well. He wants to do full days, but I’m not sure he’s ready,” Kimberly said. “He has physical therapy and occupational therapy in Hot Springs, and he’s supposed to be starting speech therapy soon.”[Text Wrapping Break]Clay is itching to be back on a horse and has been offered a familiar mount, one loaned to him last year when his sister, Mykelsi, had his calf-roping horse at college to use competing in breakaway. Frank and Marla Peters’ horse, Sierra, was used in years before by their son Matt, then their daughter Courtney, in high school. “When a conflict arose with Clay’s high school rodeo season and Mykelsi’s college rodeos getting postponed and rescheduled, the Peters’ offered up Sierra to Clay to use for tie down, and they got along well,” Kim said. “Sierra is a pretty calm and quiet horse, which is exactly what Clay needs to get reacquainted with riding again. Our horses are either too crippled, not broke yet, or too energetic to trust with Clay yet, or not ideal for him to get back with the program anyway.”[Text Wrapping Break]On New Years Eve, he finally laughed for the first time in four months, much to the relief of his mother, and he smiles now without being prompted. His smiles are usually a result of talking about horses and rodeo, though he will have to return to riding in a safe manner. “He needs to ride with a helmet; what he had was similar to a traumatic brain injury. He can’t afford a head injury,” Kimberly said. “Just this morning he was looking at the state high school rodeo calendar and said, ‘I think I’m going to take regionals this year.'”[Text Wrapping Break]Chris and Nicole Glines’ indoor arena south of Oglala has been like a second home to Clay and a few other rodeo boys in the area, and he has spent his Sunday afternoons there, as he did before. It has been good for Clay’s healing and recovery to be around that atmosphere and camaraderie, his mom said. “Clay has a long road to recovery, to regain his strength, balance and cognitive skills,” Kim said. “He will likely be making trips to the Denver area every couple of months for a while to keep up with his change in progress and to make sure he doesn’t go backward.” To help the Schnose family with future ongoing expenses, Nicole Glines has arranged an online fundraiser for Clay on the Southern Hills Rowdies page on Facebook. To donate items to the fundraiser, call or text Nicole Glines at 605-454-2022 or message her on the Southern Hills Rowdies Facebook page. The auction will open at 7 p.m. Feb. 1 and close at 7 p.m. Feb. 10. Funds may also be donated to the Schnose family by PayPal through or by mailing a check to Black Hills Federal Credit Union, where an account has been opened in Clay’s name. “The goal is definitely to cover their deductible for 2019,” Nicole said. “They’re going to have a lot of medical expenses. We want to release the burden a little bit.”

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Celebrex is the brand name for the prescription pain reliever celecoxib, the drug’s active ingredient. Doctors prescribe Celebrex to treat pain, swelling, and stiffness of arthritis and some other conditions.
Celebrex is a non-steroidal anti-inflammatory drug, often referred to simply as an NSAID. NSAIDs block swelling, pain, and fever. Celebrex works by stopping the production of COX-2, a natural substance in the body that causes pain and inflammation. Celebrex is an NSAID and a COX-2 inhibitor.
The Food and Drug Administration (FDA) approved celecoxib in 1998 for the drug company G.D. Searle under the brand name Celebrex. In May 2014, the FDA approved the generic version of celecoxib.
The FDA has approved Celebrex to treat:
Also, a study in the May 2014 issue of the journal Human Psychopharmacology suggested that celecoxib holds promise as an add-on treatment for people with depression. The researchers noted, though, that more study needs to be done to determine its safety and effectiveness long-term. What Are the Key Things I Need to Know About Celebrex?
There are two important warnings you should be aware of before taking Celebrex: Celebrex and other NSAIDs can increase the risk of heart attack and stroke that may occur without warning and can be fatal. This risk may increase if you take Celebrex for a long time. You also may be at higher risk if you have a history of heart disease or high blood pressure. Celebrex and other NSAIDs may cause ulcers, stomach perforations, and sudden bleeding in your stomach or intestine. You may be at higher risk for this if you’re elderly, drink a lot of alcohol, smoke, are in poor health, or take any blood-thinning medications. You also may be at higher risk if you have a history of ulcers or gastrointestinal (GI) bleeding.
. Is There Anything Special I Should Discuss With My Doctor Before Taking Celebrex?
Talk to your doctor about Celebrex warnings, especially if you have a history of heart disease, stroke, ulcers, or GI bleeding. Ask how your doctor will monitor you for these conditions and what the warning symptoms are.
Always tell your doctor if you have allergies to any medications. You may not be able to take Celebrex if you have had allergic reactions to other NSAIDs or drugs called sulfonamides. You also may not be able to take Celebrex if you’ve ever had hives or asthma after taking aspirin or another NSAID. You should not take Celebrex in the days before or after some types of heart surgery, including coronary artery bypass graft surgery.
If you’re a woman, let your doctor know if you are or may be pregnant, or if you’re breastfeeding.
Before prescribing Celebrex, your doctor will also want to know if other conditions or situations apply to you, such as: Frequent use of alcohol Swelling of the face or body High blood pressure Celebrex Side Effects What Are the Most Common and Serious Side Effects of Celebrex?
If you have any side effects from Celebrex, let your doctor know. The most common side effects are indigestion and headache. Other side effects may include: Stomach ache Swelling of feet or hands Body aches Upper airway congestion or infection Rash
Serious side effects can occur. If you have any of these side effects, stop taking Celebrex right away. Call your doctor, get emergency help, or call 911. Chest pain Weakness on one side of the body Slurred speech Vomiting blood or something that looks like coffee grounds Bloody diarrhea or tarry stools Unusual bleeding or bruising Severe skin rash or blistering of skin Hives Swelling of the face, throat, tongue, or body Difficulty swallowing or talking Blood-tinged urine, dark urine, or trouble passing urine Fever Extreme tiredness or lack of energy Yellowing of skin or eyes
It’s not safe to take Celebrex during pregnancy. There is some evidence in animals that it may cause heart defects when used late in pregnancy. Tell your doctor if you’re pregnant or may become pregnant before taking Celebrex. If you become pregnant while taking Celebrex, tell your doctor right away. Celebrex is also not a safe drug to take while breastfeeding.
