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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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Aleve D Sinus and Headache (Naproxen and Pseudoephedrine)

Aleve-D Sinus and Headache caplets is a combination of two drugs:

Naproxen: an NSAID with antipyretic, anti-inflammatory, and analgesic effects
Pseudoephedrine: an adrenergic and Beta-receptor agonist that acts as a decongestant.

Aleve-D Sinus and Headache Uses:

Used to treat cold, sinus, and flu symptoms temporarily, such as nasal congestion, sinus pressure or congestion, headaches, minor aches and pains, fever, and sinus congestion.

Aleve-D Sinus and Headache Dose in Adults

Aleve-D Sinus and Headache Dose in the treatment of Cold, sinus, and flu symptoms:

Oral:

Twelve caplets every day
The maximum dose is two capsules each day.
It is not advised to receive treatment for fewer than 7 days unless your doctor specifically instructs you to.

Aleve-D Sinus and Headache Dose in Children

Refer to adults dosing.

Dose in Pregnancy & lactation

See individual agents (Naproxen and pseudoephedrine)

Aleve-D Sinus and Headache use during breastfeeding:

See individual agents.

Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer’s labeling.
See individual agents.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer’s labeling.
See individual agents.

Side Effects of Aleve-D Sinus and Headache

See individual agents.

Contraindications to Aleve-D Sinus and Headache:

Hypersensitivity to any ingredient in the formulation, including aspirin, naproxen, pseudoephedrine, or other NSAIDs.
MAO inhibitor therapy can be used during or within 14 days
Before or after coronary bypass graft surgery (CABG).

Warnings and precautions

Anaphylactoid reactions
- Anaphylactoid reactions can occur even in patients who have never been exposed.
- Patients with the "aspirin trifecta" (bronchial asthma and aspirin intolerance, rhinitis) could be at higher risk.
- Patients who have rhinitis, bronchospasm or asthma should not be given this medication.
Aseptic meningitis
- Aseptic meningitis may increase in patients with systemic Lupus Erythematosus (SLE), and mixed connective tissue disorders.
Hemostasis and bleeding:
- It is possible to decrease platelet adhesion or aggregation
- May extend the time of bleeding
- Anticoagulant users or patients with coagulation issues need to be closely watched.
- Anemia may develop.
- Patients receiving long-term NSAID therapy should have their anaemia evaluated.
Cardiovascular events
- NSAIDs increase the risk of serious cardiovascular events like MI, stroke, or newly developed hypertension.
- Preexisting heart disease or other cardiovascular risk factors may increase the risk.
- Before prescribing, it is important to carefully assess each individual's cardiovascular risk profile.
- Fluid retention should be avoided.
- Avoid use in the event of heart failure
- Concurrent use of ibuprofen and possibly other nonselective NSAIDs may impair aspirin's cardioprotective benefits.
- To reduce the risk of heart attacks, use the lowest effective dose for the most time. Patients at high risk should consider alternate treatments.
Gastrointestinal events:
- NSAIDs can increase the risk for gastrointestinal irritation, inflammation and ulceration as well as bleeding and perforation.
- These events can occur without warning and at any time during therapy.
- Avoid using this medication if you have a history of GI diseases (bleeding or ulcers), are taking concurrent anticoagulant and/or corticosteroids therapy, smoke, drink, elderly patients, or those with a disability.
- To reduce the risk of GI adverse reactions, use the lowest effective dose for the shortest time. Patients at high-risk should consider alternate therapies.
- Concomitant gastroprotective medication, such as PPI, is advised since there is a significant increase in the risk of gastrointestinal problems (such as ulcers) when used with aspirin doses =325 mg (Bhatt 2008).
Reactions to skin:
- NSAIDs have the potential to induce severe skin side effects, such as exfoliative dermatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome (SJS) (SJS).
- Stop using the product immediately if you feel a skin rash or hypersensitivity.
Asthma
- Patients with asthma that is aspirin sensitive should not be treated
- It is possible to experience severe bronchospasm.
- Patients with other forms or asthma should be cautious.
Bariatric surgery
- After bariatric surgery, refrain from taking non-selective oral NSAIDs on a regular basis.
- Anastomotic ulceration and perforations are both possible.
- Celecoxib or intravenous ketorolac should be used briefly to treat postoperative pain as part of a multimodal pain management strategy.
Coronary bypass surgery for coronary artery bypass graft:
- Contraindicated use of this medication immediately before or after coronary bypass graft surgery (CABG).
- After CABG surgery, stroke and MI risk may increase.
Diabetes:
- Patients with diabetes mellitus should be cautious.
Hepatic impairment
- Patients with reduced hepatic function should be cautious.
- Monitor patients with abnormal LFT closely.
- Rarely, severe hepatic reactions have been reported with NSAIDs.
- If liver disease symptoms or systemic manifestations develop, discontinue use.
Glaucoma/increased intraocular pressure
- Patients with elevated intraocular pressure and angle-closure Glaucoma should be cautious.
Prostatic hyperplasia, urinary obstruction
- Patients with prostatic hyperplasia or urinary obstruction should be cautious.
Renal impairment
- Use of NSAIDs may impair current renal function.
- NSAIDs may lead to a dose-dependent decrease in prostaglandin synthesis, which can cause renal decompensation.
- Patients who take diuretics and ACE inhibitors, have heart disease, liver dysfunction, heart failure, or are dehydrated are more likely to experience renal damage.
- Before starting treatment, hydrate the patient; closely monitor RFTs.
- Advanced renal disease is not recommended.
- Renal papillary necrosis may result from prolonged usage of NSAIDs.
Thyroid disease:
- Patients with thyroid disease should be cautious.

