Celecoxib interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Another generic nonsteroidal anti-inflammatory drug (NSAID) is celecoxib, also known by its brand name Celebrex. This medication can reduce inflammation and pain in the body by targeting the hormones (COX-2 inhibitor) responsible for these symptoms. It is approved by the United States Food and Drug Administration (FDA) to treat autoimmune diseases such as juvenile rheumatoid arthritis in those as young as two years old, polyps in the colon, menstrual cramps, osteoarthritis, ankylosing spondylitis, and other conditions responsible for chronic inflammation. There are many ways celecoxib interacts with NSAIDs and other medications, and therefore, it’s vital to understand any drug interactions related to the medication.

Celecoxib drug interactions

As taking celecoxib may pose some serious health risks, it is important to know what possible health concerns may arise when this medication is added to others.

Nonsteroidal anti-inflammatory drugs and celecoxib

Taking multiple medications in the same class can cause adverse reactions, and therefore it’s not advised to take multiple NSAIDs. Adverse side effects include abdominal issues, GI complications, and other potential issues. In some cases, it may be recommended to take multiple NSAIDs, but this should only be done under the guidance of a healthcare provider. If you notice tarry stools, vomit that looks like coffee grounds, have abdominal cramps, or are unable to urinate, contact your doctor now.

Common NSAIDs include:

• Diclofenac
• Etodolac
• Ibuprofen
• Indomethacin
• Ketoprofen
• Ketorolac
• Meloxicam
• Nabumetone 
• Naproxen

Corticosteroids and celecoxib

Corticosteroids are popular options for chronic inflammatory conditions, acute pulmonary conditions, and allergic reactions. Sometimes, these medications are needed in combination with celecoxib. Unfortunately, when both medicines are required, there is an increased risk of stomach pain from GI ulcers and bleeds.

Common steroids include:

• Methylprednisolone
• Prednisolone
• Prednisone

Aspirin and celecoxib

Baby aspirin, usually used to prevent heart failure, should not be combined with celecoxib. Aspirin is a salicylate and not an NSAID, but it is still not recommended to be taken with celecoxib. In some cases, short-term use of celecoxib and aspirin may be allowed but must be closely monitored. Both medications have antiplatelet effects, thinning the blood and helping to reduce clotting in the body. If celecoxib is added, aspirin may lose its effectiveness. This, unfortunately, places someone at increased risk of developing heart attacks or strokes.

Common aspirins include:

• Aspirin
• Alka-Seltzer
• Bismuth-subsalicylate

Anticoagulants and celecoxib

Celecoxib is not recommended to be taken with a blood thinner. It poses a similar problem when combined with low-dose aspirin. Its antiplatelet properties mentioned previously cause the blood to become too thin and increase your chances of GI or brain bleeds. Usually, a different pain reliever may be considered, but in some cases, your doctor may combine your anticoagulant with celecoxib. At any time, if you develop unexplained bleeding or bruising, be sure to mention this to your doctor.

Common anticoagulants include:

• Eliquis (apixaban)
• Plavix (clopidogre)
• Pradaxa (dabigatran)
• Lovenox (enoxaparin)
• Xarelto (rivaroxaban)
• Brilinta (ticagrelor)
• Coumadin, Jantoven (warfarin)

Blood pressure medications and celecoxib

Antihypertensive medications are known to be hard on the kidneys. Therefore, combining celecoxib is not encouraged. Both may increase the chances of irreversible kidney problems. It decreases the effectiveness of your blood pressure medications. Angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), diuretics, and beta blockers used for heart disease are all examples to closely monitor while on celecoxib. Celecoxib may still be prescribed, as so many people take blood pressure medications and have chronic pain. Be sure to make your doctor aware if you notice swelling in your feet or legs, have trouble urinating, or suffer from fatigue. This may be a sign that the kidneys are not functioning properly.

Common blood pressure medications include:

• Amlodipine
• Clonidine
• Furosemide
• Guanfacine
• Hydralazine
• Hydrochlorothiazide
• Lisinopril
• Losartan
• Propranolol
• Ramipril
• Valsartan

Psychiatric drugs and celecoxib

Antidepressants in the selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) category should be closely monitored if celecoxib is also needed for chronic pain. These types of antidepressants increase the chances of serious GI problems (stomach ulcers and GI bleeds).

