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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Advil Congestion Relief (Ibuprofen and Phenylephrine)

Ibuprofen and phenylephrine are two different medications often used for different purposes.

Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relieve pain, reduce inflammation, and lower fever. It is often used to treat conditions such as headaches, dental pain, menstrual cramps, muscle aches, and arthritis. Ibuprofen works by inhibiting the production of certain chemicals in the body that cause inflammation and pain.

Phenylephrine: Phenylephrine is a decongestant that works by narrowing the blood vessels in the nasal passages, which reduces swelling and congestion. It is commonly used to relieve nasal congestion caused by allergies, colds, or sinusitis. Phenylephrine can be found in various forms, including nasal sprays, oral medications, and eye drops.

Advil Congestion Relief contains Ibuprofen and Phenylephrine. Ibuprofen is a non-selective NSAID that is used to relieve pain, inflammation, and fever. Phenylephrine is a vasoconstrictor medicine that is used to relieve congestion.

Ibuprofen and phenylephrine Uses:

Common cold and flu:
- It is used to temporarily relieve cold-related symptoms such as sinus discomfort and pressure, rhinorrhea, and nasal congestion.

Ibuprofen and phenylephrine Dose in Adults:

Advil Congestion Relief Dose in the treatment of Common cold/flu:

When treating a common cold or flu, you can take Ibuprofen and phenylephrine together in a tablet form by mouth.
The recommended dose is Ibuprofen 200 mg and phenylephrine 10 mg every 4 hours.
But remember not to exceed a maximum of Ibuprofen 1,200 mg and phenylephrine 60 mg within a 24-hour period.
This helps relieve symptoms like fever, pain, and congestion.
Always follow the dosage instructions on the medication label or as advised by your doctor.

Advil Congestion Relief Dose in Children:

Ibuprofen should not be used in excess of 10 mg/kg/dose (or 400 mg each dosage) or 40 mg/kg/day in children.

Pregnancy Risk Category: C/D

Refer to individual agents (Ibuprofen & Phenylephrine) for details regarding their use in pregnancy and breastfeeding.

Dose in Kidney Disease:

The manufacturer's labeling does not specify dosage adjustments for Ibuprofen and phenylephrine combination. However, it's crucial to use these medications with caution, especially in certain situations.

According to the KDIGO 2012 guidelines:

If the estimated Glomerular Filtration Rate (eGFR) is between 30 to <60 mL/minute/1.73 m², it's recommended to avoid using NSAIDs like Ibuprofen in patients with intercurrent diseases that increase the risk of acute kidney injury.
If the eGFR is less than 30 mL/minute/1.73 m², it's advised to avoid using NSAIDs altogether.

These guidelines highlight the importance of being cautious when using NSAIDs, including Ibuprofen, in individuals with compromised kidney function.

Dose in Liver disease:

The manufacturer's instructions don't mention specific dosage adjustments for people with liver problems when using Ibuprofen and phenylephrine together.
However, it's essential to be cautious.
If you have liver issues, it's wise to use these medications carefully and possibly at lower doses.

Side effects of Advil Congestion Relief:

Hypersensitivity:
- Hypersensitivity reaction
Oncologic & Hematologic:
- Upper gastrointestinal hemorrhage

See Ibuprofen and Phenylephrine for detailed side effects.

Contraindications to Advil Congestion Relief:

When using Ibuprofen and phenylephrine for self-medication, there are several precautions to keep in mind.
Firstly, do not use if you're allergic to any other pain relievers or fever reducers.
Additionally, avoid giving these medications to children under 12 years old.
It's also crucial to refrain from using them before or after cardiac surgery.
Lastly, do not take them if you've used or stopped taking a monoamine oxidase inhibitor (MAOI) within the past 14 days.
These precautions are essential for your safety and to prevent potential complications.
Always read the labels and follow the instructions carefully before using any medication.

Warnings and precautions

Cardiovascular events

When using Ibuprofen, it's essential to be aware of potential risks, particularly related to cardiovascular events.
NSAIDs like Ibuprofen can increase the chances of adverse cardiovascular problems such as heart attacks and strokes, especially in people with existing heart issues or those who use them for an extended period.
Before prescribing, healthcare providers should carefully assess each individual's cardiovascular risk factors.
It's also important to be cautious of fluid retention, and avoid using Ibuprofen in individuals with heart failure.
Combining Ibuprofen with aspirin might reduce aspirin's protective effects on the heart.
To minimize these risks, it's recommended to use the lowest effective dose for the shortest possible time, considering the patient's needs, and to explore alternative treatments for those at higher risk of cardiovascular events.

