Zobrex 200

Zobrex 200 is a hard capsule holding 200 mg of celecoxib per capsule, made by MacroPhar in Thailand. A box holds 1 strip of 10 capsules.

Celecoxib is an NSAID (non-steroidal anti-inflammatory drug) believed to work mainly by blocking the COX-2 enzyme, which is involved in making prostaglandins, the chemicals behind pain and inflammation.

Drug facts here come from documents for celecoxib 200 mg in general (Celebrex label, UK SmPC, MedlinePlus, NHS), not a Zobrex leaflet. Product details come from the Singapore listing. Read the leaflet in the box too.

What is celecoxib 200 mg for? Going by documents for celecoxib in general, it eases pain, swelling and stiffness in these cases.

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Acute pain in adults
• Primary dysmenorrhea (painful periods)

The Singapore listing for Zobrex names these uses and adds management of chronic low back pain. That use appears on the Singapore listing only, not in the US label or UK SmPC that were read.

A doctor or pharmacist sets the dose. General information for celecoxib 200 mg:

• Osteoarthritis — 200 mg once a day or in two divided doses, up to 200 mg twice a day if relief is not enough (UK SmPC).
• Rheumatoid arthritis — 100-200 mg twice a day (US label).
• Acute pain and period pain — 400 mg first, then 200 mg if needed on day 1; after that 200 mg twice a day as needed (US label).
• Maximum — 400 mg a day for every use (UK SmPC).
• Food — doses up to 200 mg can be taken with or without food; larger doses go with food (MedlinePlus).
• Missed dose — take it when you remember unless the next one is nearly due. Never double up.
• Lower starting doses — older adults start at 200 mg a day; moderate liver impairment means half the dose.

From the Celebrex label, MedlinePlus and the NHS.

• Common — gas or bloating, stomach ache, diarrhoea, feeling sick, indigestion, dizziness, headache, rash, sore throat, cold symptoms, constipation and a change in taste.
• Figures from osteoarthritis and rheumatoid arthritis trials (Celebrex against placebo) — indigestion 8.8% against 6.2%, diarrhoea 5.6% against 3.8%, headache 15.8% against 20.2%.

Stop and get medical help for stomach pain, vomit that is bloody or like coffee grounds, black tarry stools, a rash or allergic reaction (including the severe drug reaction called DRESS), or signs of liver disease.

• Heart and blood vessels — NSAIDs, celecoxib included, raise the risk of heart attack and stroke, which can be fatal. The risk may be higher with long-term use (boxed warning on the Celebrex label).
• Stomach and gut — a risk of bleeding, ulcers and perforation, which can be fatal. It is higher in older adults and in people who have had an ulcer or stomach bleeding.
• Allergy — do not use with an allergy to celecoxib or sulfa drugs, or if aspirin or another NSAID has caused asthma, hives or an allergic reaction.
• Heart bypass surgery (CABG) — do not use around the operation.
• Ruled out by the UK SmPC — an active ulcer or bleeding, inflammatory bowel disease, heart failure (NYHA II-IV), ischaemic heart disease, peripheral arterial disease and cerebrovascular disease.
• Liver and kidney — do not use with severe liver dysfunction or creatinine clearance under 30 ml/min. Kidney function needs monitoring with kidney disease, heart failure or dehydration.
• Pregnancy and breastfeeding — the NHS says NSAIDs are not usually recommended; the US label limits use from about 20 weeks, and the UK SmPC rules out use in pregnancy and breastfeeding.

• Arcoxia (Etoricoxib) — also a COX-2 drug and the closest to Zobrex 200 in the store. Pick it when you want another COX-2 option.
• Ibrofen 400 (Ibuprofen) — a traditional NSAID that does not target COX-2 specifically. Pick it when you want ibuprofen.
• Nurofen Zavance (Ibuprofen) — also ibuprofen, another brand to choose from.
• Soproxen (Naproxen) — another traditional NSAID. Pick it when you want naproxen.

Celebrex is the original celecoxib brand and is not sold here. In the 9-month CLASS study, the difference in complicated ulcers against ibuprofen and diclofenac was not statistically significant, so it carries the same stomach bleeding warning as its class.

In short: for another COX-2 drug look at Arcoxia; for a traditional NSAID look at Ibrofen 400, Nurofen Zavance or Soproxen. If unsure, ask a pharmacist first.

• Anticoagulants such as warfarin — a combined effect on bleeding; monitoring is needed.
• Aspirin — pain-relief doses are not recommended together, low-dose aspirin raises the risk of stomach ulcers, and celecoxib cannot replace low-dose aspirin for heart protection.
• Other NSAIDs — not recommended: more stomach irritation for little extra benefit.
• ACE inhibitors, ARBs and diuretics — their effect may be weaker and kidney function can be affected.
• Fluconazole — may raise celecoxib levels, and the UK SmPC says to use half the dose. Rifampin may weaken celecoxib.
• SSRIs and SNRIs such as sertraline, fluoxetine and duloxetine, and oral steroids — MedlinePlus lists them as interacting with celecoxib.
• Alcohol — large amounts raise the risk of stomach bleeding.

Tell a pharmacist or doctor about every medicine, supplement and herb you take before you start.

• Peak blood level — about 3 hours after a dose (a mean of 2.8 hours when fasting). The UK SmPC says 2-3 hours.
• High-fat meal — delays the peak by 1-2 hours and raises total absorption by 10-20%.
• Half-life — about 11 hours when fasting. The UK SmPC says 8-12 hours.

The documents read do not say when pain improves, and it differs from person to person. If you see no change, ask a pharmacist or doctor.

Where can you buy Zobrex 200?

Order online from Intimo Life, shipped across Thailand in 1-3 working days. Packed discreetly for privacy, with no product name on the parcel.