Celebrex

My mom was diagnosed with Hep C. We do not know how long she has had it.  She is 64 but she also has osteoporosis and arthritis in her lower back.  The back doctor just prescribed Celebrex, is this the safest drug for her?   Also what should people with Hep C do to better care for their liver eventhough so far she seems to have a healthy liver.  For the osteoporosis she is on Fosamax.  She has been on it for several years.  I am just afraid that too many potent drugs can be harmful for her liver.  But I realize that they do have to get control over the swelling on her articulations.


This discussion is related to Re: celebrex and hep c.

[Bill1954]

I can’t comment on celebrex, but acetaminophen remains the most widely recommended analgesic for Hep C patients. Despite its liver toxicity, taken in prescribed doses seems to be the best overall pain killer for us:
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Jorge L. Herrera M.D.
Division of Gastroenterology
University of South Alabama College of Medicine
Mobile AL

http://www.hcvadvocate.org/hcsp/articles/Herrera.html

“Acetaminophen use: Contrary to popular belief, acetaminophen (the active ingredient in Tylenol®) is perfectly safe for patients with cirrhosis as long as it is used cautiously. Any person who drinks alcohol regularly should not consume any acetaminophen. For patients with early cirrhosis (CPT class A or B), the use of acetaminophen is safe as long as the recommended dose is not exceeded (1,000 mg per dose, repeated no more often than every 6 hours). Patients with more advanced cirrhosis should take only ½ of the recommended dose. In fact, for patients with cirrhosis, acetaminophen, when used as described, is the preferred medication for the treatment of pain.”
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Her doctor should be informed of any changes in medication; you’re correct; some of them can be harmful to her, especially over long periods. Other than that, achieving and maintaining proper weight and avoiding alcohol are about all she can do in terms of diet.

Best of luck to you both—

Bill

[JennyPenny]

This is the opinion of my hep doctor. Fosamax is safe for liver patients. Celebrex in the short term (for a couple of weeks) should not be harmful. However, it is not something he wants me on for any length of time.

[FloridaMouse]

I am a  hepper with rheumatoid arthritis.  I took Celebrex for a year while I was on treatment this last time at the recommendation of Shands at the University of Florida.  I made the decision to come off the Celebrex on  my own because of all the black box warnings that came out regarding the heart while on Celebrex.

I just came back from Shands on 7/21.  I was up there for another evaluation after having relapsed for a second time.   We discussed Celebrex in detail and the head of hepatobilliary department at Shands, who writes a lot of the research you see, said he has absolutely no problem with me taking Celebrex long term.  I am a hepper with cirrhosis, I have a healthy heart and well controlled hypertension.  I think as long as your mom doesn't have heart issues and she gets regular physian followups that she will benefit from Celebrex.  I know I do.

Mouse

[JennyPenny]

Wow, isn't that amazing. Such a difference of opinion. My doc at Mt Sinai said short term only. This is why one must check with their own doctors who know them best. And definitely do not take what those on the internet say as gospel. Also, I think the doctors weigh the risk against the benefit for each individual patient.

[CoWriter]

You probably remember a study that showed that Aspirin (acetylsalicylic acid) inhibits viral replication.

http://www.hivandhepatitis.com/hep_c/news/2008/062008_a.html

The study's investigators concluded.... "our findings suggest that the anti-HCV effect of acetylsalicylic acid in the Huh7 replicon cells IS DUE TO ITS INHIBITORY EFFECT ON COX-2 EXPRESSION"

And CELEBREX  is also a COX-2 inhibitor.  So it might help inhibit viral replication.

Also.....

The Hepatitis C virus induces COX-2 activation via oxidative stress.....and the activation of COX-2 is implicated in HCV-associated liver cancer, so inhibiting COX-2 with something like Celebrex, would maybe help prevent liver cancer.

That's why many hepatologists have no problem using it.  But as you say, your doctor is the only one who's familiar with your condition and only he can tell you whether it is safe for you to use Celebrex (or any other meds).

Co




Hepatitis C virus stimulates the expression of cyclooxygenase-2 (Cox-2) via oxidative stress: role of prostaglandin E2 in RNA replication.

Waris G, Siddiqui A.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, which can lead to the development of liver cirrhosis and hepatocellular carcinoma. Recently, the activation of cyclooxygenase-2 (Cox-2) has been implicated in the HCV-associated hepatocellular carcinoma. In this study, we focus on the signaling pathway leading to Cox-2 activation induced by HCV gene expression. Here, we demonstrate that the HCV-induced reactive oxygen species and subsequent activation of NF-kappaB mediate the activation of Cox-2. The HCV-induced Cox-2 was sensitive to antioxidant (pyrrolidine dithiocarbamate), Ca(2+) chelator (BAPTA-AM), and calpain inhibitor (N-acetyl-Leu-Leu-Met-H). The levels of prostaglandin E(2) (PGE(2)), the product of Cox-2 activity, are increased in HCV-expressing cells. Furthermore, HCV-expressing cells treated with the inhibitors of Cox-2 celecoxib (Celebrex) and NS-398 showed significant reduction in PGE(2) levels. We also observed the enhanced phosphorylation of Akt and its downstream substrates glycogen synthase kinase-3beta and proapoptotic Bad in the HCV replicon-expressing cells. These phosphorylation events were sensitive to inhibitors of Cox-2 (celecoxib and NS-398) and phosphatidylinositol 3-kinase (LY294002). Our results also suggest a potential role of Cox-2 and PGE(2) in HCV RNA replication. These studies provide insight into the mechanisms by which HCV induces intracellular events relevant to liver pathogenesis associated with viral infection.

http://www.ncbi.nlm.nih.gov/sites/entrez