Children with juvenile arthritis may take Celebrex if they’re older than 2. People older than 65 may have an increased risk for GI bleeding and kidney failure. Celebrex Interactions Do Other Drugs Affect the Way Celebrex Works?
Some drugs may affect the way Celebrex works, and Celebrex may affect other drugs you are taking. It’s very important to let your doctor know about all drugs you are taking, including any over-the-counter drugs and any herbs or supplements.
Drugs known to interact with Celebrex include: Should I Avoid Any Food, Drink, or Activity While Taking Celebrex?
You don’t need to change your diet or activities while taking Celebrex, but don’t drink alcohol heavily while you’re taking the drug. Celebrex Dosage What Is a Typical Dose of Celebrex?
Celebrex comes in capsules of 50, 100, 200, and 400 milligrams (mg), and your doctor will try to find the lowest dose of Celebrex that works for you.
You’ll take Celebrex once or twice a day, with or without food. If you’re taking large doses, though, your doctor may ask you to take your dose with some food. Take your medication at the same time every day. For children or adults who have trouble swallowing capsules, it’s okay to open the capsules and sprinkle the medication on a teaspoon of applesauce.
Typical dose schedules for Celebrex are: 200 mg a day for an adult with osteoarthritis or rheumatoid arthritis 200 to 400 mg a day for an adult with ankylosing spondylitis 200 mg twice a day for pain from injury or menstruation 400 mg twice a day, taken with food, for an adult with familial polyposis
Children with rheumatoid arthritis take Celebrex twice a day, and doctors base the dose on the child’s weight. People with liver disease may need to take a reduced dose. What Happens If I Take Too Much Celebrex and Overdose?
An overdose of Celebrex can cause tiredness, weakness, nausea, vomiting, GI bleeding, and abdominal pain. In rare cases, a large overdose can cause kidney failure, high blood pressure, difficulty breathing, and even a coma. If you think you have taken an overdose or if someone else may have overdosed on Celebrex, call a poison control center at 1-800-222-1222 or call 911. What Happens If I Miss a Dose of Celebrex or Don’t Take It as Prescribed?
Take Celebrex exactly as directed by your doctor. Don’t take more or less. If you miss a dose of Celebrex, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue your regular dose schedule. Don’t double your dose to make up for the missed one. Celebrex Pictures Celebrex 100 mg, white, capsule, Celebrex 400 mg, white, capsule, Celebrex 200 mg, white, capsule, Celebrex FAQ Q: Does Celebrex cause weight gain?
A: Weight gain is a possible side effect of Celebrex according to the prescribing literature. If you are experiencing excess weight gain, I would discuss this with your health care provider to be sure the weight increase is not being caused by another medical condition rather than from taking Celebrex. Q: If I’m allergic to sulfa drugs, can I take Celebrex?
A: There have been no reports of sulfa-allergic patients reacting to Celebrex. However, since there is a component in Celebrex related to the molecule that causes sulfa allergy reactions, it is a theoretical concern. The recommendation is that sulfa-allergic patients avoid this medication. Q: I’ve been using Celebrex for 4 months because of arthoscopic knee surgery. The pills helped in the beginning and they are not helping now. Could it be because I stand all day on my job? Does it cause weight gain?
A: The pain can be caused by excessive use and standing all day. You might want to try a knee brace to use at work, which might alleviate some of the strain. If that doesn’t help, talk with your physician to see what other solutions you can come up with. Q: I am taking Celebrex for knee inflammation. The bottle says not to take aspirin at the same time, but can I take ibuprophen and acetaminophen along with the Celebrex?
A: According to the package insert, Celebrex should not be taken with aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) including ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), or piroxicam (Feldene). Acetaminophen is in a different class of pain relievers (not a NSAID), and studies have shown that Celebrex and acetaminophen (Tylenol) can be used together. It is important to take all drugs in the recommended doses and alert your healthcare provider of all prescription and over-the-counter medicines that you are taking. For more information about Celebrex, please visit //www.everydayhealth.com/drugs/celebrexMichelle McDermott, PharmD Q: Can a person who is allergic to sulfa drugs take Celebrex?
A: A sulfa allergy refers to adverse reactions to sulfonamides, a group of drugs that includes antibiotics and nonantibiotics. The antibiotic sulfonamides are different structurally from the nonantibiotic sulfonamides, and they appear to be much more likely to result in allergic reactions. Many of the sulfa nonantibiotics, therefore, do not cause problems in people with sulfa antibiotic allergy. Celebrex (celecoxib), a popular medication used for the treatment of arthritis and for controlling pain, is a sulfonamide nonantibiotic medication. Although there have been no reports of sulfa-allergic patients reacting to Celebrex, it is a theoretical concern, so the recommendation is that sulfa-allergic patients avoid this medication. Here is a link to more information on Celebrex: //www.everydayhealth.com/drugs/celebrex.Lori Poulin, PharmD Q: Is there something effective that can replace Celebrex? Q: What are the side effects of Celebrex?
A: Celebrex (celecoxib) belongs to the group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat pain or inflammation caused by conditions such as arthritis. According to the package insert, some of the most common side effects of Celebrex include upset stomach, heartburn, diarrhea, constipation, bloating, dizziness, headache, skin rash, itching, blurred vision, and ringing of the ears. Celebrex can also cause some serious side effects. Chronic use of Celebrex may cause an increased risk of life-threatening heart or circulation problems, which include heart attack and stroke. Celebrex can also cause high blood pressure and serious gastrointestinal events including bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine. To minimize the potential risk for a serious side effect, the lowest effective dose should be used for the shortest period of time consistent with individual patient treatment goals. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/celebrex. Michelle McDermott, PharmD Q: I would like your point of view on Celebrex. My mom was prescribed said medication and I am worried as to the numerous side effects it has.
