Bisolfren, Arinac, and other brands (mentioned below) contain Ibuprofen and pseudoephedrine. This combination pill is used to treat patients with upper respiratory tract symptoms.
(Arinac, Bisolfren )Pseudoephedrine and ibuprofen Uses:
-
Cold, sinus, and flu symptoms:
- Common cold, sinus, and flu symptoms are temporarily relieved (including nasal congestion, sinus pressure, headache, minor body aches and pains, and fever)
Arinac, Bisolfren Dose in Adults
Arinac, Bisolfren Dose in the treatment of Cold, sinus, and flu symptoms:
- Oral: One capsule/tablet (pseudoephedrine 30 mg/ibuprofen 200 mg) every 4 to 6 hours while symptoms persist;
- The dose may be increased to 2 tablets/capsules (pseudoephedrine 60 mg/ibuprofen 400 mg) every 4 to 6 hours if symptoms
- The maximum dose is 6 tablets/capsules per 24 hours [pseudoephedrine 180 mg/ibuprofen 1,200 mg per 24 hours]).
Arinac, Bisolfren Dose in Childrens
Bisolfren dose as an analgesic and decongestant:
- Oral suspension: Contain Ibuprofen 100 mg and pseudoephedrine 15 mg per 5 mL:
-
Children 4 to 5 years:
- 5 mL every 6 hours;
- The maximum daily dose: 4 doses/24 hours
-
Children 6 to 11 years:
- 10 mL every 6 hours;
- The maximum daily dose: 4 doses/24 hours
- Oral capsule/caplet: Ibuprofen 200 mg and pseudoephedrine 30 mg per capsule/caplet:
-
Children ≥12 years and Adolescents:
- One capsule/caplet every 4 to 6 hours as needed;
- The dose may be increased to 2 doses if necessary;
- maximum daily dose: 6 doses/24 hours
Dose in Pregnancy & lactation
- Refer to individual agents.
Pseudoephedrine and ibuprofen use during breastfeeding:
- Refer to individual agents.
Bisolfren Dose in Kidney disease:
- There are no dosage adjustments provided in the drug manufacturer’s labeling; use with caution
Bisolfren Dose in Liver disease:
- There are no dosage adjustments provided in the drug manufacturer’s labeling; use with caution
See individual agents (Ibuprofen and Pseudoephedrine). See warnings.
Contraindications to Bisolfren (Pseudoephedrine and ibuprofen):
- OTC labeling
- Children under 12 years old;
- Before or after cardiac surgery
- Use within 2 weeks after discontinuing MAO inhibitor.
Warnings and precautions
-
Anaphylactoid reactions
- Even in patients who have never been exposed, anaphylactoid reactions can occur.
- Patients who have the "aspirin trifecta" (rhinitis, aspirin sensitivity, and bronchial asthma) may be more vulnerable.
- Patients who have previously used aspirin, NSAIDs, or both and who have developed rhinitis, urticaria, or bronchospasm should not be utilised.
-
Aseptic meningitis
- Aseptic meningitis may increase in patients with systemic Lupus Erythematosus (SLE), and mixed connective tissue disorders.
-
Cardiovascular events
- Aspirin may have a decreased risk of cardiovascular disease due to NSAIDs.
- Take care.
-
Gastrointestinal events:
- NSAIDs can increase the risk for gastrointestinal irritation, inflammation and ulceration.
- Be careful if you have a history of gastrointestinal disorders (bleeding or ulcers), are taking anticoagulants, aspirin, corticosteroids, or are a smoker. If you are a senior or a patient who is disabled, you should take extra precautions.
- Use the lowest effective dose for the shortest amount of time.
-
Hematologic effects
- The possibility of platelet adhesion or aggregation being reduced may increase bleeding time.
- Patients who have coagulation issues or are taking anticoagulants need to be watched carefully.
- Anemia may happen. Patients on long-term NSAID therapy must be carefully watched.
