Celecoxib with Voriconazole Interaction Details
Brand Names Associated with Celecoxib
- Celebrex®
- Celecoxib
- Consensi® (as a combination product containing Amlodipine, Celecoxib)
- Elyxyb®
Brand Names Associated with Voriconazole
- Vfend®
- Voriconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 15, 2023
Interaction Effect
Increased celecoxib exposure and plasma concentration
Interaction Summary
Concomitant administration of celecoxib, a CYP2C9 substrate, together with voriconazole may result in increased celecoxib exposure and plasma concentration due to inhibition of CYP2C9-mediated celecoxib metabolism by voriconazole. Although no formal drug interaction studies have been performed with celecoxib and voriconazole, two separate single-dose drug interaction studies involving coadministration of ibuprofen or diclofenac (both are CYP2C9 substrates) with voriconazole demonstrated significantly increased ibuprofen and diclofenac exposure and plasma concentration. Frequent monitoring for NSAID toxicities is recommended during coadministration and dosage reduction of celecoxib may be necessary .
Severity
Moderate
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Use caution with the coadministration of celecoxib and voriconazole as this may result in increased celecoxib exposure and plasma concentration. Close monitoring for NSAID-related adverse events is recommended and dosage reduction of celecoxib may be warranted.
Mechanism Of Interaction
Inhibition of CYP2C9-mediated celecoxib metabolism
Literature Reports
A) Voriconazole significantly increased exposure and plasma concentration of diclofenac in a two-way, crossover design study in 10 healthy male volunteers. Adults (age range, 20 to 31 yr) received a single oral dose of diclofenac 50 mg either alone (control phase) or 1 hour following receipt of the final dose of voriconazole on day 2 (400 mg orally twice daily on day 1, followed by 200 mg orally twice daily on day 2). The washout interval between phases was 2 weeks. During the voriconazole phase, the diclofenac AUC was 178% (95% confidence interval (CI), 143% to 212%); p less than 0.001) and the diclofenac Cmax was 214% (95% CI 128% to 300%; p less than 0.05) of their respective control value, representing an increase of 78% and 114% in AUC and Cmax, respectively. Concurrent administration of voriconazole also decreased the renal clearance of diclofenac by 47% (95% CI, -76% to -16%; p less than 0.01) compared with control; however, the amount of diclofenac excreted in the urine was only 0.7% and 0.6% of the total dose in the control and voriconazole phases, respectively. Voriconazole administration did not effect the elimination half-life of diclofenac. Inhibition of CYP2C9-mediated diclofenac metabolism by voriconazole was proposed as the most probable mechanism of this interaction .
B) Voriconazole significantly increased the exposure and plasma concentration of the pharmacologically active S-(+) enantiomer of ibuprofen in a two-way, crossover design study in 12 healthy male volunteers. Adults (age range, 19 to 23 yr) a single oral dose of ibuprofen 400 mg either alone (control phase) or 1 hour following receipt of the final dose of voriconazole on day 2 (400 mg orally twice daily on day 1, followed by 200 mg orally twice daily on day 2). The washout interval between phases was 2 weeks. During the voriconazole phase, the AUC of the S-(+) ibuprofen was 205% (p less than 0.001) and the Cmax 122% (p less than 0.01) of the respective control value, representing an increase of 105% and 22% in AUC and Cmax, respectively. The mean elimination half-life of S-(+) ibuprofen was prolonged by 43% (going from 2.4 hr to 3.2 hr) compared with control (p less than 0.01). The effect of voriconazole of the R-(-) enantiomer of ibuprofen was much less, with no effect observed in the Cmax and just a 20% increase in AUC (p less than 0.05). Inhibition of CYP2C9-mediated ibuprofen metabolism by voriconazole was proposed as the most probable mechanism of this interaction .
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.
Voriconazole Overview
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Voriconazole is used in adults and children 2 years of age and older to treat serious fungal infections such as invasive aspergillosis (a fungal infection that begins in the lungs and spreads through the bloodstream to other organs), esophageal candidiasis (a yeast [a type of fungus] infection that may cause white patching in the mouth and throat), and candidemia (a fungal infection in the blood). It is also used to treat certain other fungal infections when other medications will not work for certain patients. Voriconazole is in a class of antifungal medications called triazoles. It works by slowing the growth of the fungi that cause infection.
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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.