The only type of selective cyclo–oxygenase 2 (COX–2) inhibitor approved for sale in the United States is celecoxib (Celebrex). Patients should consult their physician before taking any additional prescriptions, over–the–counter medications, nutritional supplements or herbal medications. Concerns of individuals taking celecoxib include:

• Other nonsteroidal anti–inflammatory drugs (NSAIDs). These may be administered in low doses. However, some NSAIDs (e.g., aspirin, ibuprofen) taken together with celecoxib may increase the risk for serious side effects such as ulcer.
  
  
• ACE inhibitors. A group of drugs that treat high blood pressure. Celecoxib and other COX–2 inhibitors may diminish the effectiveness of ACE inhibitors.
  
  
• Some other antihypertensives, including diuretics and metoprolol (a beta blocker).
  
  
• Antiarrhythmics including amiodarone, mexiletine and propafenone, used to treat irregular heartbeats. Mexiletine can also be used topically to ease chronic nerve pain (neuralgia).
  
  
• Certain antibiotics used to treat nonviral infections, including sulfonamides (sulfa drugs) and metronidazole.
  
  
• Clopidogrel. An antiplatelet used to prevent heart attacks and strokes.
  
  
• Dextromethorphan. An ingredient in some cough medications.
  
  
• Fluconazole. An antifungal used to treat yeast infections.
  
  
• Fluvastatin. A type of cholesterol-controlling statin drug.
  
  
• HIV drugs including atazanavir, efavirenz and ritonavir.
  
  
• Lithium and certain other drugs for depression and mental illness.
  
  
• Ondansetron. Used in preventing nausea and vomiting due to chemotherapy and other procedures.
  
  
• Some opioids (codeine and tramadol).
  
  
• Sulfinpyrazone. Used to treat gout.
  
  
• Tamoxifen. An anti-estrogen used to fight breast cancer.
  
  
• Timolol. Used to treat glaucoma and high blood pressure and to prevent angina, heart attack and migraine.
  
  
• Zafirlukast. An asthma drug.