Drug Interactions between celecoxib / tramadol and heparin flush

MONITOR: Coadministration with celecoxib may increase the plasma concentrations of drugs that are substrates of the CYP450 2D6 isoenzyme. The mechanism is decreased clearance due to inhibition of CYP450 2D6 activity by celecoxib.

MANAGEMENT: Caution is advised if celecoxib must be used concurrently with medications that undergo metabolism by CYP450 2D6, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever celecoxib is added to or withdrawn from therapy.

MONITOR: Concomitant use of heparin flush and drugs that interfere with platelet function or coagulation or drugs that commonly cause thrombocytopenia may potentiate the risk of bleeding complications. Although uncommon, inadvertent anticoagulation resulting in hemorrhagic events may occur with heparin flushes, particularly during repeated or excessive use or administration of higher concentration flush solutions.

MANAGEMENT: Caution and monitoring (e.g., platelet counts, hematocrits, tests for occult blood in stools) are advised when heparin flushes are given to patients receiving systemic anticoagulants, platelet inhibitors, antithrombotic agents, thrombolytics, or drugs with known risks of thrombocytopenia or bleeding. An unexplained fall in hematocrit, fall in blood pressure, or any other unexplained symptom should lead to serious consideration of a hemorrhagic event.