Discontinue use if persistently abnormal LFTs are detected. Greater risk of serious CV thrombotic events, MI & stroke in patients w/ known CV disease or its risk factors. Concurrent use of aspirin & NSAIDs. Increased MI & stroke incidence when used for pain in the 1st 10-14 days following CABG surgery. Concomitant use of thiazides or loop diuretics; oral steroids or anticoagulants. Patients w/ HTN; closely monitor BP during NSAID treatment initiation & throughout the course of therapy. Patients w/ fluid retention or heart failure. Patients w/ history of PUD &/or GI bleeding. Immediately evaluate & give additional treatment if serious GI effects are suspected; considered alternative therapy that does not include NSAIDs for high-risk patient. Dehydration; rehydrate patients prior to starting therapy. Possible fluid retention, edema or HTN exacerbation in patients w/ pre-existing edema, HTN or heart failure. Possible more frequent & severe HTN particularly at high doses; consider alternative treatment if BP rises significantly. Patients w/ medical history of ischemic heart disease. Possible development of GI ulcers/ulcer complications. Patients who have previously experienced acute asthmatic attacks, urticaria or rhinitis. May mask fever. ALT &/or AST elevations. Not recommended in patients w/ advanced renal disease. Close monitoring of renal function in patients w/ estimated CrCl <30 mL/min. Pre-existing significantly impaired renal function, uncompensated heart failure or cirrhosis; consider monitoring renal function. Pregnancy (1st & 2nd trimesters). Lactation. Childn. Elderly >65 yr. Debilitated patients.
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