Celecoxib and Coumadin

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using warfarin together with celecoxib may cause you to bleed more easily. You may need a dose adjustment based on your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration with celecoxib may infrequently enhance the hypoprothrombinemic effect of warfarin. The proposed mechanism is competitive inhibition of the CYP450 2C9 metabolism of warfarin by celecoxib, as both drugs are substrates of this isoenzyme. A study involving 24 healthy volunteers found no effect of celecoxib (200 mg twice daily) on the prothrombin time or steady-state pharmacokinetics of warfarin. However, there have been isolated post-marketing case reports of elderly patients stabilized on warfarin who developed INR increases and/or bleeding complications following the addition of celecoxib. It is possible that patients with variant alleles resulting in reduced CYP450 2C9 metabolism (i.e., CYP450 2C9 poor metabolizers) may be at increased risk for this interaction, since they have reduced clearance of both celecoxib and warfarin.

MANAGEMENT: Given the potential for interaction and the high degree of interpatient variability with respect to warfarin metabolism, patients should be closely monitored during concomitant therapy with celecoxib. The INR should be checked frequently and warfarin dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of celecoxib in patients who are stabilized on their warfarin regimen. The same precaution may be applicable during therapy with other oral anticoagulants, although clinical data are lacking. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

Celecoxib

Generic Name: celecoxib

Brand name: Celebrex, Celebrex

Synonyms: n.a.

What is Celecoxib?

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?