CELECOXIB Drug Interactions
Also known as: celecoxib
CELECOXIB (brand name: celecoxib) is a NSAIDs. 1 INDICATIONS AND USAGE Celecoxib capsules are indicated Celecoxib capsules are a nonsteroidal anti-inflammatory drug indicated for: • Osteoarthritis (OA) ( 1.1 ) • Rheumatoid Arthritis (RA) ( 1.2 ) • Juvenile Rheumatoid Arthritis (JRA) in patients 2 years and older ( 1.3 ) • Ankylosing Spondylitis…CELECOXIB has 19 documented drug interactions in our database, including 0 contraindicated, 17 major, 2 moderate, and 0 minor interactions.
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Contraindicated
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Major
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Moderate
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Minor
Combining celecoxib with low-dose aspirin significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided unless specifically recommended and closely monitored by your doctor.
Mechanism
Celecoxib, a COX-2 selective NSAID, inhibits prostaglandin synthesis which can impair gastric mucosal protection. Aspirin, even at low doses, irreversibly inhibits platelet aggregation via COX-1 inhibition. The additive antiplatelet effect of aspirin combined with the gastrointestinal mucosal damage from celecoxib substantially elevates bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage). Symptoms may include black, tarry stools, vomiting blood, or unusual bruising. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. This combination should be avoided if possible. If concomitant therapy is deemed essential, use the lowest effective doses for the shortest duration, and consider gastroprotective agents (e.g., proton pump inhibitors). Patients must be closely monitored for signs of bleeding, and alternatives to celecoxib should be explored.
Combining celecoxib with apixaban significantly increases your risk of serious bleeding, including internal bleeding. Your doctor will likely recommend avoiding this combination.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which impairs platelet aggregation and damages the gastrointestinal mucosa, increasing bleeding risk. Apixaban is a direct oral anticoagulant that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents results in additive antihemostatic effects.
Clinical Management
This combination substantially increases the risk of major bleeding events, including gastrointestinal bleeding, intracranial hemorrhage, and other site-specific bleeding. Studies show a significantly elevated risk of major bleeding (e.g., 2-4 fold higher) compared to anticoagulant monotherapy, particularly in the GI tract. Avoid concurrent use of celecoxib and apixaban. If an analgesic is required, consider acetaminophen or opioid analgesics as alternatives. If NSAID use is absolutely unavoidable and the benefits outweigh the risks, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding. Consider proton pump inhibitor co-therapy to mitigate GI bleeding risk.
Combining celecoxib (a pain reliever) with rivaroxaban (a blood thinner) significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor may need to adjust your medications or monitor you closely.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation. Rivaroxaban is a direct oral anticoagulant that inhibits Factor Xa, preventing clot formation. The combination leads to additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage, substantially elevating bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, but also other sites like intracranial hemorrhage. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 1.5 to 2-fold compared to DOACs alone, with gastrointestinal bleeding being the most common and serious manifestation. Avoid concomitant use if possible. If concurrent use is unavoidable, use the lowest effective dose of celecoxib for the shortest duration. Closely monitor for signs and symptoms of bleeding (e.g., black stools, unusual bruising, blood in urine). Consider gastroprotective agents (e.g., PPIs) if NSAID use is essential. Evaluate alternative pain management strategies that do not increase bleeding risk.
Combining celecoxib with argatroban significantly increases your risk of bleeding, including serious and life-threatening bleeding episodes. This combination should generally be avoided.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation, although its COX-2 selectivity means a lesser effect on platelets than non-selective NSAIDs. Argatroban is a direct thrombin inhibitor that directly interferes with the coagulation cascade. The concurrent use leads to additive antihemostatic effects, increasing the risk of hemorrhage.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This can manifest as gastrointestinal bleeding (e.g., melena, hematemesis), intracranial hemorrhage, hematuria, epistaxis, or excessive bruising. The risk of major bleeding is significantly elevated compared to either drug alone. This combination should generally be avoided due to the high risk of severe bleeding. If concurrent use is absolutely necessary, it should be done with extreme caution, close monitoring for signs of bleeding, and frequent assessment of coagulation parameters (e.g., aPTT for argatroban). Consider alternative pain management strategies that do not involve NSAIDs. If an NSAID is unavoidable, consider topical formulations with lower systemic absorption, though even these carry some risk.
