Drug Interaction Report

MONITOR: Coadministration of 5-aminosalicylate with other nephrotoxic agents may increase the risk and severity of renal impairment due to additive effects on the kidney. The use of 5-aminosalicylate or its prodrugs has been associated with rare reports of renal impairment including minimal change nephropathy, acute and chronic interstitial nephritis, and renal failure. Animal studies have also shown the kidney to be the major target organ of 5-aminosalicylate toxicity. Renal lesions including granular and hyaline casts, tubular degeneration, tubular dilation, renal infarct, papillary edema, papillary necrosis, tubular necrosis, interstitial fibrosis, and interstitial nephritis have been observed with large doses.

MANAGEMENT: Caution is advised when 5-aminosalicylate preparations are prescribed to patients who have recently received or are receiving treatment with other potentially nephrotoxic agents (e.g., aminoglycosides; polypeptide, glycopeptide, and polymyxin antibiotics; amphotericin B; adefovir; cidofovir; foscarnet; cisplatin; deferasirox; gallium nitrate; lithium; certain immunosuppressants; intravenous bisphosphonates; intravenous pentamidine; high intravenous dosages of methotrexate; high dosages and/or chronic use of nonsteroidal anti-inflammatory agents). Renal function should be evaluated prior to and during 5-aminosalicylate therapy.

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as well as clinical and laboratory monitoring may be appropriate for some drugs whenever celecoxib is added to or withdrawn from therapy.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.