A: Celebrex (celecoxib) is classified as a nonsteroidal anti inflammatory drug, and is COX-2 selective. It is used for the treatment of osteoarthritis, ankylosing spondylitis, rheumatoid arthritis, acute pain, familial adenomatous polyposis and treatment of dysmenorrhea. The lowest possible dose and shortest possible duration of time should be used in patients taking Celebrex. There are some serious warnings associated with the medication. These include cardiovascular, coronary, and gastrointestinal warnings. NSAIDs (non steroidal anti inflammatory drugs) as a class have been shown to be associated with an increased risk of cardiovascular events such as heart attacks and strokes. There is a theory that the risk may be increased with longer duration of use of this type of medication or if patients have a history of cardiovascular disease or risk factors. The gastrointestinal warnings state that NSAIDs as a class can increase the risk of gastrointestinal irritation, ulceration, bleeding and perforation. Celebrex is contraindicated for treatment of pain after surgery of coronary artery bypass graft surgery due to increased risk of heart attacks and strokes. This is not an inclusive list of all possible side effects of Celebrex. All medications have possible adverse effects associated with them. When deciding on an appropriate medication, the patient and the physician must weigh the benefit of the medication against the risks associated with it. There are many patient specific variables of your mother’s that must be examined to determine if Celebrex is an appropriate treatment for her. These variables include her medical conditions, other medications she is taking, overall health, etc. Her physician is best able to evaluate the possible risks specifically to your mother. Please have your mother or yourself speak with her physician regarding your concerns about the safety profile of Celebrex. Jen Marsico, RPh Q: I take one Celebrex daily for knee arthritis. I am not overweight,exercise daily, and live a moderate lifestyle. Is there any other drug(s) I could take to help with knee stiffness?
A: If you have osteoarthritis of the knee, you can take advantage of a wide range of treatment options. The effectiveness of different treatments varies from person to person and the choice of treatment should be a joint decision between you and your physician. Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle. Several types of drugs can be used in treating arthritis of the knee. Because every patient is different, and because not all people respond the same to medications, your physician should be consulted on a program for your specific condition. Glucosamine and chondroitin are oral supplements that may relieve the pain of osteoarthritis. These are two large molecules that are naturally found in the cartilage of our joints. These substances can help reduce swelling and tenderness, as well as improve mobility and function. If you decide to take this therapy, be aware that at least two months of continuous use is necessary before the full effect is realized. Although glucosamine and chondroitin sulfate are natural substances, sometimes classified as food additives, they can cause side effects such as headaches, stomach upset, nausea, vomiting, and skin reactions. These supplements can interact with other medications, so keep your doctor informed about your use of them. Lori Mendoza, PharmD Poulin, PharmD Q: I had prostate surgery in November 2009. I also have rheumatoid arthritis. I go to the bathroom very often at night, every 1 1/2 to 2 hrs. Whenever I take Celebrex for pain, it reduces urination frequency. Can you educate me, please. Is it good or bad?
A: Celebrex (celecoxib) is frequently used to reduce pain caused by a variety of conditions. Usually, after prostate surgery the frequency of urination will increase. It is normally not a problem to reduce the frequency of urination with medication. However, with Celebrex, you should notify your health care provider about the decrease in urinary frequency as this is listed as a more serious side effect of Celebrex. Anytime you notice changes in your daily routine, you should let your health care provider know. Sometimes, the changes will not matter and other times they may need to adjust your medication regimen. It is also good to keep a current list of any prescription medication and over-the-counter products you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Megan Uehara, PharmD Q: My doctor prescribed Celebrex, but I can’t afford it. What over-the-counter drug will relieve inflammation and pain?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work to reduce hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It is also used in the treatment of hereditary polyps in the colon. There are NSAIDS available for purchase over-the-counter, including ibuprofen (Motrin, Advil) and naproxen (Aleve). However, they work slightly differently than Celebrex. Talk to your doctor to see if either of those medications would be appropriate for you and what dose you should take. Your doctor is best able to guide your treatment choices based on your specific circumstances. Common side effects of NSAIDS include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, skin rash, blurred vision, and ringing in your ears. The use of NSAIDS carries the risk of serious side effects, such as heart attack, stroke, and bleeding from your digestive tract. The risk of heart attack and stroke increases with long-term use of NSAIDS. However, bleeding from the digestive tract can occur anytime during treatment. Seek immediate medical attention if you experience chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance. Contact your doctor at once if you experience signs that you could be bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. This is not a complete list of side effects that can occur with NSAIDS. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh, PharmD Q: My doctor prescribed Celebrex and I have GERD and Barrett’s. Is it safe for me to take the Celebrex? What else can I take for the bursitis in my hip?
A: Celebrex (celecoxib) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Common side effects of Celebrex include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, headache, skin rash, itching, blurred vision, and ringing in your ears. More serious side effects can occur and this is not a complete list of possible side effects associated with Celebrex. Using Celebrex increases the risk of serious conditions involving the stomach and intestines, including bleeding, ulceration, and perforation (forming a hole in the wall of the stomach or intestines). These conditions can be life-threatening and can occur without warning at any time during treatment with Celebrex. Because of this risk, people with a history of stomach ulcers or bleeding should not use Celebrex. The risk is also increased in elderly patients (over the age of 65) and with longer duration of therapy. There is no specific warning against using Celebrex in patients with GERD and/or Barrett’s contained in the prescribing information for Celebrex. If you are concerned about the safety of Celebrex use, talk to your doctor for information based on your specific circumstances. Contact your doctor right away if you have symptoms of bleeding from your digestive tract. These include black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications. Sarah Lewis, RPh Q: Over the past year, I have gained about 25 lbs, with excess “flab” around the midsection and a stomach I’ve never had to deal with before. I started taking Celebrex daily for over a year thinking it was better for me than taking 600-800 mg of ibuprofen everyday. I’m really struggling with my weight. Has the Celebrex caused “some” of my weight gain?