Combining celecoxib with bivalirudin significantly increases your risk of bleeding, including serious internal bleeding. Your doctor may need to adjust your medications or monitor you closely.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair platelet function and damage the gastrointestinal mucosa, increasing the risk of bleeding. Bivalirudin is a direct thrombin inhibitor, which directly interferes with the coagulation cascade. The concurrent use leads to an additive pharmacodynamic effect, significantly increasing the risk of hemorrhage.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., melena, hematemesis), hematuria, epistaxis, bruising, or even intracranial hemorrhage. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. Concurrent use should generally be avoided due to the high bleeding risk. If co-administration is deemed absolutely necessary, it should be done with extreme caution, very close monitoring for signs of bleeding, and the lowest effective doses for the shortest possible duration. Consider alternative pain management strategies that do not increase bleeding risk.
Concomitant use of celecoxib with warfarin significantly increases the risk of serious bleeding events, including gastrointestinal hemorrhage. Patients may experience bruising, epistaxis, hematuria, or melena, potentially leading to hospitalization or death.
Mechanism
Celecoxib, a COX-2 inhibitor, can inhibit platelet aggregation to some extent and cause gastrointestinal irritation, increasing the risk of bleeding. It also displaces warfarin from plasma protein binding sites and inhibits warfarin metabolism (CYP2C9), leading to increased free warfarin concentrations and enhanced anticoagulant effect.
Clinical Management
Avoid concomitant use if possible. If co-administration is necessary, closely monitor INR and for signs of bleeding, especially during initiation or dose changes of celecoxib. Adjust warfarin dose as needed to maintain target INR.
Taking celecoxib with warfarin significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor or pharmacist will likely advise against using these medications together.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Warfarin, an anticoagulant, inhibits vitamin K-dependent clotting factors. The combination leads to an additive antiplatelet effect and increased gastrointestinal mucosal damage, potentiating the risk of hemorrhage.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, which can be life-threatening. Studies show that concurrent use of NSAIDs with warfarin can increase the risk of serious GI bleeding by 3 to 15 times compared to warfarin alone. Other bleeding sites, such as intracranial hemorrhage, can also be elevated. Concurrent use of celecoxib and warfarin should generally be avoided due to the high risk of severe bleeding. If an NSAID is absolutely necessary, consider alternatives with lower GI risk or shorter half-lives, and monitor INR very closely. Proton pump inhibitors should be co-prescribed to reduce GI bleeding risk if the combination is unavoidable. Consider non-pharmacological pain management or non-NSAID analgesics.
Combining celecoxib with dabigatran significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the serious bleeding potential.
Mechanism
Celecoxib, a COX-2 selective NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal defense and platelet function (to a lesser extent than non-selective NSAIDs). Dabigatran is a direct thrombin inhibitor, which prevents clot formation. Their combined effect leads to an additive increase in bleeding risk by affecting both primary hemostasis and the coagulation cascade.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal bleeding (e.g., stomach ulcers, melena, hematemesis), intracranial hemorrhage, and other serious bleeding events. The risk of major gastrointestinal bleeding can be substantially elevated compared to either drug alone. This combination should generally be avoided. If concurrent therapy is absolutely necessary, use the lowest effective dose of celecoxib for the shortest possible duration, and consider gastroprotective agents (e.g., proton pump inhibitors). Closely monitor for signs and symptoms of bleeding, and regularly assess hemoglobin and hematocrit levels. Alternative pain management strategies that do not increase bleeding risk should be explored.
Combining celecoxib with edoxaban significantly increases your risk of serious bleeding, including internal bleeding. This combination should generally be avoided due to the heightened bleeding risk.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal defense and platelet aggregation, thereby increasing the risk of gastrointestinal bleeding. Edoxaban is a direct oral anticoagulant (DOAC) that inhibits Factor Xa, preventing clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or life-threatening. Other bleeding sites may include intracranial hemorrhage, hematuria, or epistaxis. Studies show that combining NSAIDs with anticoagulants can increase GI bleeding risk by 3 to 15 times. This combination should be avoided if possible. If an NSAID is absolutely necessary, consider alternative pain management strategies or a different NSAID with lower systemic absorption (e.g., topical diclofenac) under strict medical supervision. Closely monitor for signs of bleeding (e.g., black/tarry stools, unusual bruising, prolonged bleeding from cuts). Proton pump inhibitor co-therapy may be considered to reduce GI bleeding risk if NSAID use is unavoidable.