Gastrointestinal events:

When using Ibuprofen, it's important to consider the risk of gastrointestinal events, especially gastrointestinal bleeding.
Elderly patients are particularly vulnerable to serious adverse effects.
Caution should be exercised in patients aged 60 and older, as well as those with a history of gastrointestinal issues such as bleeding or ulcers, those taking other NSAIDs, aspirin, anticoagulants, or corticosteroids, and individuals who consume three or more alcoholic drinks per day.
To mitigate these risks, it's advisable to use the lowest effective dose for the shortest possible duration.
If any signs or symptoms of gastrointestinal bleeding occur, such as dizziness, black stool, vomiting blood, or new or worsening stomach pain, discontinuation of Ibuprofen is recommended, and medical attention should be sought immediately.

Hypersensitivity

Ibuprofen can trigger severe hypersensitivity reactions in some individuals.
Those with a condition known as "aspirin triad," which includes bronchial asthma, aspirin intolerance, and rhinitis, might be at a higher risk.
If any signs of allergic or hypersensitivity reactions such as rash, itching, swelling, difficulty breathing, or wheezing occur, it's crucial to stop using Ibuprofen immediately and seek medical attention promptly.

Asthma

Ibuprofen should be used cautiously in patients with asthma.
While it's generally safe for most individuals, those with asthma may experience exacerbation of their symptoms.
It's essential to monitor closely for any worsening of asthma symptoms, such as difficulty breathing, wheezing, or chest tightness, while taking Ibuprofen.

Bariatric surgery

After undergoing bariatric surgery, it's crucial to avoid long-term use of oral nonselective NSAIDs like Ibuprofen due to the risk of gastric ulceration.
Chronic use of these medications may lead to the development of ulcerations or perforations in the surgical site.
Instead, short-term use of drugs like celecoxib or IV ketorolac is recommended as part of a comprehensive pain management plan for postoperative pain.
These recommendations are supported by various studies and guidelines aimed at minimizing the risk of complications after bariatric surgery.

Cardiovascular disease

It's important to exercise caution when using Ibuprofen in patients with cardiovascular disease, including conditions like hypertension (high blood pressure) and ischemic heart disease (reduced blood flow to the heart).
While Ibuprofen can effectively relieve pain and inflammation, it may also increase the risk of cardiovascular events such as heart attacks or strokes, particularly in those with preexisting heart conditions.

Diabetes:

When using Ibuprofen, it's advisable to exercise caution in patients with diabetes mellitus.
Although Ibuprofen is commonly used to relieve pain and inflammation, it can affect blood sugar levels, potentially complicating diabetes management.
Individuals with diabetes should monitor their blood sugar levels closely while taking Ibuprofen and be aware of any changes.

Gastrointestinal Disease:

Patients with a history of gastrointestinal (GI) disease, such as bleeding, ulcers, or gastroesophageal reflux, should use Ibuprofen with caution.
While Ibuprofen is effective for pain relief and reducing inflammation, it can increase the risk of GI complications, including bleeding and ulcers, particularly in individuals with preexisting GI conditions.

Hepatic impairment

Patients with hepatic impairment or active liver disease should use Ibuprofen with caution.
Since Ibuprofen is metabolized in the liver, individuals with liver problems may be at increased risk of adverse effects.
It's important to discuss any existing liver conditions with doctor before taking Ibuprofen.
In some cases, a lower dose or alternative pain management strategies may be recommended to minimize the risk of liver-related complications.
Regular monitoring of liver function may also be necessary while using Ibuprofen in patients with hepatic impairment.
If any symptoms of liver problems, such as jaundice or abdominal pain, occur while taking Ibuprofen, it's essential to seek medical attention promptly.

Prostatic hyperplasia, urinary obstruction

Patients with prostatic hyperplasia (enlarged prostate) or urinary obstruction should use Ibuprofen with caution.
Ibuprofen can potentially exacerbate urinary symptoms by causing relaxation of the smooth muscles in the prostate and bladder neck, leading to increased urinary retention or difficulty urinating.

Renal impairment

Patients with renal impairment should use Ibuprofen with caution.
Since Ibuprofen is primarily eliminated from the body through the kidneys, individuals with kidney problems may be at increased risk of adverse effects.

