Major
celecoxib × Lithium
Selective COX-2 inhibitor (coxib)×Psycholeptics. Lithium
Mechanism
NSAIDs (including selective COX-2 inhibitors like celecoxib) reduce renal lithium clearance. Lithium plasma levels rise.
Symptoms
Tremor, muscle twitching, nausea, diarrhoea, confusion, ataxia. Symptoms emerge when serum lithium exceeds 1.2 mmol/L.
Management
For prolonged celecoxib therapy, reduce lithium by 25%; check level at 1 week and then monthly. Alternative analgesic without lithium effect: paracetamol.