Exploring the Impact of Co-Crystal Celecoxib and Tramadol Combination

Exploring the Impact of Co-Crystal Celecoxib and Tramadol Combination

Combining tramadol and celecoxib into a co-crystal of celecoxib-tramadol gives peripherally and centrally mediated analgesia.

The Countrywide Institutes of Health report that agony is the most popular reason for in search of clinical treatment.1 Details from 2012 estimated that 126.1 million grownups in the United States put up with from pain,2 which can be nociceptive (from tissue damage), neuropathic (from nerve injuries), or nociplastic (from a sensitized nervous procedure). There is also overlap in the distinctive kinds of soreness.3

Multimodal remedy to address suffering isdefined by the Global Affiliation for the Review of Agony as the concurrent use of different therapeutic brokers with diverse mechanisms of motion. This combination of brokers is aimed to handle diverse ache mechanisms.4,5 Co-crystal formulations can be thought of a multimodal remedy.

The Fda defines co-crystals as crystalline elements composed of 2 or a lot more various molecules in the exact lattice.6 Combining tramadol and celecoxib into a co-crystal of celecoxib-tramadol (CTC) offers peripherally and centrally mediated analgesia.4

Mechanism OF Motion

CTC (Seglentis Kowa Prescribed drugs The us, Inc) is an Food and drug administration-accepted Plan IV managed substance. It is indicated for the management of acute discomfort in adults that is severe more than enough to call for an opioid analgesic and for which substitute treatment plans are inadequate.

The manner of action of tramadol is not absolutely comprehended. It is thought to be owing to binding to mu-opioid receptors and weak inhibition of reuptake of norepinephrine and serotonin. The system of motion of celecoxib is considered to be due to inhibition of prostaglandin synthesis, generally through cyclooxygenase-2 (COX-2).7


CTC contains celecoxib 56 mg and tramadol hydrochloride 44 mg. Initiate treatment with 2 tablets every single 12 several hours as needed for pain relief. When starting up remedy with this celecoxib-tramadol tablet formulation, contemplate the discomfort severity, individual response, prior analgesic cure, and risk things for habit, abuse, and misuse.

The whole prescribing information recommends to focus on availability of naloxone with the affected individual. CTC should be employed for the shortest length aligned with client treatment method goals.7

Clinical TRIALS

The efficacy and basic safety of CTC was evaluated in a randomized, double-blind, parallel team examine comparing CTC to tramadol, celecoxib, and placebo for acute suffering after bunionectomy with osteotomy (bone cutting process). The examine enrolled individuals ≥18 decades of age with acute postoperative soreness (rated >5 and <9 on a 0-10 Numeric Pain Rating Scale [NPRS]). Patients had a mean baseline pain intensity of 6.7 on the NPRS.7

The primary efficacy endpoint was time-weighted summed pain intensity difference over 48 hours (SPID48). Researchers reported patients in the CTC group had statistically significantly better mean SPID48 scores than any of the other groups after bunionectomy.7

Negative differences in the score corresponded to an amelioration of pain. The total scale ranged from -480 (best) to +480 (worst). A higher negative value of SPID indicated greater pain relief (Table 1).8

Table 1. Outcome Measures8


The most common AEs with incidence greater than 5{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} in adults taking CTC are nausea, vomiting, dizziness, headache, and somnolence. There is a boxed warning in the FDA-approved label that describes the risks of addiction, abuse, and misuse. The celecoxib-tramadol tablet is available under the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program.7

The boxed warning also includes cardiovascular thrombotic events and risk factors for life-threatening respiratory depression in children. It also describes gastrointestinal bleeding, ulceration, and perforation.

Cytochrome P450 interactions and risk with concomitant CNS depressants are also explained. Due to the large volume of information in the boxed warning, pharmacists should refer to the full prescribing information for comprehensive details.7

CTC is contraindicated in ages <12 years of age and during postoperative management in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. It should not be used in CABG surgery or in individuals with acute or severe bronchial asthma.

CTC is contraindicated with gastrointestinal obstruction and with monoamine oxidase inhibitors (MAOIs) within the past 14 days. It should not be used in individuals with urticaria or other allergic reactions after taking aspirin or other nonsteroidal anti-inflammatory agents. Additional warnings include serotonin syndrome, risk of seizure, risk of suicide, adrenal insufficiency, renal and hepatotoxicity.7


There is a risk of fetal harm with CTC in pregnant women. Breastfeeding is not recommended. The safety and efficacy of CTC in pediatrics has not been established. Elderly individuals taking nonsteroidal anti-inflammatory agents are determined to be at greater risk for serious AEs so individuals taking CTC should be monitored.7

In summary, despite the availability of multiple pharmacotherapies, many individuals

continue to suffer in pain. Because pain can involve multiple mechanisms, combining products with different mechanisms of action, or in the form of a co-crystal formulation, may be a therapeutic option.


  1. Pain. National Institutes for Health. National Center for Complementary and Integrative Health. Updated June 3, 2022. Accessed June 3, 2022. https://www.nccih.nih.gov/health/pain
  2. Nahin R. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 201516(8):769-780. doi:10.1016/j.jpain.2015.05.002
  3. Cohen S., Vase L., Hooten W. Chronic pain: an update on burden, best practices and new advances. Lancet.2021397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7
  4. Almansa C, Frampton C, Vela J, Whitelock S, Plata-Salamán C. Co-crystals as a new approach to multimodal analgesia and the treatment of pain. J Pain Res.201912:2679–2689
  5. Raffa R, Pergolizzi J Jr., Tallarida R. Analgesic combinations. J Pain.201011(8):701–709. doi:10.1016/j.jpain.2009.12.010
  6. Regulatory classification of pharmaceutical co-crystals guidance for the industry. US Food and Drug Administration. February 2018. Accessed 6/3/2022. https://www.fda.gov/media/81824/download
  7. Seglentis. Prescribing information. Kowa Pharmaceuticals America, Inc. 2021. Accessed June 1, 2022. https://www.kowapharma.com/documents/SEGLENTIS_Prescribing_Information.pdf
  8. Seglentis. Efficacy demonstrated in the phase 3 clinical trial. Kowa Pharmaceuticals America, Inc. May 2022. Accessed June 1, 2022. https://www.seglentis.com/clinical-data/efficacy