30–50 Dose as in normal renal function. Use with caution10–30 Dose as in normal renal function, but avoid if possible
<10           : Dose as in normal renal function, but only use if on dialysis
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as in normal renal function
HD                     :Unlikely to be dialysed. Dose as in normal renal function
HDF/high flux   :Unknown dialysability. Dose as in normal renal function
CAV/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
ACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemia
Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)
Antibacterials: possibly increased risk of convulsions with quinolones
Anticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins
Antidepressants: increased risk of bleeding with SSRIs and venlafaxine
Antidiabetic agents: effects of sulphonylureas enhanced
Antifungals: if used with fluconazole, halve the dose of celecoxib. Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir
Ciclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib
Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diuretics
Lithium: excretion decreased Pentoxifylline: possibly increased risk of bleeding
Tacrolimus: increased risk of nephrotoxicity
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
Clinical trials have shown renal effects similar to those observed with comparative NSAIDs.
Monitor patient for deterioration in renal function and fluid retention
Inhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease.
Avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID.
If raised, discontinue NSAID therapy
Use normal doses in patients with ERF on dialysis if they do not pass any urine. Use with caution in renal transplant recipients – can reduce intrarenal autocoid synthesis
Celecoxib should be used with caution in uraemic patients predisposed to gastrointestinal bleeding or uraemic coagulopathies
Contraindicated in patients with ischaemic heart disease or cerebrovascular disease and class II–IV NYHA congestive heart failure.