Common psychiatric drugs include:

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Sertraline
• Vortioxetine

Lithium

Lithium, used for bipolar, should also be avoided while taking celecoxib. The use of both medications could be life-threatening as celecoxib can increase lithium levels in the blood, causing toxicity. If you are taking medication for your mental health but need pain relief, discuss this with your doctor, as alternatives or medications to protect the stomach may be recommended. If you become drowsy, dizzy, have blurred vision, seizures, or can not stop vomiting, this is a medical emergency and requires immediate attention.

Digoxin

Digoxin is associated with several known medication interactions. Celecoxib is one of them. Because celecoxib may affect the kidneys, this may cause the levels of digoxin to be higher in the body, which may increase the serious side effects of digoxin. While managing heart failure with digoxin, your healthcare provider may recommend regular blood tests to monitor levels if taken with celecoxib. At any time, if there are any signs of shortness of breath or trouble breathing, go immediately to the hospital.

Methotrexate

Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate are commonly used for chronic autoimmune conditions such as rheumatoid arthritis, psoriasis, and Crohn’s disease. Celecoxib can also be prescribed while on methotrexate, but the combination must be closely monitored as celecoxib can increase methotrexate levels. It is important to monitor methotrexate levels while taking celecoxib, as too much methotrexate can be lethal. Signs to look out for are nausea, vomiting, headache, mouth sores, hair loss, and muscle aches and pain.

Celecoxib food interactions

There are no known food interactions associated with the use of celecoxib. In fact, many times, it is recommended to eat with NSAIDs as this reduces many of the gastrointestinal complications associated with its use. Some people have found lifestyle changes have helped to reduce inflammation in the body, which is what celecoxib is used for. Read more about natural ways to reduce inflammation.

Other celecoxib interactions

Knowing what medications interact with celecoxib helps to reduce unwanted side effects. But sometimes, a disclaimer for other less common interactions must also be addressed for things not in the over-the-counter or prescription medication categories.

Celecoxib and alcohol

Alcohol should be avoided while taking celecoxib as the combination causes increased GI problems.

Celecoxib and caffeine

Caffeine has similar issues when combined with celecoxib as alcohol does. Worsening symptoms of abdominal pain and an increased chance of GI bleeds can occur when caffeine is combined with NSAIDs.

Celecoxib and disease/CBD/illicit drugs/vitamins/herbal supplements/etc.

Heart medical conditions or people with a history of blood clots will likely not be prescribed celecoxib. If you are scheduled for coronary artery bypass graft (CABG) surgery, you will be asked to discontinue your celecoxib. If this medication is taken before CABG surgery, it can be life-threatening. There are contraindications for use of celecoxib while pregnant or breastfeeding. Additionally, if you are allergic to sulfa drugs like sulfonamide antibiotics, celecoxib will not be prescribed to you.

CBD has been linked to causing liver disease. There is also a warning for increased liver problems with the use of celecoxib. To be safe, both should be avoided if needed simultaneously.

Make sure to read all labels closely when taking supplements. Vitamin C has been shown to increase levels of NSAIDs.

How to minimize celecoxib interactions

Understanding the risks associated with taking celecoxib is important to reduce interactions when combined with other medications you are taking. Checking the active ingredients in all drugs is important because some medicines have a combination formula. If you take several medications (including OTC), keeping a list may be helpful so you do not forget and can properly disclose this information to your healthcare team. Once any negative side effects start, call your doctor, and do not ignore them.

When to talk to a healthcare provider about celecoxib interactions

As previously mentioned, there are many serious interactions associated with celecoxib. If you notice tarry stools, vomit blood or coffee grounds, experience abdominal pain, unexplained bleeding, increased swelling to the lower extremities, or have trouble urinating, contact your doctor for the appropriate medical advice. Do not ignore any new symptoms, even if you do not believe they are related to taking celecoxib. Only your healthcare provider can determine if the symptoms require you to discontinue celecoxib or if an alternative should be given.