Drug interactions
Celecoxib + Methotrexate
Severity: Major
Celecoxib and Methotrexate: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
NSAIDs can raise methotrexate concentrations and prolong exposure, particularly with high-dose methotrexate or renal impairment, leading to severe myelosuppression and mucosal toxicity. Celecoxib appears to have a smaller effect at low weekly doses, but caution remains important.
What this interaction means in plain words
Celecoxib and Methotrexate can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Celecoxib belongs to Musculoskeletal; Methotrexate belongs to Oncology.
Why it happens
Reduced renal tubular secretion of methotrexate and NSAID-related lowering of renal blood flow.
What to do
Avoid with high-dose methotrexate. With low-dose therapy, monitor renal function and blood counts and watch for mucositis.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Methotrexate
- Acitretin + Methotrexate Contraindicated
- Adenovirus types 4 and 7 live + Methotrexate Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Methotrexate Contraindicated
- Ketorolac + Methotrexate Contraindicated
- Measles mumps and rubella vaccine live + Methotrexate Contraindicated
- Measles mumps and rubella vaccine + Methotrexate Contraindicated
Other interactions of Celecoxib
- Celecoxib + Ketorolac Contraindicated
- Celecoxib + Ketorolac intranasal Contraindicated
- Aceclofenac + Celecoxib Major
- Acemetacin + Celecoxib Major
- Amiloride + Celecoxib Major
- Apixaban + Celecoxib Major
Frequently asked questions
Can I take Celecoxib with Methotrexate?
MediHelp rates the interaction as major. Celecoxib and Methotrexate can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. NSAIDs can raise methotrexate concentrations and prolong exposure, particularly with high-dose methotrexate or renal impairment, leading to severe myelosuppression and mucosal toxicity. Celecoxib appears to have a smaller effect at low weekly doses, but caution remains important.
How serious is the interaction between Celecoxib and Methotrexate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid with high-dose methotrexate. With low-dose therapy, monitor renal function and blood counts and watch for mucositis.
What other medicines interact with Methotrexate?
MediHelp also lists interactions of Methotrexate with, for example, Acitretin, Adenovirus types 4 and 7 live, Influenza virus vaccine quadrivalent intranasal. The full list is on the Methotrexate page.
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