Naproxen and pseudoephedrine: Drug Interaction

Risk Factor C (Monitor therapy)
5-Aminosalicylic Acid Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives.
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	Other agents with antiplatelet properties may have an enhanced antiplatelet impact.
Alcohol (Ethyl)	Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. In particular, this combination may make GI 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, periodically check on renal function. Patients with advanced age, fluid depletion, or pre-existing renal impairment are at increased risk for renal failure.
Alkalinizing Agents	May raise the serum level of beta- and alpha-agonists (IndirectActing).
Alpha1-Blockers	May lessen the vasoconstriction caused by alpha/beta agonists. The vasodilation caused by Alpha1-Blocker may also be resisted by Alpha-/Beta-Agonists.
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.
Anticoagulants	Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.
AtoMOXetine	Could make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by atoMOXetine.
Beta-Blockers	Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Exceptions: Levobunolol; Metipranolol.
Bisphosphonate Derivatives	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern.
Cannabinoid-Containing Products	May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol.
Carbonic Anhydrase Inhibitors	May raise the serum level of beta- and alpha-agonists (Indirect-Acting).
Cephalothin	Agents having antiplatelet properties may intensify cephalothin's harmful or hazardous effects. In particular, there may be an elevated risk of bleeding.
Chloroprocaine	Alpha-/Beta-Agonists' hypertensive effects might be amplified.
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.
Digoxin	Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin.
Doxofylline	Simpathomimetic drugs may intensify Doxofylline's harmful or hazardous effects.
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	The serum concentration of FentaNYL may be decreased by alpha-/beta-agonists (indirect-acting). The serum concentrations of fentanyl nasal spray may fall, and the effects may take longer to manifest.
Glucosamine	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Guanethidine	Could make sympathomimetics more arrhythmogenic. Guanethidine might make sympathomimetic drugs more hypertensive.
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.
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
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.
Prostacyclin Analogues	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Prostaglandins (Ophthalmic)	Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic).
Quinolones	Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Solriamfetol	Sympathomimetics may enhance the hypertensive effect of Solriamfetol.
Spironolactone	May diminish the vasoconstricting effect of Alpha-/Beta-Agonists.
Sympathomimetics	It might intensify the harmful or toxic effects of other sympathomimetics.
Tacrolimus (Systemic)	Tacrolimus' nephrotoxic impact may be increased by non-steroidal anti-inflammatory drugs (Systemic).
Tedizolid	Could make sympathomimetic drugs more hypertensive. Sympathomimetics' tachycardic impact may be strengthened by Tedizolid.
Thiazide and Thiazide-Like Diuretics	May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Tipranavir	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Tolperisone	Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents.
Tricyclic Antidepressants (Tertiary Amine)	May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Urinary Acidifying Agents	May lower the serum level of beta- and alpha-agonists (Indirect-Acting).
Vancomycin	The serum concentration of vancomycin
Verteporfin	May rise in response to non-steroidal anti-inflammatory drugs.
Vitamin E (Systemic)	Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents.
Risk Factor D (Consider therapy modification)
Apixaban	Agents with antiplatelet properties may have an enhanced antiplatelet impact. Naproxen may intensify Apixaban's harmful or hazardous effects. In particular, there may be an elevated risk of bleeding. Apixaban's serum levels may rise in response to naproxen.
Bemiparin	Bemiparin's anticoagulant action may be strengthened by nonsteroidal anti-inflammatory drugs. Management: Due to the increased risk of bleeding, bemiparin and nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used concurrently. If concurrent use is unavoidable, keep a cautious eye out for bleeding signs and symptoms.
Bemiparin	Bemiparin's anticoagulant impact may be strengthened by substances with antiplatelet properties. Management: Avoid taking bemiparin at the same time as antiplatelet medications. If concurrent use is unavoidable, keep a cautious eye out for bleeding signs and symptoms.
Benzylpenicilloyl Polylysine	Alpha-/Beta-Agonists may lessen the Benzylpenicilloyl Polylysine's ability to diagnose. Management: To evaluate a patient's capacity to mount a wheal and flare response, consider using a histamine skin test as a positive control.
Bile Acid Sequestrants	Can make nonsteroidal anti-inflammatory drugs less absorbable.
Cocaine (Topical)	Could make sympathomimetics' hypertensive effects stronger. Management: Whenever possible, look at alternatives to using this combo. When used concurrently, keep a close 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.
Linezolid	May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available.
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.
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.
Serotonin/Norepinephrine Reuptake Inhibitors	Alpha-/Beta-Agonists' tachycardic impact may be boosted. The vasopressor impact of alpha/beta agonists may be enhanced by serotonin/norepinephrine reuptake inhibitors.
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)	The anticoagulant effect of vitamin K antagonists may be enhanced by nonsteroidal anti-inflammatory drugs (Nonselective).
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	Alpha-/Beta-Agonists' hypertensive effects might be amplified. Alpha-/Beta-Agonists' vasoconstrictive effects may be strengthened by ergot derivatives. Exceptions: Mesylates of ergoloid; nicergoline
Floctafenine	Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects.
Iobenguane Radiopharmaceutical Products	Iobenguane radiopharmaceutical products' therapeutic effects may be lessened by alpha-/beta-agonists (indirect-acting). Treatment: Before administering iobenguane, stop taking any medications that could impede or interfere with catecholamine transport or uptake for at least five biological half-lives. After each dose 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	Might make alpha-/beta-agonists' hypertensive effects more pronounced (Indirect-Acting). Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs. Exceptions: Tedizolid; linezolid.
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:

