Peinlos Drug Interactions

Aspirin: When ibuprofen is administered with aspirin, ibuprofen's protein binding is reduced, although the clearance of free ibuprofen is no altered. The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of Ibuprofen and aspirin is not generally recommended because of the potential for increased adverse effects.
Anticoagulants: The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a higher risk of serious GI bleeding than users of either drug alone [see Precautions].
ACE Inhibitors: Combination use of ACE inhibitors or angiotensin receptor antagonists, anti-inflammatory drugs and thiazide diuretics.
NSAIDs may diminish the antihypertensive effect of ACE inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE inhibitors. Ibuprofen like other NSAIDs can reduce the antihypertensive effect of ACE inhibitors and beta-blockers with possible loss of blood pressure control and can attenuate the natriuretic effects of thiazide diuretics and furosemide. Diuretics can also increase the risk nephrotoxicity of NSAIDs. The combined use of the three classes of drugs, thiazides, an ACE inhibiting drug (ACE-inhibitor or angiotensin receptor antagonist) and an antiinflammatory drug (NSAID or COX-2 inhibitor) all at the same time increases the risk of renal impairment.
Diuretics: Clinical studies and postmarketing observations have shown that ibuprofen can reduce the natriuretic effects of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with NSAIDs, observe patients closely for signs of renal failure, as well as to assure diuretic efficacy [see Precautions].
Lithium: Ibuprofen should be avoided in patients taking lithium as NSAIDs have produced elevations of plasma lithium levels and a reduction in renal lithium clearance.
Methotrexate: NSAIDs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices. This indicates that NSAIDs may enhance the toxicity of methotrexate. Use caution when NSAIDs are administered concomitantly with methotrexate.
H-2 Antagonists: In studies of human volunteers, co-administration of cimetidine or ranitidine with ibuprofen had no substantive effect on ibuprofen serum concentrations.
Aminoglycosides: NSAIDS may decrease the excretion of aminoglycosides.
Cardiac Glycosides: NSAIDs may exacerbate cardiac failure, reduce glomerular filtration rate and increase plasma cardiac glycosides levels. Care should therefore be taken in patients treated with cardiac glycosides.
Corticosteroids: Increased risk of gastrointestinal bleeding.
Cyclosporin or Tacrolimus: Increased risk of nephrotoxicity when used with NSAIDs.
Mifepristone: NSAIDs should not be used for 8-12 days after mifepristone administrations NSAIDs can reduce the effects of mifepristone.
Quinolone Antibiotics: Animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of developing convulsions.
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is evidence of an increased risk haemarthroses and hematoma in HIV (+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen.
Selective Serotonin Reuptake Inhibitors (SSRIs): Concomitant administration of NSAIDs and SSRIs may increase the risk of gastrointestinal ulceration and bleeding.