Moderate
Established
الوصف
Celecoxib, a selective COX-2 inhibitor, can inhibit CYP2C9-mediated warfarin metabolism and may increase GI bleeding risk, though platelet function is less impaired than with non-selective NSAIDs.
الآلية
Celecoxib inhibits CYP2C9, raising S-warfarin plasma concentrations; selective COX-2 inhibition spares COX-1–mediated gastroprotection, potentially increasing GI mucosal vulnerability.
الأهمية السريرية
Clinically significant INR elevations and GI bleeding events have been reported; the risk is lower than non-selective NSAIDs but not negligible.
التدبير
Monitor INR within 1 week of starting celecoxib; use the lowest effective dose for the shortest duration; add a PPI.