A woman with osteoarthritis gives a history of a severe rash after cotrimoxazole. Which NSAID must be prescribed with caution because of a shared structural concern?
- A Celecoxib ✓
- B Diclofenac
- C Naproxen
- D Indomethacin
Correct answer: A. Celecoxib
Explanation
Celecoxib contains a sulfonamide group and can cause cross-reactive cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, in patients with documented sulfonamide hypersensitivity. Naproxen, diclofenac and indomethacin lack the sulfonamide moiety and carry no such cross-reactivity. This structural detail is a frequently examined prescribing safety point, particularly because celecoxib is otherwise attractive when gastrointestinal risk demands a COX-2 selective agent.
Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
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