Celebrex with Valtrex: A PubMed review

Raoul T wrote on Health Rising asked me:

Hi Ken, Maybe I was over reacting but i was intrigued to learn about the feature “Big Antiviral Trial Could Usher in New Treatment Era for FM” on Health Rising a couple of weeks ago discussing the promising use of Celebrex with Valtrex as a new and effective strategy for FM and CFS. I just wondered what you opinion on this might be. Are there significant heath risks associated with Celebrex? If so are there any good alternatives? Has anyone you know tried or had success using this therapy?
 

This is a difficult question to answer well in comments, so I am answering in a post. I am also declaring that I am evaluating it against my current model of CFS is: a stable dysfunction of microbiota.

Celebrex is a nonsteroidal anti-inflammatory drug (NSAID – i.e. acteaminophen like) and selective COX-2 inhibitor Valacycloviris an antiviral drug effective against several members of the Herpes family (which is associated with some CFS sub-populations).

To test against the model, I grab my microflora grid:

Antibiotic Family Klebsiella/Enterobacter Enterococcus Streptococcus E.Coli Bifidobacterium Lactobacillus
In CFS Patients HIGH HIGH HIGH low low low
Celebrex N/I INCREASE N/I INCREASE REDUCES (?) N/I
Valacyvlovir N/I N/I N/I N/I N/I N/I
Herpes Virus:
  • N/I – No Information
  • (?) Study is not clear (drug combination involved so uncertainity

On the other side, the presence of the virus does impact the microbiota [2013],[2008], [2013]

For CFS, there are three studies on Valacyclovir – all done by a team lead by AM Lerner:

And one with Fibromyalgia – “No effect of antiviral (valacyclovir) treatment in fibromyalgia: a double blind, randomized study.”[2004] “Valacyclovir cannot be recommended as a therapy for FM at this point.” and none for IBS.

Bottom Line

This treatment appears effective for a minority subset of those matching a research definition of CFS (and likely an even smaller number of the general CFS population). Appropriate testing should occur before the start and if the results of the testing does not match that of the subset, it is best not to proceed with this treatment.  I am opposed to “well, it’s not an exact match — but let us try it anyway” approach of some MDs.

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