Warfarin Celecoxib

Acenocoumarol, amiodarone, celecoxib, coumadin, dexamethasone, diclofenac, etoposide, fluconazole, fluoxetine, fluvas-tatin, fluvoxamine, ghmepiride, ghpizide, glyburide, ibuprofen, irbesartan, isoniazid, losartan, midazolam, phenylbutazone, phenytoin, rifampin, teniposide, tenoxicam, thiotepa, tolbutamide, torsemide, vitamin D, warfarin... 

C9 Celecoxib, flurbiprofen, hexobarbital, ibuprofen, losartan, phenytoin, tolbutamide, trimethadione, sulfaphenazole, S-warfarin, ticrynafen Barbiturates, rifampin Tienilic acid, sulfaphenazole... 

Celecoxib is associated with fewer endoscopic ulcers than most other NSAIDs. Probably because it is a sulfonamide, celecoxib may cause rashes. It does not affect platelet aggregation at usual doses. It interacts occasionally with warfarin—as would be expected of a drug metabolized via CYP2C9. Adverse effects are the common toxicities listed above. 

Karim A, Tolbert D, Piergies A, Hubbard RC, Harper K, Wallemark CB, Slater M, Geis GS. Celecoxib does not significantly alter the pharmacokinetics or hypoprothrombi-nemic effect of warfarin in healthy subjects. J Chn Pharmacol 2000 40(6) 655-63. 

Mersfelder TL, Stewart LR. Warfarin and celecoxib interaction. Ann Pharmacother 2000 34(3) 325-7. 

Haase KK, Rojas-Fernandez CH, Lane L, Frank DA. Potential interaction between celecoxib and warfarin. Ann Pharmacother 2000 34(5) 666-7. 

The COX-2 selective non-steroidal anti-inflammatory drug celecoxib did not alter the pharmacokinetics or the hypoprothrombinemic effect of warfarin in 24 healthy subjects (30). However, there have been at least two reports of increased INR in patients taking stable warfarin therapy and celecoxib (31,101). 

Standard monitoring of INR in patients taking warfarin should be performed when therapy with celecoxib or rofecoxib is begun or changed. 

Drug interactions May decrease antihypertensive effects of ACE inhibitors and angiotensin II antagonists decrease of antihypertensive and diuretic effects of thiazides and loop diuretics Agents are CYP2C9 substrates may decease effects of ACE inhibitors, thiazides, and loop diuretics fluconazole Increases levels of celecoxib may increase INR when added to warfarin... 

Clinically important, potentially hazardous interactions with aspirin, celecoxib, citalopram, etoricoxib, fluoxetine, NSAIDs, paroxetine, venlafaxine, warfarin... 

Angiotensin blockers not Irbesartan Losartan Candesartan not Valsartan Celecoxib Flnvastatin Naproxen Phenytoin Sulfamethoxazole Tamoxifen Tolbutamide Torsemide Warfarin... 

However, they increase prothrombin time (PT) when used with warfarin and may possibly exert prothombotic effects via inhibition of endothelial cell function. Celecoxib is cross-allergenic with sulfonamides. Potential cardiotoxicity ... 

Acetaminophen, aldrin, alfentanil, amiodarone, aminopyrine, amitriptyline, amprenavir, androstenedione,antipyrine, astemizole, benzphetamine, budesonide, carbamazepine, celecoxib, chlorpromazine, chlorzoxazone, cisapride, clarithromycin, clozapine, cocaine, codeine, cortisol, cyclophosphamide,cyclosporin, dapsone, delavirdine, dextromethorphan, digitoxin, diltiazem, diazepam, erythromycin, 17j3-estradiol, ethinylestradiol, etoposide, felbamate, fentanyl, flutamide, hydroxyarginine, ifosphamide, imipramine, indinavir, ketoconazole, lansoprazole, loratidine, losartan, lovastatin, (iS)"mephen3d in, methadone, mianserin, miconazole, mifepristone, nelfinavir, nevirapine, nicardipine, nifedipine, odansetron, omeprazole, orphenadrine, proguanil, propafenone, quinidine, quinine, rapamycin, retinoic acid, ritonavir, saquinavir, selegiline, serindole, sufentanil, sulfinpyrazone, tacrolimus, tamoxifen, tamsulosin, taxol, teniposide, terfenadine, tetrahydrocannabinol, theophylline, toremifene, triazolam, trimethadone, trimethoprim, troleandomycin, verapamil, warfarin, zatosetron, Zolpidem, zonisamide... 

