Moderate
Probable
Descripción
Celecoxib may increase methotrexate exposure by reducing its renal clearance, raising the risk of toxicity in patients on MTX-based regimens.
Mecanismo
COX-2 inhibition reduces renal prostaglandin-mediated vasodilation, impairing tubular secretion of methotrexate; the effect is less pronounced than with non-selective NSAIDs.
Relevancia clínica
MTX levels can increase modestly; the clinical impact is greatest with higher MTX doses or in patients with renal impairment.
Manejo clínico
Monitor CBC, renal function, and MTX levels; use the minimum celecoxib dose for the shortest duration. Hydrate adequately.