A: Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. According to the manufacturer’s package insert for Celebrex (celecoxib), an increase in weight and edema are potential adverse effects from the use of Celebrex. So yes, it is possible that Celebrex is responsible for your weight gain. Q: Is Celebrex one of the drugs that will make one have bad dreams, because I take it daily, and have bad dreams more than I care to.
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It can also be used in the treatment of hereditary polyps in the colon. Common side effects of Celebrex include upset stomach, mild heartburn, diarrhea, constipation, bloating, gas, dizziness, nervousness, skin rash, blurred vision, and ringing in the ears. This is not a complete list of side effects that can occur with Celebrex. A search of a drug database and the prescribing information for Celebrex did not specifically list bad dreams as a side effect of the drug. If bad dreams continue or get worse, consult your doctor for specific recommendations. Your doctor may be able to determine if the dreams are caused by Celebrex or not. Do not stop or change the amount of medication you take without talking to your health care provider first. Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U.S. Food and Drug Administration by visiting www.fda.gov/medwatch or by calling 1-800-FDA-1088. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh Q: Can Celebrex be taken only when needed for pain, or does it need to be taken daily?
A: Celebrex (celecoxib) is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause pain and inflammation. Celebrex can be taken every day for pain prevention, or it can be taken on an as needed basis. People who have chronic pain conditions such as arthritis may need to take Celebrex every morning for pain prevention. People who have intermittent pain conditions can take Celebrex on an as needed only basis. You should consult your physician for more information about how often to take Celebrex. The most common side effects of Celebrex are constipation, diarrhea, dizziness, gas, headache, heartburn, nausea, sore throat, and stomach upset. This is not a complete list of side effects. More severe side effects are possible. Celebrex can interact with other medications. Burton Dunaway, PharmD Q: Can Celebrex affect your stomach, and how long can it be used for muscle tendonitis?
A: Celebrex is classified as a COX-II inhibitor that does not usually cause stomach problems. But if you are experiencing stomach pain or stomach bleeding, please consult your physician. Other causes or other medications must be ruled out. Studies suggest different time periods of treatment for muscle tendonitis depending on pain severity, tolerance to medication and physician preference. Studies also show concern regarding cardiovascular health in some patients using Celebrex. Please keep up with doctor’s appointments for your physician to monitor lab results and heart health. For more information, please see //www.everydayhealth.com/drugs/celebrex Q: What are the long-term (5+ years) side effects of taking 200 mg Celebrex daily?
A: our question concerns long-term side effects of Celebrex (celecoxib) //www.everydayhealth.com/drugs/celebrex. Long-term use of Celebrex may cause renal (kidney) toxicity and decreased blood flow to the heart. Kidney damage may also result. In one study, patients on Celebrex for three years had an increased risk of serious cardiovascular events which included heart attacks, strokes, and heart failures. It is always a good idea to check with one’s health care provider in matters like this. Please consult your health care provider for guidance in your specific case. Gregory Latham, MS, RPh Q: My husband just started taking Celebrex for pain in his shoulder, back, and arm. Is there a generic version, or another medication that is similar but less expensive?
A: Celebrex (celecoxib) belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause inflammation and pain. Currently, there is no generic available in the United States for Celebrex. For cheaper alternatives, consult with your health care provider. For more information on this medication, go to //www.everydayhealth.com/drugs/celebrex. Kimberly Hotz, PharmD Q: Is Celebrex good for gout, or are there over-the-counter aids you could recommend?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain and inflammation caused by many conditions, such as arthritis, ankylosing spondylitis, and menstrual pain. It’s also used to treat hereditary polyps in the colon. Gout is a type of arthritis caused when too much of a chemical called uric acid builds up in the blood. Uric acid comes from the breakdown of protein, whether from the turnover of our own cells or from foods and beverages. Usually, the kidneys can get rid of normal levels of uric acid. In gout, it builds up and is not gotten rid of properly. This can lead to the formation of crystals that deposit in joints and cause pain. The treatment of gout focuses on decreasing both the uric acid levels and the pain caused by the crystal deposits. NSAIDS are a good option for treating gout pain because inflammation is part of the problem. Over-the-counter NSAIDS include ibuprofen (Advil, Motrin) and naproxen (Aleve). Discuss their use with your health care provider before taking them. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, RPh, PharmD Q: I’ve been taking Celebrex, and it isn’t giving me so much relief anymore. Is there another drug besides Celebrex that I might discuss with my doctor?
A: Aleve (naproxen) and Motrin/Advil (ibuprofen) are over-the-counter (OTC) NSAIDs (non-steroid anti-inflammatory drugs) used to treat pain by bringing down swelling. There are also many prescription NSAIDs such as Voltaren (diclofenac), Lodine (etodolac), Indocin (indomethacin), Orudis (ketoprofen), Toradol (ketorolac), Relafen (nabumetone), Daypro (oxaprozin), Feldene (piroxicam), and Clinoril (sulindac). The main concern with these medications is that over time, they can cause bleeding in the gastrointestinal (GI) tract, which includes the esophagus leading into the stomach, the stomach, and the intestines. An alternative is Tylenol (acetaminophen), as it works differently, but it does not reduce inflammation. NSAIDs work by reducing the effects of prostaglandins, which cause inflammation, pain, and fever in the body. Two enzymes, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) make the prostaglandins work. COX-1 makes prostaglandins that support platelets and protect the stomach lining. When they are blocked, the platelets cannot cause the blood to clot as easily. COX-2 makes the prostaglandins that cause inflammation, swelling, and as a result, pain. Of the NSAIDs, Mobic (meloxicam) is thought to go down the COX-1 pathway less than most of the NSAIDs. Scientists were able to make COX-2 inhibitors, which did not go down the COX-1 pathway much, but most of them (Vioxx, Bextra, etc.) were removed from the market, as they caused heart problems. Celebrex (celecoxib) is a COX-2 inhibitor that is still on the market and is considered safe, as long as the person taking it does not have any past heart problems or risk factors for them. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Patti Brown, PharmD Q: Do you recommend Celebrex for mild arthritis?
