Celcoxx Drug Interactions

General: Celecoxib metabolism is predominantly mediated via cytochrome P-450 2C9 in the liver. Co-administration of celecoxib with drugs that are known to inhibit 2C9 should be done with caution. Patients who are known or suspected to be P-450 2C9 poor metabolizers based on a previous history should be administered celecoxib with caution as they may have abnormally high plasma levels due to reduced metabolic clearance.
ACE Inhibitors: Reports suggest that NSAID may diminish the antihypertensive effect of Angiotensin Converting Enzyme (ACE) inhibitors. This interaction should be given consideration in patients taking celecoxib concomitantly with ACE inhibitors.
Furosemide: Clinical studies, as well as post-marketing observations have shown that NSAIDs can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
Aspirin: Celecoxib can be used with low dose aspirin. However, concomitant administration of aspirin with celecoxib may result in an increased rate of GI ulceration or other complications, compared to use of celecoxib alone. Because of the lack of platelet effects, celecoxib is not a substitute for aspirin for cardiovascular prophylaxis.
Fluconazole: Concomitant administration of fluconazole at 200 mg 4 times daily resulted in a 2-fold increase in celecoxib plasma concentration. This increase is due to the inhibition of celecoxib metabolism via P-450 CYP2C9 by fluconazole. Celecoxib should be introduced at the lowest recommended dose in patients receiving fluconazole.
Lithium: Clinical studies showed that the mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 mg twice daily with celecoxib 200 mg twice daily as compared to subjects receiving lithium alone. Patients on lithium treatment should be closely monitored when celecoxib is introduced or withdrawn.
Warfarin: Anticoagulant activity should be monitored, particularly in the 1st few days, after initiating or changing celecoxib therapy in patients receiving warfarin or similar agents, since these patients are at an increased risk of bleeding complications.
Antacid: Co-administration of celecoxib with an aluminum- and magnesium-containing antacid resulted in a reduction in plasma celecoxib concentrations. No dose adjustment is required.
Glucocorticoids: Oral glucocorticoids should be used with caution since they increase the risk of GI side effects eg, ulceration and bleeding. This is especially the case in older (>85 yrs) individuals.