Celecoxib, as a selective COX-2 inhibitor, is mainly used for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. It has good anti-inflammatory and analgesic effects with few gastrointestinal side effects, but attention should be paid to cardiovascular risks and individualized discontinuation plans.

1. Evaluation of treatment efficacy

(1) Osteoarthritis

Taking 200mg once or twice a day can significantly improve joint pain and function, with efficacy comparable to naproxen but reducing the risk of gastrointestinal ulcers by 57%.

(2) Rheumatoid arthritis

The dosage of 100-200mg twice daily is equivalent to traditional NSAIDs in improving morning stiffness and joint swelling, and the incidence of ulcers under endoscopy is only 1/4 of that of traditional drugs.

(3) Acute pain

The first dose of 400mg followed by 200mg twice daily has a similar analgesic effect to ibuprofen 400mg after dental surgery, with an onset time of about 30 minutes.

2. Precautions for discontinuation of medication

(1) Conventional discontinuation plan

Long term medication users should gradually reduce their dosage by 50mg every 2-3 days to avoid worsening rebound pain and inflammatory reactions.

(2) Cardiovascular risk monitoring

Sudden discontinuation of medication may increase the risk of thrombotic events, and hypertensive patients should continue to monitor their blood pressure for at least 2 weeks after discontinuation.

(3) Gastrointestinal protection

For those with a history of digestive ulcers, it is recommended to continue using PPI drugs for 4-8 weeks after discontinuation to prevent delayed ulcers.

3. Drug discontinuation management for special populations

(1) Liver dysfunction

Child Pugh B/C patients should extend the reduction period to 5-7 days when discontinuing medication, and monitor ALT/AST for one month after discontinuation.

(2) Renal insufficiency

Patients with eGFR<30mL/min need to monitor urinary protein before and after discontinuation, and delay the discontinuation process if abnormalities occur.

(3) Elderly patients

Patients aged 65 and above are recommended to adopt a slower reduction plan (25mg reduction per week) and strengthen fall risk assessment.