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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
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.
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.
- 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.