Celecoxib × Warfarin

Celecoxib and warfarin together have a synergistic effect on bleeding (US celecoxib label, FDA). With the combination, increases in prothrombin time (international normalised ratio, INR) and serious, sometimes fatal, bleeding have been reported, mostly in older patients (celecoxib SmPC). Like other non-steroidal anti-inflammatory drugs (NSAIDs), celecoxib can itself cause ulcers, perforation and bleeding in the stomach and gut (celecoxib SmPC).

Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.

High doses of non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated with warfarin (warfarin SmPC). At usual doses, celecoxib is combined with warfarin with caution (celecoxib SmPC). Monitor prothrombin time (international normalised ratio, INR) carefully, especially in the first days after starting celecoxib and after any dose change (celecoxib SmPC), and watch for signs of bleeding (US celecoxib label, FDA). The risk of gastrointestinal bleeding is higher in older patients, in those with a history of ulcer or bleeding, with concomitant aspirin, other NSAIDs or glucocorticoids, and with alcohol use (celecoxib SmPC). Celecoxib is contraindicated in active peptic ulcer or gastrointestinal bleeding (celecoxib SmPC).