CYP2C9 20 10 Celecoxib Diclofenac Fluoxetine Fluvastatin Ibuprofen Irbesarten Naproxen Amitriptyline Phenytoin Tolbutamide Torsemide S-warfarin Rosiglitazone Amiodarone Fluconazole Fluvoxamine Fluvastatin Isoniazid Sertraline Sulfaphenazole Trimethoprin Zafirlukast Rifampin Clotrimazole Carbamazepine Hyperforin Phenobarbital Ritonavir... 

Etoricoxib, lumiracoxib and rofecoxib caused a slight 8% to 15% increase in the INR in response to warfarin, whereas celecoxib and parecoxib had no effect. However, raised INRs accompanied by bleeding, particularly in the elderly, have been attributed to the use of waHarin and celecoxib or rofecoxib in other reports. In addition, in a case-control study in patients taking warfarin, the use of celecoxib or rofecoxib was associated with an increased risk of hospitalisation for upper gastrointestinal haemorrhage, which was of a similar magnitude to that seen with non-selective NSAIDs. 

In a placebo-controlled study, warfarin 2 to 5 mg daily was given to 24 healthy subjects to maintain a stable prothrombin time of 1.2 to 1.7 times their pretreatment values for at least 3 consecutive days. They were then given placebo or celecoxib 200 mg twice daily for a week. It was found that the steady-state pharmacokinetics of both S- and 7 -warfarin and the prothrombin times were unchanged by the presence of the celecoxib. ... 

However, in 16 patients stabilised on warfarin and given celecoxib 200 mg daily for 3 weeks, the INR increased by 13%, 6% and 5% at week 1, 2 and 3, respectively, the change at week 1 being statistically significant. In another analysis, of 28 patients taking warfarin who were prescribed either celecoxib or rofecoxib, 13 had increases in their INR, of which 7 (5 taking celecoxib) had no other explanation for the INR increase... 

Schaefer MG, Plowman BK, Morreale AP, Egan M. Interaction of rofecoxib and celecoxib with warfarin. Am J Health-Syst Pharm (2003) 60, 1319-23. 

Linder JD, Monkemiiller KE, Davis JV, Wilcox CM. Cyclooxygenase-2 inhibitor celecoxib a possible cause of gastropathy and hypoprothrombinemia. South MedJ (2000) 93, 930-2. Mersfedler TL, Stewart LR. Warfarin and celecoxib interaction. Ann Pharmacother (2000) 34, 325-7. 

O Donnell DC, Hooper JS. Increased international normalized ratio in a patient taking warfarin and celecoxib. JP/iarw Technol (200V), 17, 3-5. 

Stoner SC, Lea JW, Dubisar BM, Farrar C. Possible international normalized ratio elevation associated with celecoxib and warfarin in an elderly psychiatric patient. J Am Geriatr Soc... 

Malhi H, Atac B, Daly AK, Gupta S. Warfarin and celecoxib interaction in the setting of cytochrome P450 (CYP2C9) polymorphism with bleeding complication. Postgrad Med J... 

ADRAC. Interaction of celecoxib and warfarin. Aust Adverse Drug React Bull (2001) 20, 2. 

Chung L, Chakravarty EF, Kearns P, Wang C, Bush TM. Bleeding complications in patients on Celecoxib and warfarin. J Clin Pharm Ther (2005) 30, 471-7. 

Celecoxib co-administration may result in increases in international normalized ratio (INR) in patients who were on warfarin and had stable INRs before the addition of celecoxib [1]. 

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