Major
celecoxib × Iopromide
Selective COX-2 inhibitor (coxib)×X-ray contrast media. Watersoluble nephrotropic low-osmolar iodinated agents
Mechanism
Contrast (iopromide) and an NSAID (celecoxib) are both nephrotoxic. NSAID-induced reduction in renal blood flow amplifies contrast-induced nephropathy risk, especially in chronic kidney disease.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.
Management
Stop celecoxib 48 hours before planned contrast and resume 48 hours after with stable renal function. Provide contrast nephroprotection with adequate saline hydration.