Major
celecoxib × Losartan
Selective COX-2 inhibitor (coxib)×Angiotensin II receptor blockers (sartans)
Mechanism
Similar to enalapril + celecoxib. NSAIDs reduce renal blood flow; the ARB (losartan) lowers glomerular pressure. The combination causes acute kidney injury.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.
Management
For prolonged celecoxib therapy, check creatinine 2–4 weeks after start, then every 3 months. In older patients and chronic kidney disease, paracetamol is preferable.