Cybec 400 Drug Interactions

Celecoxib metabolism is predominantly mediated via cytochrome P450 CYP2C9 in the liver. Concomitant administration of Celecoxib with inhibitors of CYP2C9 can lead to increase in plasma concentrations of Celecoxib. And concomitant administration of Celecoxib with inducers of CYP2C9, such as rifampicin, carbamazepine and barbiturates, can lead to decrease in plasma concentrations of Celecoxib, a dose increase of Celecoxib may be necessary. Therefore, Celecoxib and drugs that inhibit or induce the CYP2C9 should be administered concomitantly with caution. In addition, Celecoxib also inhibits CYP2D6, and the potential therefore exists for an effect on drugs metabolized by this enzyme.
Fluconazole and Ketoconazole: Concomitant administration of Celecoxib with fluconazole can result in increased in plasma concentrations of Celecoxib. This increase may occur because of inhibition of Celecoxib metabolism. Ketoconazole, a CYP3A4 inhibitor, showed on inhibition in the metabolism of Celecoxib.
Lithium: Celecoxib can decrease renal clearance of lithium, which may lead to increased serum or plasma lithium concentrations.
Diuretics, e.g. furosemide, thiazides: NSAIDs can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
Warfarin: Concomitant administration of Celecoxib with warfarin may prolong prothrombin time. Caution should be used when coadministering Celecoxib with warfarin. Patients receiving such concomitant therapy should be monitored appropriately.
Anti-hypertensive including angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor antagonists, diuretics and beta-blockers: Concomitant administration of Celecoxib, may reduce the blood pressure response to ACE inhibitors, angiotensin II receptor antagonists, diuretics or beta-blockers because of inhibition of prostaglandins. Therefore, blood pressure should be monitored carefully.
In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with ACE-inhibitors, angiotensin II antagonists or diuretics, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Therefore, the concomitant administration of these drugs should be done with caution. Patients should be adequately hydrated and the clinical need to monitor the renal function should be assessed at the beginning of the concomitant treatment and periodically thereafter.
Cyclosporine: Concomitant administration of cyclosporine and Celecoxib may result in an increased risk of cyclosporine nephrotoxicity.
Dextromethorphan and metoprolol: Concomitant administration of Celecoxib resulted in increases in plasma concentrations of dextromethorphan and metoprolol (CYP2D6 substrates). These increases are due to Celecoxib inhibition to the CYP2D6 metabolism.
Aspirin: Celecoxib dose not interfere with the anti-platelet effect of low-dose aspirin. Because of its lack of platelet effects, Celecoxib is not a replacement for aspirin in the prophylactic treatment of cardiovascular disease.
Other drugs: No clinically important interactions have been observed with Celecoxib and antacids (aluminium and magnesium), omeprazole, glibenclamide (glyburide), phenytoin or tolbutamide.