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Related Experiment Videos

Celecoxib-induced methemoglobinemia.

Prashant Kaushik1, Steven J Zuckerman, Nicholas J Campo

  • 1Department of Internal Medicine, Hospital Medicine Group, Baton Rouge General Medical Center, Baton Rouge, LA, USA. kaushikprashant@hotmail.com

The Annals of Pharmacotherapy
|August 26, 2004
PubMed
Summary

Celecoxib, a common osteoarthritis drug, can cause acute methemoglobinemia, a serious condition. Prompt treatment with methylene blue and other therapies can reverse these effects.

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Area of Science:

  • Pharmacology
  • Toxicology
  • Internal Medicine

Background:

  • Celecoxib is a selective cyclooxygenase-2 inhibitor used for osteoarthritis.
  • Acute methemoglobinemia is a rare but potentially fatal condition characterized by impaired oxygen transport.
  • Nonspecific symptoms of methemoglobinemia can include headache, fatigue, and dyspnea, potentially progressing to severe outcomes.

Observation:

  • A 72-year-old man developed an acute confusional state after one month of celecoxib treatment for knee osteoarthritis.
  • No other causes for the acute confusional state were identified.
  • Severe methemoglobinemia was diagnosed (serum methemoglobin fraction 9%).

Findings:

  • Treatment with methylene blue significantly improved the patient's symptoms and reduced methemoglobin levels.

Related Experiment Videos

  • Discontinuation of celecoxib and supportive care with riboflavin and ascorbic acid led to full recovery.
  • The Naranjo probability scale indicated a probable link between celecoxib and the methemoglobinemia.

    • Implications:

    • This case highlights a potential adverse effect of celecoxib, emphasizing the importance of considering drug-induced methemoglobinemia.
    • Early recognition and intervention, including drug withdrawal and administration of antidotes, are crucial for managing celecoxib-associated methemoglobinemia.
    • Clinicians should be aware of this association when patients present with unexplained symptoms during celecoxib therapy.