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