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Monitor blood pressureBPduring the initiation of NSAID treatment and throughout the course of therapy.

Use the lowest effective dosage for the shortest possible durationAvoid administration of more than one NSAID at a timeAvoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleedingFor such patientsas well as those with active GI bleedingconsider alternate therapies other than NSAIDsRemain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapyIf a serious GI adverse event is suspectedpromptly initiate evaluation and treatmentand discontinue CELEBREX until a serious GI adverse event is ruled outIn the setting of concomitant use of low-dose aspirin for cardiac prophylaxismonitor patients more closely for evidence of GI bleedingsee DRUG INTERACTIONS

Increases in serum potassium concentrationincluding hyperkalemiahave been reported with use of NSAIDseven in some patients without renal impairmentIn patients with normal renal functionthese effects have been attributed to a hyporeninemichypoadosteronism state.

Celecoxib is a potent inhibitor of prostaglandin synthesis in vitroCelecoxib concentrations reached during therapy have produced in vivo effectsProstaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal modelsProstaglandins are mediators of inflammationSince celecoxib is an inhibitor of prostaglandin synthesisits mode of action may be due to a decrease of prostaglandins in peripheral tissues.

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