Hepatic Impairment: The daily dose of celecoxib should be reduced by approximately 50% in patients with moderate hepatic impairment. The use of celecoxib in patients with severe hepatic impairment is not recommended.
Renal Insufficiency: There is no clinical experience in patients with severe renal impairment thus the use of celecoxib is not advised.
Poor Metabolizers of CYP2C9 Substrates: Celecoxib should be administered with caution in patients who are poor CYP2C9 metabolizers based on genotype or previous history with other CYP2C9 substrates such as warfarin or phenytoin. Consider starting treatment at half of the lowest recommended dose in poor metabolizers and consider using alternative management in JRA patients who are poor metabolizers.