NSAIDs cause an increased risk of serious (and potentially fatal) adverse cardiovascular thrombotic events, including MI and stroke. Risk may occur early during treatment and may increase with duration of use.
NSAIDs cause an increased risk of serious gastrointestinal inflammatory, ulceration, bleeding, and perforation (may be fatal); elderly patients and patients with history of peptic ulcer disease GI events. The events may occur at any time during therapy and with warning.
Use with caution in patients with decreased hepatic (dosage adjustments are recommended for moderate hepatic impairment; not recommended for patients with severe hepatic impairment) or renal function.
Patients with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics, ACE inhibitors, angiotensin II receptor blockers, and the elderly are at greater risk for renal toxicity. Rehydrate patient before starting therapy; monitor renal function closely. Avoid use in patients with advanced renal disease; discontinue use with persistent or worsening abnormal renal function test. Long-term NSAID use may result in renal papillary necrosis.
Anemia may occur with use; monitor hemoglobin or hematocrit in patients on long-term treatment. Celecoxib does not affect PT, PTT or platelet count; does not inhibit platelet aggregation at approved doses. Potentially significant drug-drug interaction may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy.