X hits on this document

Word document

Strong Opioids +/- adjuvant therapy - page 10 / 38

69 views

0 shares

0 downloads

0 comments

10 / 38

less frequently :

stomatitis

constipation

palpitations

fatigue

paraesthesia

muscle cramps

(aggravation of epilepsy)

Contraindications:

in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID),)

coagulation defects

ischaemic heart disease

cerebrovascular disease

peripheral arterial disease

moderate or severe heart failure

active pepticulceration

Cautions:

Hepatic impairment: Increased risk of gastro-intestinal bleeding and can cause fluid retention; avoid in severe liver disease; halve initial dose in moderate liver disease;

Renal impairment: Use lowest effective dose and monitor renal function; sodium and water retention; deterioration in renal function possibly leading to renal failure; deterioration also reported after topical use.  Moderate-severe: avoid if possible

Pregnancy: Most manufacturers advise avoid unless potential benefit outweighs risk. @ 3rd trimester: with regular use failure of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. Delayed onset and increased duration of labour

Interactions:

Celecoxib-specific:

Drug

Effect of interaction

Coumarins

celecoxib possibly enhances anticoagulant effect of coumarins

Fluconazole

plasma concentration of celecoxib increased by fluconazole (halve dose of celecoxib)

See also NSAID-associated side effects (numerous in BNF)

Avoid concomitant use of NSAIDs with aspirin (increased side-effects)

Monitoring: monitor function in hepatic and renal impairment.

Dose:

Osteoarthritis, 200 mg daily in 1–2 divided doses, increased if necessary to max. 200 mg twice daily; child not recommended

Rheumatoid arthritis, 200–400 mg daily in 2 divided doses; elderly initially 200 mg daily in 2 divided doses; max. 200 mg twice daily; child not recommended

10

Document info
Document views69
Page views69
Page last viewedWed Nov 30 08:55:42 UTC 2016
Pages38
Paragraphs1579
Words11304

Comments