Limited Use Note(s)

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CELECOXIB100mg Cap
Reason For Use CodeClinical Criteria
Osteoarthritis
316For patients who have failed an adequate trial of acetaminophen (e.g. acetaminophen 1g QID for several weeks) and have had:
History of a documented, clinically significant ulcer or GI bleed; or Failure or intolerance to at least three listed NSAIDS.
NOTE: The maximum daily dose of celecoxib which will be reimbursed for the treatment of osteoarthritis is 200mg.
LU Authorization Period: 1 year
Rheumatoid arthritis
317For patients who have had:
History of a documented, clinically significant ulcer or GI bleed; or Failure or intolerance to at least three listed NSAIDS.
NOTE: The maximum daily dose of celecoxib which will be reimbursed for the treatment of rheumatoid arthritis is 400mg.
LU Authorization Period: 1 year