Filler in meds is not cause of symptoms

Dear Dr. Roach: I have a question about excipients. Twice in my life, I took Celebrex for orthopedic pain. The episodes were about five years apart. Both times, I suffered severe liver disfunction, turned yellow, lost weight and had dark urine and abnormal ALT, AST and bilirubin counts, etc. My doctor said the reaction was caused by the sulfonamide base in Celebrex. Is sulfonamide used as an excipient in many other drugs? Should I be wary? Is there any advice other than just steering clear of all drugs with sulfonamide excipients? — T.R.

An excipient is a substance used in a medication that is not an active ingredient. This includes fillers to make a tablet hold its shape, a dye or a preservative. An ideal excipient does not cause any side effects. However, no excipient is perfect, and occasionally people have reactions to the inactive ingredients in a medication.

It’s the active ingredient in celecoxib (Celebrex), not any excipient, that contains a sulfonamide group. People are frequently allergic to the sulfonamide groups in antibiotics. While in theory, people with allergies to sulfonamide antibiotics can also be allergic to Celebrex, this appears to be very rare.

I reviewed the reports of liver damage with Celebrex and found rare accounts of people with elevations in the ALT and AST enzymes made in the liver. High levels of these in the blood represent damage to liver cells. The accounts did not include high bilirubin. It represents damage to the bile ducts. Your reaction to Celebrex is quite unusual. However, avoiding sulfonamide antibiotics might be prudent. Other drugs to be concerned with include the diuretics hydrochlorothiazide and furosemide; sulfonylurea diabetes drugs like glipizide; the “triptan” anti-migraine drugs like sumatriptan (Imitrex); and a few others.