Monitor for fever and response to the treatment. A persistent fever and thick purulent discharge may be indicative of bacterial infection and require the use of antimicrobial drugs. See individual agents.

How to Take Aleve-D Sinus and Headache Pills?

Avoid crushing or chewing before swallowing.
Each dose should be followed by a full glass of water.
If your stomach feels unsettled, you can give yourself some food or milk.

Aleve-D Sinus and Headache Mechanism of action:

Aleve-D Sinus & Headache combines two drugs:
- Naproxen and
- Pseudoephedrine
Naproxen, an NSAID, has analgesic, anti-inflammatory, and antipyretic effects.
Pseudoephedrine, a decongestant drug, causes vasoconstriction. It also reduces the secretion of the airways. It stimulates Beta-receptors, which results in smooth muscle relaxation.

See individual agents.

International Brands of Naproxen and pseudoephedrine:

Aleve-D Sinus & Cold
Aleve-D Sinus & Headache
Sudafed 12 Hour Pressure + Pain

Naproxen and pseudoephedrine Brand Names in Pakistan:

No Brands Available in Pakistan.

Aleve D Sinus and Headache (Naproxen and Pseudoephedrine)

Aleve-D Sinus and Headache Uses:

Aleve-D Sinus and Headache Dose in Adults

Aleve-D Sinus and Headache Dose in the treatment of Cold, sinus, and flu symptoms:

Oral:

Aleve-D Sinus and Headache Dose in Children

Dose in Pregnancy & lactation

Aleve-D Sinus and Headache use during breastfeeding:

Dose in Kidney Disease:

Dose in Liver disease:

Side Effects of Aleve-D Sinus and Headache

Contraindications to Aleve-D Sinus and Headache:

Warnings and precautions

Anaphylactoid reactions

Aseptic meningitis

Hemostasis and bleeding:

Cardiovascular events

Gastrointestinal events:

Reactions to skin:

Asthma

Bariatric surgery

Coronary bypass surgery for coronary artery bypass graft:

Diabetes:

Hepatic impairment

Glaucoma/increased intraocular pressure

Prostatic hyperplasia, urinary obstruction

Renal impairment

Thyroid disease:

Monitoring parameters:

How to Take Aleve-D Sinus and Headache Pills?

Aleve-D Sinus and Headache Mechanism of action:

International Brands of Naproxen and pseudoephedrine:

Naproxen and pseudoephedrine Brand Names in Pakistan:

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