Drug Interactions of OTC Analgesics (Part 4):

Drug Interactions of Ketoprofen:

More presentations from Naina Mohamed Pakkir Maideen

vKetoprofen is a Non Steroidal Anti-inflammatory drug (NSAID) and is available as an OTC analgesic drug which is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.

vConcomitant use of Ketorolac and Ketoprofen is contraindicated due to cumulative risks of inducing serious NSAID-related adverse events (peptic ulcers, gastrointestinal bleeding and/or perforation).

vBleeding risk is elevated by the coadministration of Ketoprofen with drugs such as Warfarin, Heparin, Low Molecular Weight Heparins (LMWHs) (Enoxaparin, Dalteparin, Tinzaparin, etc.), Coumarins and other anticoagulants (Acenocoumarol, Dicumarol, Phenprocoumon, Dabigatran, Anisindione, Phenindione), Direct thrombin inhibitors (Dabigatran, Desirudin, Lepirudin, Bivalirudin, Argatroban), Direct factor Xa inhibitors (Apixaban, Rivaroxaban), Antiplatelets (Clopidogrel, Aspirin, Prasugrel, Ticagrelor, Ticlopidine, Dipyridamole, Abciximab, Eptifibatide, Tirofiban), Danaparoid, Fondaparinux, Selective serotonin reuptake inhibitors (SSRIs) (Escitalopram, Fluvoxamine, Paroxetine, Vortioxetine,  Sertraline, Nefazodone, vilazodone), Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine), Cilostazol, Protein C, Pentoxyfilline, Ginkgo, Meadowsweet, Erlotinib and Gossypol.

vUse of Ketoprofen in patients taking ACE Inhibitors (Captopril, Enalapril, Imidapril, Temocapril, Delapril, Ramipril, Perindopril, Cilazapril), Angiotensin II receptor blockers (ARBs) (Losartan, Valsartan, Telmisartan), Beta adrenergic blockers, Calcium Channel Blockers, Thiazide Diuretics and Loop Diuretics may decrease the antihypertensive effects by decreasing renal prostaglandin production.

vKetoprofen can decrease the renal prostaglandin synthesis and increase the toxicity of Cyclosporine, Tacrolimus and Lithium.

vThe toxicity of Methotrexate, Pralatrexate and Premetrexed may be elevated by the concomitant use of Ketoprofen, due to decreased clearance.

vConcomitant use of Ketoprofen and Fluoroquinolones (Ofloxacin, Levofloxacin, Norfloxacin) may elevate the risk of seizures.

vDue to the risk of earlier closure of ductus arteriosus, Ketoprofen should be avoided after 30 weeks of gestation in Pregnant women.

vPatients should thoroughly read the labels of all over-the-counter and prescription medicines.

vPatients should talk to their doctor or pharmacist before taking any new prescription or over the counter medication.

vPhysicians should be aware of potential drug interactions with OTC medicines when prescribing new medications.

vPharmacists can be instrumental in assisting patients with using OTC medications safely and effectively.

vPharmacists should warn consumers of the risks of misusing OTC pain relievers.

Drug Interactions of OTC Analgesics (Part 3):

Drug Interactions of Ibuprofen:

More presentations from Naina Mohamed Pakkir Maideen

©  Ibuprofen is an OTC analgesic and is used to treat pain or inflammation and to reduce fever.

©  Ibuprofen can cause serious adverse effects by interacting with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents.

©  Use of Ibuprofen by Ketorolac patients, is contraindicated due to cumulative risks of inducing serious NSAID-related adverse events such as peptic ulcers, gastrointestinal bleeding and/or perforation.

©  The risk of bleeding is increased by Ibuprofen in patients taking Warfarin, Danaparoid, Heparin, Low Molecular Weight Heparins (LMWHs) (Enoxaparin, Dalteparin, Tinzaparin, etc.), Coumarins and other anticoagulants (Acenocoumarol, Dicumarol, Phenprocoumon, Dabigatran, Anisindione, Phenindione), Direct thrombin inhibitors (Dabigatran, Desirudin, Lepirudin, Bivalirudin, Argatroban), Direct factor Xa inhibitors (Apixaban, Rivaroxaban), Antiplatelets (Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Ticlopidine, Dipyridamole, Abciximab, Eptifibatide, Tirofiban), Fondaparinux, Selective serotonin reuptake inhibitors (SSRIs) (Escitalopram, Fluvoxamine, Paroxetine, Vortioxetine,  Sertraline, Nefazodone, vilazodone), Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine), Cilostazol, Protein C, Pentoxyfilline, Ginkgo, Meadowsweet, Erlotinib and Gossypol.

©  The antihypertensive effects of ACE Inhibitors (Captopril, Enalapril, Imidapril, Temocapril, Delapril, Ramipril, Perindopril, Cilazapril), Angiotensin II receptor blockers (ARBs) (Losartan, Valsartan, Telmisartan), Beta adrenergic blockers, Calcium Channel Blockers, Thiazide Diuretics, Loop Diuretics and Potassium sparing Diuretics.

©  The plasma levels of ibuprofen is elevated by the co-administration of Amiodarone, Voriconazole and Mifepristone by inhibiting CYP2C9-mediated ibuprofen metabolism.

©  By decreasing renal prostacyclin synthesis, Ibuprofen may increase the risk of Cyclosporine associated nephrotoxicity, Tacrolimus associated acute renal failure and Lithium toxicity (weakness, tremor, excessive thirst, confusion).

©  Ibuprofen may increase the toxicity of Methotrexate, Pralatrexate and Premetrexed by decreasing their renal clearance.

