8 Celecoxib Interactions to Watch For

Celecoxib (Celebrex) is a prescription-only nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation (swelling). It’s FDA-approved to treat several conditions, including osteoarthritis (OA) and rheumatoid arthritis (RA). Celecoxib is a COX-2 selective NSAID, which means it has a lower risk of stomach-related side effects than other NSAIDs.

Certain medications may interact with celecoxib, and celecoxib can also cause some medications to reach toxic levels in the body. Certain interactions can be managed with careful monitoring by your healthcare provider. But there may be medications that you should completely avoid while taking celecoxib.

Let’s discuss eight celecoxib interactions you should be aware of. Keep in mind that these aren’t the only possible interactions.

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1. Aspirin and other NSAIDs

As mentioned above, celecoxib is an NSAID. All NSAIDs have a boxed warning (the FDA’s strictest warning) about the risk of severe gastrointestinal (stomach and intestines) side effects. These can include bleeding or ulcers.

Taking more than one NSAID raises the risk of these side effects. You shouldn’t take more than one NSAID unless you are told to by your healthcare provider.

Some NSAIDs are available over the counter (OTC), while others are prescription-only. Common NSAIDs include:

• Aspirin

• Diclofenac (Cambia, Cataflam)

• Ibuprofen (Advil, Motrin)

• Meloxicam (Mobic)

• Naproxen (Aleve, Naprosyn)

Non-selective NSAIDs, like ibuprofen, are even more likely to cause gastrointestinal (GI) side effects than COX-2 selective NSAIDs like celecoxib. 

Taking NSAIDs with food may lower your risk of stomach irritation. But you should watch for symptoms of GI bleeding. These may include black or tarry stool, coffee-ground-like vomit, or bright red blood in your vomit or stool. If you notice any of these, you should contact a healthcare provider right away.

2. Blood thinners

Blood thinners are medications that help treat and prevent blood clots. There are two types of blood thinners: anticoagulants and antiplatelets. NSAIDs, like celecoxib, can also affect how your blood clots. Taking celecoxib with blood thinners raises your risk of serious bleeding, including GI and brain bleeding.

Common anticoagulants include:

• Apixaban (Eliquis)

• Dabigatran (Pradaxa)

• Rivaroxaban (Xarelto)

• Warfarin (Coumadin, Jantoven)

Examples of antiplatelets include:

• Clopidogrel (Plavix)

• Prasugrel (Effient)

• Ticagrelor (Brilinta)

Generally, you should avoid NSAIDs if you take blood thinners. Your healthcare provider will likely choose a different medication for pain to avoid this interaction.

Unusual bruising, nosebleeds, or bleeding gums can be symptoms of a bleeding problem. If you notice any new or unexplained bleeding, you should contact your healthcare provider. And be sure to report any symptoms of serious bleeding (such as black or bloody stools) right away.

3. Certain antidepressants (SSRIs and SNRIs)

Antidepressants are FDA-approved to treat mental health conditions, including depression and anxiety. But some antidepressants can raise your risk of bleeding. These include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). The risk of serious bleeding goes up when you combine celecoxib with an SSRI or SNRI.

Common SSRIs include:

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Sertraline (Zoloft)

Examples of SNRIs include:

• Desvenlafaxine (Pristiq)

• Duloxetine (Cymbalta)

• Milnacipran (Savella)

• Venlafaxine (Effexor XR)

Make sure your healthcare provider knows if you take both celecoxib and an SSRI or SNRI. They may want to change one of your medications to help avoid this interaction. If you need to take both medications, watch for the symptoms of GI bleeding discussed above.

4. Corticosteroids

Corticosteroids (“steroids”) include medications such as prednisone, methylprednisolone, and prednisolone. They treat a variety of conditions including allergic reactions, rheumatoid arthritis, and certain lung infections. Steroids work by decreasing inflammation and suppressing your immune system.

Taking steroids with celecoxib raises your risk of developing GI side effects. This includes ulcers and GI bleeding.

Sometimes people need to take both celecoxib and a steroid. If you’re taking both, watch for symptoms of GI bleeding. Eating a small snack or meal before you take these medications may lower your risk of getting an upset stomach.