A: The treatment of osteoarthritis typically follows a stepwise approach, and mild arthritis may not require drug treatment. Initially, doctors recommend that patients rest and avoid activities that cause pain, exercise to increase the strength of muscles around the affected joints, and lose weight to decrease pressure on the joints. If medication becomes necessary, it is best to start with those that have the least side effects. The first treatment is usually acetaminophen (Tylenol), which reduces pain, but does not affect inflammation. It is generally well tolerated, but taking more than recommended or having more than three alcoholic drinks per day can increase the risk of liver damage. The next treatments are nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and naproxen. Some of these drugs are available over the counter without a prescription. They can cause stomach upset, so it is recommended that they be taken with food. Both acetaminophen and NSAIDs can interfere with blood thinners, so it is important to check with your doctor before taking these medications. Celebrex (celecoxib; //www.everydayhealth.com/drugs/celebrex) is a prescription NSAID that is also called a cyclooxygenase-2 inhibitor or COX-2 inhibitor. It causes less stomach upset than other NSAIDs; however, Celebrex and other COX-2 inhibitors may cause kidney damage or increase the risk of heart attack and stroke. COX-2 inhibitors should be taken only at the lowest dose needed to relieve your pain. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, PharmD Q: Is there another medication that I can take that is equally as good as Celebrex. It’s very good but so expensive!
A: Celebrex (there is no generic but the active ingredient is celecoxib) is an expensive NSAID (non-steroidal-anti-inflammatory-drug), and there are no alternatives exactly like it, but you may be able to try something similar. Most NSAIDS follow two pathways in the body, COX-1 inhibition and COX-2 inhibition. The second one is desirable, as it decreases the inflammation. The first pathway can slowly destroy the stomach lining and over time, cause ulcers or GI bleeding. Celebrex is the only medication that does not go down the COX-1 pathway very much. Others were developed (Vioxx and Bextra), but then recalled due to issues with people having heart problems. So, if you do not have GI bleeding or an ulcer, you may want to ask your doctor about other NSAIDS. Mobic (the generic name is meloxicam) is a great alternative, because it is generic and has less GI/ulcer problems than most of the NSAIDS. Ultimately, you should see what your doctor thinks is best for you. If your doctor insists on Celebrex, you may want to contact the company and see if they have any discount coupons that your pharmacy can process. Many companies do this. The company to contact is Pfizer. For more information on pain management, please visit our link at: //www.everydayhealth.com/pain-management/pain-treatment.aspx Patti Brown, PharmD Brown, PharmD Q: How safe are Geodon and Celebrex? My doctor wants me on Celebrex, but I’ve read it can cause heart attacks.
A: All prescription medications have side effects or common reactions that are patient specific, and therefore difficult to predict. The U.S. Food and Drug Administration is charged with reviewing a drug’s safety profile before approving the drug for sales in the United States. Both Geodon and Celebrex are FDA-approved drugs. Please consult with your physician as to the best prescription medications to treat your health conditions. Lowell Sterler, RPh Q: Does prolonged use of Celebrex hinder your kidneys or liver?
A: Celebrex (celecoxib) is a nonsteroidal anti-inflammatory drug (NSAID) similar to ibuprofen, naproxen, diclofenac, and many others. According to the manufacturer, Celebrex has the advantage of causing fewer stomach and intestinal side effects compared to other NSAIDs. Like other NSAIDs, Celebrex may cause kidney and liver complications after extended use at high dosage. Clinical studies show Celebrex may cause acute renal failure in less than 0.1 percent of patients treated with Celebrex 800 mg per day. The FDA Adverse Event Reporting System reported 122 cases of renal failure associated with the use of Celebrex at the recommended dose. The prescribing information by the manufacturer also states that Celebrex should be used with caution in patients with pre-existing renal impairment. For low-risk patients, it is customary for clinician to order labs for renal function within three months after initiating therapy and repeated every six to 12 months. For those at high risk for renal failure (older than 60 years, pre-existing renal insufficiency), monitoring of renal function should be more frequent. Celebrex has been associated with increasing liver enzymes. According to research data by the manufacturer, elevated liver enzymes were reported in 0.1 percent to 1.9 percent of patients taking Celebrex up to 800 mg per day. Although liver enzymes were elevated, liver failure is rare. For patients at low risk, liver enzymes should be monitored within three months of starting treatment and repeated every six to 12 months. In high risk patients, more frequent monitoring is required. //www.everydayhealth.com/drugs/celebrex, //www.everydayhealth.com/symptom-checker/, and //www.everydayhealth.com/conditions/. Lori Mendoza, PharmD Q: What is Celebrex?
A: Celebrex (celecoxib) is a prescription non-steroidal anti-inflammatory drug (NSAID). Celebrex is indicated for the symptomatic treatment of pain or inflammation caused by osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis in children two years of age and older, ankylosing spondylitis, acute pain, primary dysmenorrhea and as an adjunct to usual care in patients with familial adenomatous polyposis. Celebrex is contraindicated in patients with documented hypersensitivity to the active ingredient, celecoxib, or sulfonamides or in patients with a medical history of asthma, urticaria, or other allergic-type reactions associated with aspirin or other NSAIDs. Treatment is Celebrex is also contraindicated during the perioperative period in patients undergoing coronary artery bypass graft (CABG) surgery. Treatment with Celebrex should be individualized and prescribed at the lowest effective dose and for the shortest duration required to achieve treatment goals for any given indication. Celebrex should be administered with food or milk to decrease stomach upset. Patients are advised to avoid alcohol while being treated with Celebrex as alcohol can increase the risk of stomach bleeding. The most commonly reported adverse reactions during clinical trials, in greater than 2% of patients, included abdominal pain, diarrhea, dyspepsia, flatulence, peripheral edema, accidental injury, dizziness, pharyngitis, rhinitis, sinusitis, upper respiratory tract and rash. During clinical studies, approximately 7% of patients receiving Celebrex discontinued treatment as a result of adverse reactions. The most commonly reported adverse reactions leading to discontinuation of treatment with Celebrex were dyspepsia and abdominal pain. More severe adverse reactions are possible with treatment with Celebrex. Celebrex carries black box warnings regarding the risk of serious cardiovascular and gastrointestinal events associated with treatment. Celebrex may cause an increased risk of serious cardiovascular thrombotic events, heart attack and stroke, which can be fatal. The risk of cardiovascular events may be increased with duration of use and in those patients with documented cardiovascular disease or risk factors for cardiovascular disease. Patients should be instructed to seek emergency medical attention if they develop any signs or symptoms which may indicate the presence of a cardiovascular event including chest pain, weakness, shortness of breath, slurred speech or vision or balance problems. Celebrex, like other NSAIDs, may cause an increased risk of serious gastrointestinal events including bleeding, ulceration and perforation of the stomach or intestines, which also may be fatal. Serious gastrointestinal adverse reactions can occur at any time during treatment and without warning symptoms. The risk of developing serious gastrointestinal events is greater in the elderly population. Contact your health care provider immediately if you experience any signs and symptoms which may indicate the presence of serious gastrointestinal events including black, bloody or tarry stools or coughing up blood or vomit that looks like coffee grinds. When considering treatment with an anti-inflammatory, the patient and health care provider are advised to carefully assess the potential benefits versus risks of Celebrex and other treatment options before deciding upon treatment with Celebrex. Q: How often should you take Celebrex?
A: How often you should take Celebrex (celecoxib) depends upon the reason for treatment. Celebrex is approved for the relief of symptoms caused by pain or inflammation associated with several medical conditions, including osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis in children ages two and older, ankylosing spondylitis, primary dysmenorrhea, acute pain or familial adenomatous polyposis as an adjunct treatment to usual care. When prescribed for the symptomatic relief in patients with osteoarthritis, Celebrex is usually taken once or twice daily. As a treatment option for relief of signs and symptoms of rheumatoid arthritis in the adult population, Celebrex is typically taken twice daily. For the treatment of symptoms of juvenile rheumatoid arthritis in the pediatric population, the usual administration schedule for Celebrex is twice daily. For the relief of signs and symptoms associated with ankylosing spondylitis, Celebrex is typically administered once or twice daily. In adult patients being treated with Celebrex for the management of acute pain or the treatment of primary dysmenorrhea, the usual dose is initially a higher dose, followed by a lower dose if needed on the first day and typically administered twice daily as needed on subsequent days of treatment when required. Lastly, when Celebrex is used as an adjunct to usual care in patients with familial adenomatous polyposis, the dose is usually taken twice daily with food. When deciding upon Celebrex as a treatment option, health care providers are urged to carefully consider the risk versus benefit of treatment with Celebrex and use the lowest effective dose for the shortest duration of treatment possible to achieve positive therapeutic outcomes. Q: What is the usual dosage of Celebrex?
A: The usual dosage of Celebrex is dependent upon the indication for treatment. Celebrex is indicated for the symptomatic relief of pain and inflammation associated with osteoarthritis, juvenile rheumatoid arthritis in patients two years of age and older, rheumatoid arthritis in adults, primary dysmenorrhea, acute pain, ankylosing spondylitis and familial adenomatous polyposis as an adjunctive treatment. The usual dosage of Celebrex recommended for the symptomatic treatment of osteoarthritis is 200 mg daily administered as a single dose or a divided dose of 100 mg administered twice daily. For the relief of the signs and symptoms of juvenile rheumatoid arthritis in the pediatric population, the recommended usual dosage of Celebrex is based on weight. For those patients greater than 10 kg but weighing less than 25 kg, the usual dosage of Celebrex is 50 mg administered twice daily. For patients weighing greater than 25 kg, the usual dosage of Celebrex is 100 mg administered twice daily. According to the prescribing information, Celebrex capsules can be opened and the contents can be added to applesauce for patients who have difficulty swallowing the capsules. Furthermore, patients should be instructed to carefully empty the entire capsule contents onto a level teaspoon of cool or room temperature applesauce and ingest immediately with water. However, the sprinkled capsule contents are stable for up to six hours under proper refrigeration at a temperature between 35 and 45 degrees Fahrenheit. The usual dosage of Celebrex recommended for the symptomatic treatment of rheumatoid arthritis in adults is 100 mg to 200 mg administered twice daily. For treatment of primary dysmenorrhea and management of acute pain, the dosage and administration recommended for Celebrex is the same. The usual dosage of Celebrex recommended for these two indications is an initial dose of 400 mg followed by an additional dose of 200 mg if needed on the first day. The recommended dose is 200 mg administered twice daily as needed on subsequent days of treatment. For the management of the signs and symptoms of ankylosing spondylitis, the usual dosage of Celebrex is 200 mg daily administered as a single dose or the dosage may be administered in divided doses twice per day. According to the prescribing information, if therapeutic effects have not been observed after six weeks of treatment, a trial dosage of Celebrex of 400 mg daily may be beneficial. If a therapeutic response is still not observed after treatment with 400 mg for six weeks, other treatment options should then be considered. Finally, for the adjunctive treatment of familial adenomatous polyposis, to reduce the number of adenomatous colorectal polyps, the usual dosage of Celebrex recommended is 400 mg administered twice daily with food. Patients should continue to receive usual medical care for familial adenomatous polyposis while being treated with Celebrex. For all uses of Celebrex, it is recommended that the lowest effective dosage be administered for the shortest duration of treatment possible in order to achieve the desired therapeutic response. Q: I was told by a doctor that the tendon on the underside of my elbow was slipping off the bone. He gave me a shot of Cortisone that did not help and he gave me Lortab. It is not helping. Would Celebrex help this any or do I need surgery right away?