Thyroid dysfunction:

Patients with thyroid dysfunction should use Ibuprofen with caution.
While Ibuprofen is generally considered safe for most individuals, it can affect thyroid function in some cases.

Ibuprofen and phenylephrine: Drug Interaction

Risk Factor C (Monitor therapy)
5-Aminosalicylic Acid Derivatives	The nephrotoxic action of 5-Aminosalicylic Acid Derivatives may be enhanced by non-steroidal anti-inflammatory drugs.
Acalabrutinib	The antiplatelet action of agents with antiplatelet properties could be enhanced.
Acetaminophen	may raise the level of phenylephrine in the blood (Systemic).
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	the antiplatelet action of other agents having antiplatelet properties may be enhanced.
Alcohol (Ethyl)	Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. In particular, this combination may make Gastrointestinal bleeding more likely.
Aliskiren	Aliskiren's ability to lower blood pressure may be diminished by nonsteroidal anti-inflammatory drugs. Nonsteroidal Anti-Inflammatory Drugs may intensify Aliskiren's nephrotoxic effects. Treatment: In patients on aliskiren and any nonsteroidal anti-inflammatory medication, frequently check on renal function. Individuals with advanced age, fluid depletion, or pre-existing renal impairment are at increased risk for renal failure.
Alpha1-Blockers	May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1Agonists may antagonize Alpha1-Blocker vasodilation.
Aminoglycosides	Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants.
Aminolevulinic Acid (Topical)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical).
Angiotensin II Receptor Blockers	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function.
Angiotensin-Converting Enzyme Inhibitors	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.
Anticoagulants	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.
AtoMOXetine	might make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by atoMOXetine.
Beta-Blockers	The antihypertensive impact of beta-blockers may be reduced by nonsteroidal anti-inflammatory drugs. Levobunolol and metipranolol are exceptions.
Bisphosphonate Derivatives	Nonsteroidal Anti-Inflammatory Drugs may intensify the harmful or hazardous effects of derivatives of bisphosphonates. The concern is raised by both an elevated risk of nephrotoxicity and an elevated risk of gastrointestinal ulcers.
Cannabinoid-Containing Products	Sympathomimetics' tachycardic action might be boosted by it. Cannabidiol is an exception.
Cephalothin	Substances having antiplatelet properties may intensify cephalothin's harmful or hazardous effects. In particular, there may be an elevated risk of bleeding.
Chloroprocaine	may intensify phenylephrine's hypertensive effects (Systemic).
CloZAPine	may lessen phenylephrine's therapeutic effects (Systemic).
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
Corticosteroids (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective).
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deferasirox	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin.
Dichlorphenamide	The serum levels of dichlorphenamide may rise in response to OAT1/3 Inhibitors.
Digoxin	Nonsteroidal Anti-Inflammatory Drugs may raise the level of digoxin in the blood.
Doxofylline	The hazardous or unpleasant effects of doxofylline may be increased by sympathomimetic drugs.
Drospirenone	Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone.
Eplerenone	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone.
Fat Emulsion (Fish Oil Based)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Felbinac	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
FentaNYL	Alpha1-Agonists may decrease the serum concentration of FentaNYL. Specifically, fentanyl nasal spray serum concentrations may decrease and the onset of the effect may be delayed.
Glucosamine	Agents having antiplatelet properties may have an enhanced antiplatelet impact.
Guanethidine	It may enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics.
Haloperidol	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion.
HydrALAZINE	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ioflupane I 123	The diagnostic impact of phenylephrine (Systemic) may be diminished.Ioflupane I 123's diagnostic effectiveness may be reduced by phenylephrine (Systemic).
Limaprost	The antiplatelet action of agents with antiplatelet properties could be enhanced.
Lumacaftor	May decrease the serum concentration of Ibuprofen.
MetFORMIN	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of MetFORMIN.
Multivitamins/Fluoride (with ADE)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with ADEK, Folate, Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Multivitamins/Minerals (with AE, No Iron)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Naftazone	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents.
Obinutuzumab	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.
Omega-3 Fatty Acids	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Pentosan Polysulfate Sodium	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.
Pentoxifylline	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Porfimer	Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.
Potassium-Sparing Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics.
PRALAtrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation.
Probenecid	May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents.
Propacetamol	may raise phenylephrine levels in the blood (Systemic). Management: If propacetamol is administered concurrently, constantly monitor patients for phenylephrine adverse effects that may worsen. Closer monitoring and evaluation of alternate medicines may be necessary for patients with underlying blood pressure or heart rhythm problems.
Prostacyclin Analogues	Agents having antiplatelet properties may have an enhanced antiplatelet impact.
Prostaglandins (Ophthalmic)	The therapeutic value of prostaglandins may be diminished by nonsteroidal anti-inflammatory drugs (Ophthalmic). The therapeutic benefits of prostaglandins may potentially be enhanced by nonsteroidal anti-inflammatory drugs (Ophthalmic).
Quinolones	Quinolones may have a stronger neuroexcitatory and/or seizure-provoking action when used with nonsteroidal anti-inflammatory drugs. Quinolones' serum concentration may rise in response to non-steroidal anti-inflammatory drugs.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Serotonin/Norepinephrine Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Solriamfetol	Sympathomimetics may intensify Solriamfetol's hypertensive effects.
Sympathomimetics	might intensify the hazardous or harmful effects of other sympathomimetics.
Tacrolimus (Systemic)	Nonsteroidal Anti-Inflammatory Drugs may intensify Tacrolimus' nephrotoxic effects (Systemic).
Tedizolid	might make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by tedizolid.
Thiazide and Thiazide-Like Diuretics	may intensify nonsteroidal anti-inflammatory drugs' nephrotoxic effects. Thiazide and Thiazide-Like Diuretics may have less of a therapeutic impact when used with nonsteroidal anti-inflammatory drugs.