©  Concomitant use of Ibuprofen and Fluoroquinolones (Ofloxacin, Levofloxacin, Norfloxacin) may elevate the risk of seizures.

©  Due to the risk of earlier closure of ductus arteriosus, Ibuprofen should be avoided after 30 weeks gestation in Pregnant women.

©  Patients should thoroughly read the labels of all over-the-counter and prescription medicines.

©  Patients should talk to their doctor or pharmacist before taking any new prescription or over the counter medication.

©  Physicians should be aware of potential drug interactions with OTC medicines when prescribing new medications.

©  Pharmacists can be instrumental in assisting patients with using OTC medications safely and effectively.

©  Pharmacists should warn consumers of the risks of misusing OTC pain relievers.  

Drug Interactions of OTC Analgesics (Part 2):

Drug Interactions of Aspirin:

More presentations from Naina Mohamed Pakkir Maideen

Ø Aspirin or Acetyl salicylic acid (ASA) is an OTC analgesic which can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents.

Ø Coadministration of the Ketorolac and aspirin is contraindicated, because of the cumulative risks of serious NSAID-related adverse events (peptic ulcers, gastrointestinal bleeding, and/or perforation).

Ø It is contraindicated to use live influenza virus vaccine and aspirin in children 2 to 17 years of age due to the potential for Reye's syndrome.

Ø The risk of Reye's syndrome is also enhanced by the use of aspirin within six weeks of Varicella vaccine administration.

Ø The risk of bleeding is increased by aspirin in patients taking Warfarin, Heparin, Low Molecular Weight Heparins (LMWHs) (Enoxaparin, Dalteparin, Tinzaparin, etc.), Coumarins and other anticoagulants (Acenocoumarol, Dicumarol, Phenprocoumon, Anisindione, Phenindione), Antiplatelets (Clopidogrel, Prasugrel, Ticagrelor, Ticlopidine, Dipyridamole, Abciximab, Eptifibatide, Tirofiban), Tissue Plasminogen Activators (Alteplase, Reteplase), Direct thrombin inhibitors (Dabigatran, Desirudin, Lepirudin, Bivalirudin, Argatroban), Direct factor Xa inhibitors (Apixaban, Rivaroxaban), Anagrelide, Cilostazol, Selective serotonin reuptake inhibitors (SSRIs) (Escitalopram, Fluvoxamine, Paroxetine, Vortioxetine,  Sertraline, Nefazodone, vilazodone) and Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine).

Ø The risk of gastrointestinal adverse effects (ulceration, bleeding, perforation) is increased by the concomitant use of aspirin and NSAIDs (Ketoprofen, Naproxen, Meloxicam, Piroxicam) and Corticosteroids (Betamethasone, Prednisone, Prednisolone, Methyl prednisolone, Dexamethasone, Paramethasone, Triamcinolone).

Ø Due to additive hypoglycemic effect of aspirin, it may increase the risk of Hypoglycemia in patients taking Antidiabetics (Insulin, Sulfonylureas).

Ø Concomitant use of aspirin and ACE Inhibitors (Captopril, Enalapril, Imidapril, Temocapril, Delapril, Ramipril, Perindopril, Cilazapril) and Angiotensin II receptor blockers (ARBs) (Losartan, Valsartan, Telmisartan) may leads to decreased antihypertensive effects.

Ø Ethanol consumption should be avoided within 12 hours of aspirin ingestion to prevent gastrointestinal blood loss.

Ø Aspirin is not recommended during pregnancy, particularly in the third trimester due to reported teratogenic and other effects.

Ø Aspirin is considered unsafe during breastfeeding, due to its association with Reye's Syndrome in children.

Ø Patients should thoroughly read the labels of all over-the-counter and prescription medicines.

Ø Patients should talk to their doctor or pharmacist before taking any new prescription or over the counter medication.

Ø Physicians should be aware of potential drug interactions with OTC medicines when prescribing new medications.

Ø Pharmacists can be instrumental in assisting patients with using OTC medications safely and effectively.

Ø Pharmacists should warn consumers of the risks of misusing OTC pain relievers.

Drug Interactions of OTC Analgesics (Part 1):

Drug Interactions of Acetaminophen (Paracetamol):

More presentations from Naina Mohamed Pakkir Maideen

ª  Acetaminophen is a most commonly used analgesic drug and can be found in over 200 OTC products.

ª  Concomitant use of Acetaminophen and warfarin may increase the risk of bleeding. Acetaminophen is still the analgesic and antipyretic of choice in warfarin patients, due to lack of a safer alternative.

ª  The risk of hepatotoxicity is elevated by the coadministration of Acetaminophen and CYP enzyme inducers (Carbamazepine, Oxcarbazepine, Phenytoin, Fosphenytoin, Deferasirox, Piperaquine, Barbiturates, Isoniazid, Rifampin, and Rifabutin).

ª  Smokers may need more dose of Acetaminophen due to increased metabolism and the toxicity of Acetaminophen is also increased.

ª  Chronic Alcoholics increase their chances to develop hepatotoxicity by using Acetaminophen.

ª  Presence of food in the GIT may delay the absorption of Acetaminophen and for rapid relief of pain it can be taken on an empty stomach.

ª  Normal therapeutic doses of Acetaminophen for a short period are considered to be safe in Pregnancy and Breast feeding.

ª  Patients should thoroughly read the labels of all over-the-counter and prescription medicines.

ª  Patients should talk to their doctor or pharmacist before taking any new prescription or over the counter medication.

ª  Physicians should be aware of potential drug interactions with OTC medicines when prescribing new medications.

ª  Pharmacists can be instrumental in assisting patients with using OTC medications safely and effectively.

ª  Pharmacists should warn consumers of the risks of misusing OTC pain relievers.