Celecoxib with Torsemide Interaction Details
Brand Names Associated with Celecoxib
- Celebrex®
- Celecoxib
- Consensi® (as a combination product containing Amlodipine, Celecoxib)
- Elyxyb®
Brand Names Associated with Torsemide
- Demadex®
- Torsemide
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
Reduced diuretic effectiveness and possible nephrotoxicity
Interaction Summary
Risk of renal toxicity is increased with combined use of NSAIDs and diuretics due to NSAID-associated dose-dependent reduction in prostaglandin formation and in renal blood flow. Coadministration of NSAIDs and loop diuretics has reduced the natriuretic effect of the diuretic in some patients, also related to the effect of NSAID inhibition of renal prostaglandin synthesis. Increased BUN, serum creatinine, serum potassium, and weight gain have been reported with furosemide coadministered with NSAIDs. CrCl was temporarily reduced with concomitant furosemide and acetylsalicylic acid in patients with chronic renal impairment (N=6) . During concomitant use of NSAIDs and diuretics, monitor for signs of worsening renal function and assure diuretic efficacy, including appropriate effects on blood pressure .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Risk of renal toxicity is increased with combined use of NSAIDs and diuretics, and use of NSAIDs with loop diuretics has reduced the natriuretic effect of the diuretic in some patients. During concomitant use of NSAIDs and diuretics, monitor for signs of worsening renal function and assure diuretic efficacy, including appropriate effects on blood pressure.
Mechanism Of Interaction
Decreased renal prostaglandin synthesis
Literature Reports
A) In part A of a study designed to investigate the influence of diuretics on renal prostaglandins, 24 healthy subjects on a constant sodium intake received furosemide (80 mg daily), hydroCHLOROthiazide (100 mg), triamterene (200 mg), or spironolactone (300 mg). In part B of the study, the same subjects were pretreated for 3 days with indomethacin (150 mg daily). This was continued during the 3-day administration of the diuretics. In study A, triamterene administration led to a rise in urinary prostaglandins E2 and F2 alpha, but this was not observed with the other diuretics. In study B, the natriuretic effect of spironolactone and furosemide was reduced and was unaffected by hydroCHLOROthiazide and triamterene. Prostaglandins were significantly inhibited in all subjects. The results suggest that prostaglandins contribute to the interaction between NSAIDs and the natriuretic effects of furosemide and spironolactone, but not to the natriuretic effects of hydroCHLOROthiazide and triamterene .
B) A base cohort study involving 10,519 patients older than 55 years who were receiving NSAIDs and diuretics was conducted to investigate the relationship between congestive heart failure (CHF) and the use of these 2 classes of drugs. The patient population was 72.2% female, with an average age of 70.8 years. During periods of concomitant NSAID and diuretic use, the risk of hospitalization for CHF was twice that of periods of diuretic use only. Patients who used diuretics on a regular basis also had an increased risk of hospitalization due to CHF compared with irregular users of diuretics. A combination of a thiazide and a potassium-sparing diuretic was the most frequently used diuretic type, and the incidence density of hospitalizations during times of use with this combination and a NSAID resulted in a 3-fold increase over that for diuretic use only .
C) Concomitant therapy with oral furosemide 40 mg daily and oral azapropazone 1200 mg daily demonstrated that the hypouricemic effect of azapropazone was only slightly antagonized by furosemide; the diuretic effect of furosemide was not altered significantly .
Celecoxib Overview
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Celecoxib is used to relieve pain, tenderness, swelling and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing spondylitis (arthritis that mainly affects the spine). Celecoxib is also used to treat juvenile rheumatoid arthritis (a type of arthritis that affects children) in children 2 years of age and older. Celecoxib is also used to treat painful menstrual periods and to relieve other types of short-term pain including pain caused by injuries, surgery and other medical or dental procedures, or medical conditions that last for a limited time. Celecoxib is in a class of NSAIDs called COX-2 inhibitors. It works by stopping the body's production of a substance that causes pain and inflammation.
Torsemide Overview
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Torsemide is used alone or in combination with other medications to treat high blood pressure. Torsemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, or liver disease. Torsemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.