Thrombolytic Agents	The anticoagulant impact of thrombolytic agents may be strengthened by agents having antiplatelet properties.
Tipranavir	Agents having antiplatelet properties may have an enhanced antiplatelet impact.
Tolperisone	Nonsteroidal Anti-Inflammatory Drugs may intensify Tolperisone's negative/toxic effects. Particularly, there may be a higher risk of hypersensitive responses. The therapeutic effects of nonsteroidal anti-inflammatory drugs may be improved by tolperisone.
Tricyclic Antidepressants	Alpha1-Agonists' potential therapeutic effects could be improved. The therapeutic benefit of Alpha1-Agonists may be diminished by Tricyclic Antidepressants.
Tricyclic Antidepressants (Tertiary Amine)	Nonsteroidal Anti-Inflammatory Drugs may improve their antiplatelet impact (Nonselective).
Vancomycin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin.
Verteporfin	Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.
Vitamin E (Systemic)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Voriconazole	May increase the serum concentration of Ibuprofen. Specifically, concentrations of the S-(+)-ibuprofen enantiomer may be increased.
Zanubrutinib	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Risk Factor D (Consider therapy modification)
Apixaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk-to-benefit assessment should be done for all patients before any concurrent use of apixaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Bemiparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Bemiparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of heparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Benzylpenicilloyl Polylysine	Alpha1-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response.
Bile Acid Sequestrants	May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents.
Cocaine (Topical)	might make sympathomimetics' hypertensive effects stronger. Management: Whenever feasible, look at alternatives to using this combo. While used concurrently, keep a watchful eye out for noticeably elevated blood pressure or heart rate as well as any signs of myocardial ischemia.
CycloSPORINE (Systemic)	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs.
Dabigatran Etexilate	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk-to-benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Diclofenac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs.
Edoxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk-to-benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Enoxaparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Enoxaparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Heparin	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required.
Heparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed.
Imatinib	Ibuprofen may decrease the serum concentration of Imatinib. Specifically, ibuprofen may decrease intracellular concentrations of imatinib, leading to decreased clinical response. Management: Consider using an alternative to ibuprofen in patients who are being treated with imatinib. Available evidence suggests other NSAIDs do not interact in a similar manner.
Linezolid	might make sympathomimetics' hypertensive effects stronger. Management: Whenever feasible, look at alternatives to using this combo. While used concurrently, keep a watchful eye out for noticeably elevated blood pressure or heart rate as well as any signs of myocardial ischemia.
Lithium	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium.
Loop Diuretics	Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended.
Methotrexate	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate.
PEMEtrexed	Ibuprofen may increase the serum concentration of PEMEtrexed. Management: In patients with an estimated creatinine clearance of 45 to 79 mL/min, avoid ibuprofen for 2 days before, the day of, and 2 days following the administration of pemetrexed. Monitor for increased pemetrexed toxicities if combined.
Rivaroxaban	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.
Salicylates	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate.
Selective Serotonin Reuptake Inhibitors	May enhance the antiplatelet effect of Nonsteroidal AntiInflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
Sodium Phosphates	May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely.
Tenofovir Products	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose.
Vitamin K Antagonists (eg, warfarin)	Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Consider alternatives to this combination when possible. If the combination must be used, monitor coagulation status closely and advise patients to promptly report any evidence of bleeding or bruising.
Risk Factor X (Avoid combination)
Acemetacin	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Aminolevulinic Acid (Systemic)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).
Dexibuprofen	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen.
Dexketoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ergot Derivatives	Alpha1-Agonists' hypertensive effects could be amplified. Alpha1-Agonists may have a greater vasoconstrictive impact when combined with ergot derivatives. Exceptions: Mesylates of ergoloid; nicergoline.
Floctafenine	Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects.
Hyaluronidase	may strengthen phenylephrine's vasoconstricting effects (Systemic). Management: Steer clear of using hyaluronidase to speed up phenylephrine absorption or dispersion. Clinical indication for the use of hyaluronidase for additional purposes in patients taking phenylephrine may exist.
Iobenguane Radiopharmaceutical Products	Iobenguane radiopharmaceutical products' therapeutic effects may be reduced by alpha1-agonists. Treatment: Before administering iobenguane, stop taking any medications that might impede or interfere with catecholamine transport or absorption for at least five biological half-lives. After each dosage of iobenguane, wait at least 7 days before administering these medications.
Ketorolac (Nasal)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Ketorolac (Systemic)	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Macimorelin	Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin.
Mifamurtide	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide.
Monoamine Oxidase Inhibitors	Alpha1-Agonists' hypertensive effects could be amplified. Although this is the predicted mode of action for linezolid, treatment guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs. Linezolid is an exception.
Morniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective).
Omacetaxine	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL.
Pelubiprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Phenylbutazone	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Talniflumate	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Tenoxicam	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.
Zaltoprofen	May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Monitoring parameters:

Relief of Symptoms:

Ibuprofen is used to relieve pain, reduce inflammation, and lower fever.

Signs and Symptoms of Gastrointestinal Adverse Effects (Abdominal Pain, Bleeding):

Ibuprofen can sometimes cause stomach-related issues like abdominal pain or bleeding.
Watch out for symptoms such as stomach pain, black or bloody stools, or vomiting blood.

Signs and Symptoms of Hypersensitivity:

Some people may have allergic reactions to Ibuprofen.
Look for signs like rash, itching, swelling, difficulty breathing, or wheezing.
If any of these symptoms occur, stop taking Ibuprofen immediately and seek medical help.

How to administer Advil Congestion Relief?

If you experience gastrointestinal upset (such as stomach discomfort) when taking Ibuprofen, you can take it with food or milk.
This can help reduce the likelihood of stomach irritation and make it easier for your stomach to tolerate the medication.
Taking Ibuprofen with food or milk can also help prevent potential stomach ulcers or bleeding that may occur with prolonged use.

Mechanism of action of Ibuprofen and phenylephrine:

Ibuprofen's Mechanism of Action:

Ibuprofen works by reversibly inhibiting cyclooxygenase-1 and 2 (COX-1 and COX-2) enzymes.
By inhibiting these enzymes, Ibuprofen decreases the formation of prostaglandin precursors.
This leads to its antipyretic (fever-reducing), analgesic (pain-relieving), and anti-inflammatory properties.

Phenylephrine's Mechanism of Action:

Phenylephrine causes vasoconstriction of the arterioles in the nasal mucosa.
This action reduces swelling and congestion in the nasal passages, making it easier to breathe.
Phenylephrine is commonly used to relieve nasal congestion associated with allergies, colds, or sinusitis.

You can also consult individual agents (ibuprofen or phenylephrine).

International Brand Names of Ibuprofen and phenylephrine:

Advil Congestion Relief
Congestion Relief
Sudafed PE Head Congestion
Advil Sinus Congestion & Pain
Ibalgin Grip
Lemsip Max All Day Cold & Flu
Lemsip Max All Day Flu Relief
Lemsip Max All Night Cold & Flu
Lemsip Max All Night Flu Relief
Nurofen Sinus Pain Relief

Ibuprofen and phenylephrine Brand Names in Pakistan:

No Brands Available in Pakistan.

Advil Congestion Relief (Ibuprofen and Phenylephrine)

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