Is it safe to take celecoxib (celecoxib), a nonsteroidal anti-inflammatory drug (NSAID), 1 tablet per day after left meniscus repair surgery in a patient with diabetes mellitus and impaired renal function (Glomerular Filtration Rate (GFR) greater than 20)?

From the Guidelines

Taking celecoxib 1 tablet per day for left meniscus surgery repair is generally acceptable for short-term use (1-2 weeks) in patients with diabetes and a GFR > 20, but caution is advised. Start with the lowest effective dose, typically 200 mg once daily, as recommended by the American Heart Association 1. Monitor kidney function closely, as NSAIDs like celecoxib can potentially worsen kidney function, especially in diabetic patients, with a risk of renal complications that may lead to discontinuation of NSAIDs in 2% of patients 1. Watch for signs of fluid retention or worsening blood pressure, as NSAIDs can increase blood pressure by an average of 5 mm Hg 1. If longer-term pain management is needed, consult with your doctor about alternative options or reducing the frequency of use. Be sure to maintain good glycemic control, as diabetes can affect healing. Report any unusual symptoms such as stomach pain, black stools, or swelling to your healthcare provider immediately. Consider using acetaminophen as an alternative or in combination with celecoxib to reduce the total NSAID dose needed, as the benefit of pain relief and reduced inflammation must be balanced against the potential risks to kidney function and diabetes management, so regular follow-up with your healthcare provider is crucial.

Some key considerations include:

• The risk of gastrointestinal bleeding, which can be mitigated by combining celecoxib with a proton pump inhibitor (PPI) or misoprostol, especially in patients with a history of NSAID-associated upper GI tract bleeding 1
• The risk of cardiovascular complications, which may be increased with the use of celecoxib, particularly in patients with a history of cardiovascular events, and should be weighed against the benefits of pain relief and reduced inflammation 1
• The importance of monitoring kidney function and blood pressure closely, as NSAIDs can worsen kidney function and increase blood pressure, especially in patients with pre-existing kidney disease or hypertension 1

From the FDA Drug Label

5.6 Renal Toxicity and Hyperkalemia Renal Toxicity Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion In these patients, administration of an NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation Patients at greatest risk of this reaction are those with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics, ACE inhibitors or the ARBs, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state No information is available from controlled clinical studies regarding the use of celecoxib capsules in patients with advanced renal disease. The renal effects of celecoxib capsules may hasten the progression of renal dysfunction in patients with preexisting renal disease. Correct volume status in dehydrated or hypovolemic patients prior to initiating celecoxib capsules Monitor renal function in patients with renal or hepatic impairment, heart failure, dehydration, or hypovolemia during use of celecoxib capsules [see Drug Interactions (7)]. Avoid the use of celecoxib capsules in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function If celecoxib capsules are used in patients with advanced renal disease, monitor patients for signs of worsening renal function.

Key Considerations:

• The patient has impaired renal function with a GFR greater than 20.
• The patient has diabetes mellitus, which may increase the risk of renal toxicity.
• Celecoxib may worsen renal function in patients with preexisting renal disease.

Answer: It is not safe to take celecoxib 1 tablet per day after left meniscus repair surgery in a patient with diabetes mellitus and impaired renal function (GFR greater than 20) without careful monitoring of renal function and consideration of alternative therapies. The benefits of using celecoxib in this patient must be carefully weighed against the potential risks of worsening renal function 2.

From the Research

Safety of Celecoxib after Meniscus Repair Surgery

• The provided studies do not directly address the safety of taking celecoxib, a nonsteroidal anti-inflammatory drug (NSAID), after left meniscus repair surgery in a patient with diabetes mellitus and impaired renal function (Glomerular Filtration Rate (GFR) greater than 20) 3, 4, 5, 6, 7.
• However, it is known that NSAIDs like celecoxib can have adverse effects on renal function and may worsen existing renal impairment 4.
• Patients with diabetes mellitus undergoing surgery may have specific needs, particularly in relation to blood glucose control, and healthcare professionals need to be able to assess and manage these individuals to ensure optimum surgical outcomes 3.
• The studies focus on the outcomes of meniscus repair and the management of patients with diabetes undergoing surgery, but do not provide information on the safety of celecoxib in this specific context 5, 6, 7.
• Intensive glycaemic control in people with diabetes undergoing surgery may result in little to no difference in all-cause mortality, but may increase the risk of hypoglycaemia 4.
• Meniscus repair outcomes at greater than five years postoperatively have been reported, but the safety of celecoxib in this context is not addressed 7.