|
Potential drug interactions with OTC analgesics[5,42,43] |
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| Drug combinations |
Effect |
Management options/considerations |
|
|
||
| Aspirin and NSAIDs or multiple NSAIDs |
Increased risk of serious GI complications. Risk increases with increased dose and number of agents |
Avoid concurrent use of more than one NSAID, if possible. Consider adding gastroprotective agents |
| Anticoagulants and NSAIDs |
Increased risk of bleeding (especially GI) and increased oral warfarin activity |
Avoid concurrent use of NSAID; monitor prothrombin time and occult blood in urine and stool |
| Corticosteroids and NSAIDs |
Increased GI side effects, including ulceration and hemorrhage |
Avoid concurrent use of NSAID and consider adding a gastroprotective agent |
| SSRIs and NSAIDs |
Increased risk of GI bleeding |
Avoid concurrent use of NSAID |
| Aspirin and ibuprofen or naproxen |
Reduced antiplatelet effects of aspirin |
Not seen with other NSAIDs or acetaminophen |
| Antihypertensive agents and NSAIDs |
Use of NSAIDs may increase blood pressure |
Monitor blood pressure and cardiac function |
| Antidiabetic agents (eg, sulfonylureas) and aspirin |
Increased hypoglycemic effect |
Avoid concurrent use and monitor blood glucose concentration |
| Lithium and NSAIDs |
Increased steady-state lithium concentration and lithium toxicity |
Monitor lithium concentrations. Interactions are less likely with aspirin than with naproxen or ibuprofen |
| Methotrexate and NSAIDs |
Reduced renal clearance. Increased plasma methotrexate concentration |
Avoid NSAIDs with high-dose methotrexate |
|
GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug; OTC = over the counter; SSRI = selective serotonin reuptake inhibitor. | ||
Fendrick et al. Osteopathic Medicine and Primary Care 2008 2:2 doi:10.1186/1750-4732-2-2 |
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