A: Cortisone (prednisone) is a corticosteroid, used to reduce pain caused from inflammation and swelling, and Celebrex (celecoxib) is a COX-2 (cyclooxygenase-2) inhibitor, and also reduces pain from inflammation and swelling, but is not as strong as a steroid, while Lortab/Vicodin (hydrocodone+acetaminophen) just “masks” the pain by blocking the pain signal from reaching the brain. Only your doctor can determine if you need surgery, but these medications will probably not keep the tendon on the bone, unless the problem is from inflammation. Celebrex (celecoxib) was created because NSAIDs (non-steroidal anti-inflammatory drugs), such as Motrin/Advil (ibuprofen) or Aleve (naproxen), which were invented first, can cause bleeding, over time, in the GI (gastrointestinal) tract which includes the esophagus, leading into the stomach, the stomach, and the intestines, so if you have a history of ulcers or GI bleeding, NSAIDs may not be the right pain relievers for you. An alternative is Tylenol (acetaminophen), as it works differently, but it does not reduce inflammation. NSAIDs work by reducing the effects of prostaglandins, which cause inflammation, pain, and fever in the body. Two enzymes, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) make the prostaglandins work. COX-1 makes prostaglandins that support platelets and protect the stomach lining. When they are blocked, the platelets cannot cause the blood to clot as easily. Cox-2 makes the prostaglandins that cause inflammation, swelling, and as a result, pain. Of the NSAIDs, Mobic (meloxicam) is thought to go down the COX-1 pathway less than most of the NSAIDs. Scientists were able to make COX-2 inhibitors, which did not go down the COX-1 pathway much, but most of them (Vioxx, Bextra, etc.) were removed from the market, as they caused heart problems. Celebrex (celecoxib) is a COX-2 inhibitor that is still on the market and is considered safe, as long as the person taking it does not have any past heart problems or risk factors for them. Patti Brown, PharmD Q: What over-the-counter medications should not be taken with Celebrex?
A: Celebrex (celecoxib) belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDS work by reducing hormones that cause inflammation and pain in the body. Celebrex is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. It is also used in the treatment of hereditary polyps in the colon. Many over-the-counter pain medicines, headache medicines, and cold medicines contain aspirin or the NSAIDS ibuprofen (Advil, Motrin) and naproxen (Aleve). People on Celebrex should avoid these products because they contain the same kind of medication. Read labels carefully for the list of ingredients in over-the-counter medicines. Ask your local pharmacist if you have any questions about whether to take a certain over-the-counter product. Always read and follow the complete directions and warnings on over-the-counter medicines and discuss their use with your doctor before taking them. Sarah Lewis, PharmD Q: I have pain in my low back and hip because of a mild degeneration of the spine. I do not need hip replacement surgery yet. My doctor has prescribed Celebrex, but I don’t want to take it every day because of the side effects. I do take 4 ibuprofen a day. Is there something else I should be doing?
A: Celebrex (celecoxib) belongs to a group of drugs called non-steroidal anti-inflammatory drugs (NDAIDs). Celebrex works by reducing hormones that cause inflammation and pain. Common side effects of Celebrex include dizziness, constipation, stomach upset, and headache. Celebrex can be taken any time of the day with food. Advil, Motrin (ibuprofen) is a non-steroidal anti-inflammatory drug (NSAID). Advil works by reducing hormones that cause inflammation. Advil is used for pain treatment and inflammation. Common side effects of Advil include upset stomach, bloating, gas, headache, and diarrhea or constipation. Advil should be taken with food or a glass of milk. Advil can also increase the risk of stomach problems. Also Advil can increase the risk of heart problems such as heart attacks and strokes. This risk increases the longer that Advil is used. Prescribing information suggests that a individual take more than 6 tablets (200mg) of ibuprofen in 24 hours. Celebrex and Ibuprofen should not be taken together. Coadministration of Celebrex and Ibuprofen may increase the potential for serious gastrointestinal toxicity including inflammation, bleeding, ulceration, and perforation. The risk is dependent on both dosage and duration of therapy. If your pain from the degeneration of the spine cannot be controlled with the Celebrex, consult with your healthcare provider. Your doctor may be able to find you an alternative medication to control your pain without causing potential risks and unwanted side effects. Let your doctor know about all the over-the-counter medications you may be taking including herbals, vitamins, and supplements. Some over-the-counter products can interact with prescription medication or make certain medical conditions worse. Kimberly Hotz, PharmD Q: I take Celebrex once a day at bedtime? Could if be making me tired?
A: Celebrex (celecoxib) belongs to a group of drugs called non-steroidal anti-inflammatory drugs (NDAIDs). Celebrex works by reducing hormones that cause inflammation and pain. Common side effects of Celebrex include dizziness, constipation, stomach upset, and headache. According to prescribing information, fatigue was an infrequent side effect reported. This is not a complete list of the side effects associated with Celebrex. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kimberly Hotz,PharmD Q: Is there a difference between brand name Celebrex and generic? What is the name of the generic form?
