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Drug Interactions between Celebrex and hydrochlorothiazide / olmesartan

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

hydroCHLOROthiazide celecoxib

Applies to: hydrochlorothiazide / olmesartan and Celebrex (celecoxib)

MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics may adversely affect renal function due to NSAID inhibition of the renal synthesis of prostaglandins that help maintain renal perfusion in dehydrated states. The risk may be increased in patients on dietary sodium restriction. At the same time, hypotensive effect of the diuretics may be reduced because inhibition of prostaglandins can lead to unopposed pressor activity and, consequently, elevation in blood pressure. Natriuretic and diuretic effects may also be reduced, as NSAIDs have been reported to cause sodium and water retention, which may account for the increased risk of congestive heart failure associated with the combination. One study showed an increase in the incidence density of congestive heart failure (in patients over 55 years of age) from 9.3 per 1,000 person-years in patients on diuretics to 23.3 per 1,000 person-years in patients on both diuretic and NSAID therapy. NSAIDs may also increase the risk of hyperkalemia associated with potassium-sparing diuretics.

MANAGEMENT: In patients receiving both diuretic and NSAID therapy, management consists of avoiding dehydration and carefully monitoring the patient's renal function and blood pressure. If renal insufficiency or hyperkalemia develops, both drugs should be discontinued until the condition is corrected.

References

  1. Allan SG, Knox J, Kerr F "Interaction between diuretics and indomethacin." Br Med J 283 (1981): 1611
  2. McCarthy JT, Torres VE, Romero JC, et al. "Acute intrinsic renal failure induced by indomethacin." Mayo Clin Proc 57 (1982): 289-96
  3. Favre L, Glasson P, Vallotton MB "Reversible acute renal failure from combined triamterene and indomethacin." Ann Intern Med 96 (1982): 317-20
  4. Poe TE, Scott RB, Keith JF Jr "Interaction of indomethacin with furosemide." J Fam Pract 16 (1983): 610-6
  5. Ahmad S "Indomethacin-bumetanide interaction: an alert." Am J Cardiol 54 (1984): 246-7
  6. Dixey JJ, Noormohamed FH, Lant AF, Brewerton DA "The effects of naproxen and sulindac on renal function and their interaction with hydrochlorothiazide and piretanide in man." Br J Clin Pharmacol 23 (1987): 55-63
  7. Brater DC, Fox WR, Chennavasin P "Interaction studies with bumetanide and furosemide: effects of probenecid and of indomethacin on response to bumetanide in man." J Clin Pharmacol 21 (1981): 647-53
  8. Smith DE, Brater DC, Lin ET, Benet LZ "Attenuation of furosemide's diuretic effect by indomethacin: pharmacokinetic evaluation." J Pharmacokinet Biopharm 7 (1979): 265-74
  9. Mor R, Pitlik S, Rosenfeld JB "Indomethacin- and Moduretic--induced hyperkalemia." Isr J Med Sci 19 (1983): 535-7
  10. Kaufman J, Hamburger R, Matheson J, Flamenbaum W "Bumetanide-induced diuresis and natriuresis: effect of prostaglandin synthetase inhibition." J Clin Pharmacol 21 (1981): 663-7
  11. Favre L, Glasson P, Riondel A, Vallotton MB "Interaction of diuretics and non-steroidal anti-inflammatory drugs in man." Clin Sci 64 (1983): 407-15
  12. Pedrinelli R, Magagna A, Arzilli F, et al. "Influence of indomethacin on the natriuretic and renin-stimulating effect of bumetanide in essential hypertension." Clin Pharmacol Ther 28 (1980): 722-31
  13. Weinberg MS, Quigg RJ, Salant DJ, Bernard DB "Anuric renal failure precipitated by indomethacin and triamterene." Nephron 40 (1985): 216-8
  14. Furst DE "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl 17 (1988): 58-62
  15. Gehr T, Sica DA, Steigler BW, Marshall C "Interaction of triamterene-hydrochlorothiazide (T-H) and ibuprofen (I)." Clin Pharmacol Ther 47 (1990): 200
  16. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co., Inc PROD (2002):
  17. Watkins J, Abbot EC, Hensby CN, Webster J, Dollery CT "Attenuation of hypotensive effect of propranolol and thiazide diuretics by indomethacin." Br Med J 281 (1980): 702-5
  18. Ripley EB, Gehr TW, Wallace H, Wade J, Kish C, Sica DA "The effect of nonsteroidal agents (NSAIDs) on the pharmacokinetics and pharmacodynamics of metolazone." Int J Clin Pharmacol Ther 32 (1994): 12-8
  19. Desaulles E, Schwartz J "A comparative study of the action of frusemide and methyclothiazide on renin release by rat kidney slices and the interaction with indomethacin." Br J Pharmacol 65 (1979): 193-6
  20. Muller FO, Schall R, Devaal AC, Groenewoud G, Hundt HKL, Middle MV "Influence of meloxicam on furosemide pharmacokinetics and pharmacodynamics in healthy volunteers." Eur J Clin Pharmacol 48 (1995): 247-51
  21. Gurwitz JH, Everitt DE, Monane M, et al. "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci 51 (1996): m74-9
  22. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med 158 (1998): 1108-12
  23. Leary WP, Reyes AJ "Drug interactions with diuretics." S Afr Med J 65 (1984): 455-61
  24. Bennett WM "Drug interactions and consequences of sodium restriction." Am J Clin Nutr 65 (1997): S678-81
  25. Marcy TR, Ripley TL "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm 63 (2006): 49-58
  26. Perazella MA "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med 109 (2000): 307-14
View all 26 references

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Moderate

celecoxib olmesartan

Applies to: Celebrex (celecoxib) and hydrochlorothiazide / olmesartan

MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effects of angiotensin II receptor antagonists. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis, which results in unopposed pressor activity producing hypertension. In addition, NSAIDs can cause fluid retention, which also affects blood pressure. Clinical data are limited.

MONITOR: Concomitant use of NSAIDs and angiotensin II receptor antagonists may cause deterioration in renal function, particularly in patients who are elderly or volume-depleted (including those on diuretic therapy) or have compromised renal function. Acute renal failure may occur, although effects are usually reversible. Chronic use of NSAIDs alone may be associated with renal toxicities, including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. Additionally, in patients with prerenal conditions whose renal perfusion may be dependent on the function of prostaglandins, NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Angiotensin II receptor antagonists can further worsen renal function by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration.

MANAGEMENT: Patients receiving angiotensin II receptor antagonists who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation, discontinuation, or change of dosage of the NSAID. Renal function should also be evaluated periodically during prolonged coadministration. The interaction is not expected to occur with low doses (e.g., low-dose aspirin) or intermittent short-term administration of NSAIDs.

References

  1. Radack KL, Deck CC, Bloomfield SS "Ibuprofen interferes with the efficacy of antihypertensive drugs: a randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen." Ann Intern Med 107 (1987): 628-35
  2. "Product Information. Toradol (ketorolac)." Roche Laboratories PROD (2002):
  3. "Multum Information Services, Inc. Expert Review Panel"
  4. "Product Information. Celebrex (celecoxib)." Searle PROD (2001):
View all 4 references

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Drug and food interactions

Moderate

olmesartan food

Applies to: hydrochlorothiazide / olmesartan

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Moderate

hydroCHLOROthiazide food

Applies to: hydrochlorothiazide / olmesartan

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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