Combining celecoxib with heparin significantly increases your risk of bleeding, which can be serious or even life-threatening. Your doctor will likely avoid this combination or monitor you very closely.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair platelet function and disrupt the integrity of the gastrointestinal mucosa. Heparin is an anticoagulant that inhibits various clotting factors, primarily through potentiation of antithrombin. The combined effect of impaired platelet aggregation, mucosal damage, and systemic anticoagulation leads to an additive and synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and bleeding from other sites. This risk can be substantial, with GI bleeding risk potentially 3-15 times higher than with either drug alone. Symptoms may include black, tarry stools, blood in vomit, easy bruising, or unusual bleeding. This combination should generally be avoided due to the high risk of serious bleeding. If co-administration is absolutely necessary, the patient must be closely monitored for signs and symptoms of bleeding, and laboratory parameters such as hemoglobin, hematocrit, and coagulation tests (e.g., aPTT) should be regularly assessed. Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen.
Combining celecoxib (an NSAID) with enoxaparin (a blood thinner) significantly increases your risk of serious bleeding, including internal bleeding. This combination should generally be avoided.
Mechanism
Celecoxib, like other NSAIDs, inhibits prostaglandin synthesis, which can impair platelet function and disrupt the integrity of the gastrointestinal mucosa. Enoxaparin directly inhibits clotting factors, primarily Factor Xa, leading to reduced blood clot formation. The concurrent use of these agents results in an additive antihemostatic effect.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of major bleeding can be several-fold higher compared to using either drug alone, potentially leading to hospitalization or life-threatening complications. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely unavoidable, the patient must be closely monitored for signs of bleeding (e.g., black stools, unusual bruising, dizziness, fatigue). Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. If an NSAID is necessary, a proton pump inhibitor (PPI) should be co-prescribed to reduce GI bleeding risk.
Combining celecoxib with fondaparinux significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided due to the heightened danger.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair platelet function and damage the gastrointestinal mucosa, leading to increased bleeding risk. Fondaparinux is a selective factor Xa inhibitor that directly reduces thrombin generation, profoundly impairing the coagulation cascade. The concurrent use results in additive antihemostatic effects, significantly elevating the risk of hemorrhage.
Clinical Management
Patients are at a substantially increased risk for major bleeding events, including gastrointestinal bleeding, intracranial hemorrhage, and other site-specific bleeding. The risk of serious GI bleeding with NSAIDs and anticoagulants can be 3 to 15 times higher than with anticoagulants alone. Symptoms may include black, tarry stools, blood in urine, unusual bruising, or prolonged bleeding from minor cuts. This combination should be avoided if possible. If concomitant use is unavoidable, patients require very close monitoring for signs of bleeding, and the lowest effective dose for the shortest duration should be used. Consider alternative pain management strategies that do not increase bleeding risk, or alternative anticoagulants if clinically appropriate and safer. Proton pump inhibitors should be co-prescribed if GI bleeding risk is a concern.
Combining celecoxib with dipyridamole significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet function. Dipyridamole is an antiplatelet agent that inhibits phosphodiesterase, leading to increased cyclic AMP and reduced platelet aggregation. The combined antiplatelet effects and gastrointestinal mucosal damage synergistically elevate bleeding risk.
Clinical Management
Patients are at a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other forms of acute bleeding. The risk of major gastrointestinal bleeding can be several-fold higher compared to either drug alone, potentially leading to anemia, hypotension, or even death. This combination should generally be avoided due to the high risk of bleeding. If concurrent therapy is absolutely necessary, closely monitor for signs of bleeding (e.g., black stools, easy bruising, nosebleeds), and consider gastroprotective agents like proton pump inhibitors. Alternative pain management strategies or antiplatelet therapies with lower bleeding risk should be explored.
Combining celecoxib with ticagrelor significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to serious potential harm.
Mechanism
Celecoxib, like other NSAIDs, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Ticagrelor is a potent antiplatelet agent that prevents platelet activation and aggregation. The combined antiplatelet effects and gastrointestinal mucosal damage lead to a synergistic increase in bleeding risk.
Clinical Management
Patients are at a significantly elevated risk of major bleeding events, including gastrointestinal hemorrhage (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, and other severe bleeding complications. The risk of GI bleeding can be several-fold higher compared to either drug alone. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternatives to celecoxib with lower GI risk (e.g., acetaminophen) or a proton pump inhibitor (PPI) for gastroprotection. Closely monitor for any signs of bleeding (e.g., black stools, easy bruising, nosebleeds) and consider dose adjustments or discontinuation under medical supervision.
Combining celecoxib with clopidogrel significantly increases your risk of bleeding, especially in the stomach or intestines. You should avoid taking these medications together unless specifically directed by your doctor.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal defense and platelet aggregation. Clopidogrel is an antiplatelet agent that irreversibly inhibits the P2Y12 ADP receptor on platelets, preventing platelet activation and aggregation. The combined antiplatelet effects and gastric irritation from celecoxib lead to an additive increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage), but also bruising, nosebleeds, and other hemorrhagic events. Studies show a significantly higher risk of major bleeding events when NSAIDs are co-administered with antiplatelets, potentially increasing risk by 2-4 times compared to antiplatelet monotherapy. Concomitant use of celecoxib and clopidogrel should generally be avoided due to the high bleeding risk. If co-administration is deemed absolutely necessary by a physician, use the lowest effective dose of celecoxib for the shortest duration possible, and consider gastroprotective agents (e.g., proton pump inhibitors). Closely monitor for any signs of bleeding, such as black tarry stools, unusual bruising, or persistent nosebleeds. Alternative pain management strategies should be explored.
Combining celecoxib with prasugrel significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the heightened bleeding risk.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and inhibit platelet aggregation. Prasugrel is a potent antiplatelet agent that irreversibly inhibits the P2Y12 receptor on platelets, preventing platelet activation and aggregation. The concurrent use of both drugs leads to an additive antiplatelet effect and increased gastrointestinal toxicity, substantially raising the risk of bleeding.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including serious and life-threatening events such as gastrointestinal hemorrhage, intracranial hemorrhage, or other major bleeding. Studies show that combining NSAIDs with antiplatelets can increase the risk of major bleeding by 2-4 fold compared to antiplatelet therapy alone. Avoid concomitant use of celecoxib and prasugrel due to the substantial increase in bleeding risk. If an NSAID is absolutely necessary, consider alternative pain management strategies or discuss safer options with your doctor. If no alternatives exist, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding such as black, tarry stools, easy bruising, or unusual bleeding.
Combining celecoxib with cilostazol significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The additive antiplatelet effects and gastrointestinal mucosal damage lead to a substantially increased risk of hemorrhage.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal hemorrhage, intracranial hemorrhage, and other serious bleeding events. Patients may experience symptoms such as black, tarry stools, blood in vomit, easy bruising, or prolonged bleeding from cuts. The risk of serious GI bleeding can be several-fold higher with this combination. This combination should generally be avoided due to the high risk of serious bleeding. If co-administration is unavoidable, patients must be closely monitored for signs and symptoms of bleeding, and the lowest effective doses should be used for the shortest possible duration. Consider alternative pain management strategies or antiplatelet agents if clinically appropriate.
Concomitant use of celecoxib and naproxen, both non-steroidal anti-inflammatory drugs (NSAIDs), significantly increases the risk of gastrointestinal adverse events, including ulcers, bleeding, and perforation, as well as renal toxicity and cardiovascular events. There is no evidence of increased efficacy with this combination compared to monotherapy with either drug.
Mechanism
Both celecoxib (a selective COX-2 inhibitor) and naproxen (a non-selective COX inhibitor) exert their therapeutic and adverse effects by inhibiting prostaglandin synthesis. Concurrent administration leads to an additive pharmacological effect, increasing the suppression of protective prostaglandins in the gastrointestinal tract and kidneys, and potentially increasing prothrombotic effects.
Clinical Management
The concomitant use of celecoxib and naproxen is generally not recommended due to the increased risk of adverse effects without additional therapeutic benefit. If NSAID therapy is required, clinicians should opt for monotherapy and consider gastroprotective agents or alternative pain management strategies. Patients should be monitored closely for signs of gastrointestinal bleeding, renal dysfunction, and cardiovascular events.
High-dose aspirin combined with celecoxib negates celecoxib's GI safety advantage and increases GI bleeding risk.
Mechanism
Aspirin inhibits COX-1-mediated prostaglandin production in the GI mucosa, removing the protective benefit of selective COX-2 inhibition.
Clinical Management
If low-dose aspirin (≤81 mg) for cardiovascular prophylaxis is required with celecoxib, add a PPI for GI protection.
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