5. Certain blood pressure medications

Some blood pressure medications can be hard on the kidneys. When combined with celecoxib, the risk of kidney damage goes up. Celecoxib can also make blood pressure medications less effective.

Blood pressure medications that interact with celecoxib include:

• Angiotensin-converting enzyme inhibitors (ACE) inhibitors, such as lisinopril (Zestril) and enalapril (Vasotec)

• Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar) and valsartan (Diovan)

• Beta blockers, such as propranolol and metoprolol (Lopressor, Toprol XL)

• Diuretics (“water pills”), such as hydrochlorothiazide (Microzide) and furosemide (Lasix)

Your healthcare provider may prescribe both celecoxib and blood pressure medications despite this interaction. Staying hydrated may help lower the risk of kidney problems. Your provider may also suggest going for more frequent kidney function tests if you’re taking celecoxib and blood pressure medication.

You should watch for symptoms of kidney injury. These may include urinating less often, feeling tired, or swelling in your legs or ankles. Let your healthcare provider know right away if you notice these.

6. Digoxin

Digoxin (Lanoxin) is FDA-approved to treat heart failure and atrial fibrillation (an abnormal heart rhythm). Digoxin has many interactions. This is because small changes of digoxin levels in the body can greatly affect how it works.

Celecoxib can affect kidney function, which can reduce how quickly your body removes digoxin from the blood. Taking celecoxib with digoxin may raise your risk of digoxin toxicity (high digoxin levels).

Symptoms of digoxin toxicity include:

• Nausea

• Persistent diarrhea

• Abnormal heartbeat

• Vision changes

• Trouble breathing

If you experience any of these symptoms, contact your healthcare provider right away.

Discuss taking NSAIDs, including celecoxib, with your healthcare provider if you take or will be taking digoxin. They may suggest an alternative for pain relief. If they feel you need both celecoxib and digoxin, be sure to go for any recommended blood tests. These can help make sure your digoxin level isn’t too high.

7. Lithium

Lithium (Lithobid) is a mood stabilizer prescribed to people living with bipolar disorder. Taking celecoxib with lithium can raise your blood lithium levels. This can lead to a serious complication called lithium toxicity.

Some symptoms of lithium toxicity include:

• Severe lightheadedness or drowsiness

• Weakness

• Muscle twitching

• Blurred vision

• Slurred speech or trouble speaking

• Ringing in the ears

• Severe confusion

• Seizures

• Uncontrollable vomiting

If you experience symptoms of lithium toxicity, call 911 or seek immediate medical attention.

Lithium levels should be closely monitored with blood tests. This is especially true when starting or stopping certain medications, including celecoxib. Your healthcare provider will determine if you’re able to safely take both celecoxib and lithium.

8. Methotrexate

Methotrexate is used to treat autoimmune disorders like rheumatoid arthritis. Methotrexate is cleared from the body by the kidneys. Celecoxib can slow the kidneys’ ability to do this. This may cause methotrexate levels in the body to rise and increase the risk of methotrexate toxicity.

Symptoms of methotrexate toxicity include:

• Nausea or vomiting

• Mouth ulcers

• Hair loss

• Dizziness

• Fever

• Trouble focusing

• Headache

• Muscle pain

Your healthcare provider may still prescribe both medications. If this is the case, they may suggest more frequent methotrexate blood tests. It’s important to have your methotrexate levels checked regularly when you’re also taking an NSAID like celecoxib.

When should I contact my healthcare provider about a celecoxib interaction?

It’s important to consult with your healthcare provider before stopping or starting any medication to make sure the combination is safe. You should also reach out if you experience new or worsening side effects from your medications after starting celecoxib. These could point to a potential interaction. If anything feels severe or extreme, you should seek medical care right away.

Ask your healthcare provider and pharmacist to review your current medication list for celecoxib interactions. They can determine if you need to take any precautions to manage or prevent complications. They can also make adjustments to your medications, if needed.

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Written by:

Elizabeth Cambria, PharmD

Elizabeth Cambria is a licensed, registered pharmacist, and certified pharmacist immunizer in the state of Pennsylvania. She graduated with a Doctor of Pharmacy from the University of Pittsburgh School of Pharmacy.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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