A: Celebrex (celecoxib) is classified as a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). Celebrex is approved for the treatment of osteoarthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, rheumatoid arthritis, treatment of acute pain, primary dysmenorrhea, and for the reduction of intestinal polyps in familial adenomatous polyposis. In the United States, Celebrex is currently only available as a brand name medication. The drug company that makes Celebrex still has patent rights on the medication. In the future, when the generic becomes approved it will be marketed by the chemical name, celecoxib. Generic medications are less expensive alternatives to brand name medications. Generic medications can look differently and can have a few other minor differences from their brand name counterpart. However, their labeling and directions must be virtually the same as that of the brand name product. Generic products must contain the same active ingredient as the brand name products. Both brand name and generic drug manufacturing facilities must meet the United States Food and Drug Administration’s (FDA) specifications. Generics, as well as brand name medications, must follow the same standards of good manufacturing practices. The FDA requires that generic drugs be bioequivalent to the brand name medication. This means that both generic drugs and brand name drugs will work the same way in your body. Generics are considered by the FDA to be identical to brand name drugs in dose, strength, quality, route of administration, safety, efficacy, and intended use. Generic medications do not need to contain the same inactive ingredients as brand name medications. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh Q: I have been taking Celebrex for 9 months with no side effects. However, I recently have noticed a skin irritation similar to a bad sunburn where my skin is red and flaking off. I do not want to stop taking Celebrex as it has helped my severely arthritic right hip. I do not want to have hip replacement surgery now. Can Celebrex be the cause of the skin irritation?
A: Celebrex (celecoxib) is a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) which is approved for the treatment of osteoarthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, rheumatoid arthritis, management of acute pain, and treatment of primary dysmenorrhea. Celebrex treats pain and inflammation. COX-2 inhibitors, such as Celebrex, are marketed to have less gastrointestinal side effects than traditional NSAIDs. However, they still carry that risk. COX-2 inhibitors may also have an increased risk of heart attack and stroke over traditional NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). The most common side effects associated with Celebrex include hypertension (high blood pressure), headache, and diarrhea. Some potential dermatological side effects, which are listed in the prescribing information for Celebrex, include skin rash, bruising, cellulitis (skin infection), skin itching, dry skin, and sensitivity to the sun. The prescribing information for Celebrex does recommend to stop treatment and to see your healthcare provider if a rash develops. You will want to have your redness evaluated by your health care provider for proper diagnosis of the underlying cause and treatment options, if necessary. You may wish to see a dermatologist to determine what type of skin condition you have. For dry skin, a skin moisturizing cream or lotion can help with redness and flaking. Celebrex can make the skin more sensitive to the sun which could result in a sun burn. It is recommended to wear a sunscreen with at least SPF 15 everyday, even on cloudy days or when not expecting to be in the sun. Celebrex should be taken with food, if stomach upset develops. Celebrex can interact with over-the-counter (OTC) pain medications, so speak with your doctor before taking any OTC pain medications. It is important to discuss any side effects you experience from medications with your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Video: Celebrex: Stomach and Intestinal Side Effects Celebrex images

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Hello everyone. I just found this site last night. Sure wish I would have found it earlier but maybe it was good I didn’t. I tried to stay away from all types of groups because I am a worrier and I didn’t want to add to the what ifs, etc. while waiting for endless test results. I started radiation treatment yesterday. I will have 20 treatments. No idea about dosage or anything, they don’t say and I don’t know what to ask. I just know that I fell into a category for qualified me for hypofractionated radiation. Doc said I could do internal radiation for 5 days twice a day, that was a no for me. I am a little behind in research, I just saw the rad doc for the first time last Wednesday, had planning Thursday and started yesterday. I was super busy last weekend and then I have had a really bad flare up this week of my Rhuematoid Arthritis, haven’t been able to use my hands. Trying to figure out if I should be on a special diet (other than make sure I eat protein daily), etc. Right now exercise is out of the question. I have been off my RA meds for three months and the only thing I am on for it right now is the dreaded prednisone so I am flaring up for days at a time. Right now it is my hands, wrists and hip. Keeping my arms above my head for treatment is not helping with the shoulder flare ups either. I can only guess that will continue the entire time. How much water should I be drinking daily? Dx 10/18/2018, IDC, Right, <1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 11/26/2018 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 1/10/2019 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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Hello everyone. I just found this site last night. Sure wish I would have found it earlier but maybe it was good I didn’t. I tried to stay away from all types of groups because I am a worrier and I didn’t want to add to the what ifs, etc. while waiting for endless test results. I started radiation treatment yesterday. I will have 20 treatments. No idea about dosage or anything, they don’t say and I don’t know what to ask. I just know that I fell into a category for qualified me for hypofractionated radiation. Doc said I could do internal radiation for 5 days twice a day, that was a no for me. I am a little behind in research, I just saw the rad doc for the first time last Wednesday, had planning Thursday and started yesterday. I was super busy last weekend and then I have had a really bad flare up this week of my Rhuematoid Arthritis, haven’t been able to use my hands. Trying to figure out if I should be on a special diet (other than make sure I eat protein daily), etc. Right now exercise is out of the question. I have been off my RA meds for three months and the only thing I am on for it right now is the dreaded prednisone so I am flaring up for days at a time. Right now it is my hands, wrists and hip. Keeping my arms above my head for treatment is not helping with the shoulder flare ups either. I can only guess that will continue the entire time. How much water should I be drinking daily? Dx 10/18/2018, IDC, Right, <1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 11/26/2018 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 1/10/2019 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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Hi, If you have taken prednisone for more than a few weeks, your adrenal glands decrease cortisol synthesis. Hence, a gradual reduction in prednisone dosage is necessary as it gives your adrenal glands time to resume their normal functions. If you abruptly stop taking prednisone or taper off too quickly, you might experience prednisone withdrawal symptoms in the form of Severe fatigue, Weakness, Body aches, Joint pain, Nausea, Loss of appetite and Lightheadedness. The amount of time it takes to taper off prednisone depends on the disease being treated, the dose and duration of use, and other medical considerations. There are no set rules to direct the tapering process. This decision depends largely on clinical experience. You can consider to taper by lesser dose gradually every 3 days and eventually stop it completely. The other way of doing it is by tapering on an every-other-day basis, which is called ‘alternate-day taper’. Tapering may not always prevent withdrawal symptoms. People on long-term chronic therapy are clearly at greatest risk of experiencing withdrawal symptoms. Hence it needs to be done under medical supervision. Kindly consult your doctor for proper regimen and follow the instructions as advised by your doctor. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ashakiran S, General & Family Physician

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