- NSAIDs have sporadically been linked to potentially serious blood disorders (eg, agranulocytosis or thrombocytopenia and anemia).
-
Hyperkalemia:
- NSAIDs can raise the risk of hyperkalemia, particularly in the elderly, diabetics, and those who use them concurrently with other medications that cause hyperkalemia (eg ACE-inhibitors).
- Keep an eye on potassium levels.
-
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) (TEN).
- Stop using the product immediately if you feel a skin rash or are hypersensitive.
-
Asthma
- Patients with asthma that is aspirin-sensitive should not be given medication; severe bronchospasm can occur.
- Patients with other forms or asthma should be cautious.
-
Bariatric surgery
- Gastric ulceration
- After bariatric surgery, avoid the use of non-selective NSAIDs in long-term.
- the development of anastomotic ulcerations/perforations may occur.
- Short-term use of celecoxib or IV ketorolac is recommended as part of a multimodal pain management strategy for postoperative pain.
-
Coronary bypass surgery for coronary artery bypass graft:
- It is not recommended to use 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.
-
Hypertension:
- Take care.
- It can lead to new hypertension, or worsening existing hypertension.
- Concurrent use of NSAIDs may impair the ability to respond to ACE inhibitors or thiazides or loop diuretics.
-
Glaucoma and 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 caution when taking NSAIDs.
-
Seizure disorder:
- Patients with seizure disorders should be cautious; it may cause CNS stimulation.
-
Thyroid dysfunction:
- Patients with thyroid dysfunction should be cautious.
Pseudoephedrine and ibuprofen: Drug Interaction
|
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.) |
May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. |
|
Alcohol (Ethyl) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. |
|
Aliskiren |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction. |
|
Alkalinizing Agents |
May increase the serum concentration of Alpha-/Beta-Agonists (IndirectActing). |
|
Alpha1-Blockers |
May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists 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. |
|
Anticoagulants |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin. |
|
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 increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). |
|
Cephalothin |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. |
|
Chloroprocaine |
May enhance the hypertensive effect of Alpha-/Beta-Agonists. |
|
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 |
Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. |
|
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. |
|
Lumacaftor |
Serum concentration of ibuprofen can drop. |
|
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 |
Could intensify the hazardous or harmful effects of other sympathomimetics. |
|
Tacrolimus (Systemic) |
Nonsteroidal Anti-Inflammatory Drugs may intensify Tacrolimus' nephrotoxic effects (Systemic). |
|
Tedizolid |
May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. |
|
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 with antiplatelet properties. |
|
Tipranavir |
Agents with 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 reactions. The therapeutic effects of nonsteroidal anti-inflammatory drugs may be improved by tolperisone. |
|
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). |
|
Verteporfin |
The serum concentration of vancomycin may rise in response to non-steroidal anti-inflammatory drugs. |
|
Vitamin E (Systemic) |
Agents with antiplatelet properties may have an enhanced antiplatelet impact. |
|
Voriconazole |
Ibuprofen serum concentration might rise. In particular, a rise in S-(+)-ibuprofen enantiomer concentrations is possible. |
|
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 |
|
|
Bemiparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Benzylpenicilloyl Polylysine |
Alpha-/Beta-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 |
Can make nonsteroidal anti-inflammatory drugs less absorbable. |
|
Cocaine (Topical) |
May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. |
|
CycloSPORINE (Systemic) |
Nonsteroidal Anti-Inflammatory Drugs may intensify CycloSPORINE's nephrotoxic impact (Systemic). The serum concentration of CycloSPORINE may rise in response to nonsteroidal anti-inflammatory drugs (NSAIDs) (Systemic). Nonsteroidal Anti-Inflammatory Agents' serum concentration may rise when CycloSPORINE (Systemic) is taken. Management: Alternatives to non-steroidal anti-inflammatory drugs should be considered (NSAIDs). During concurrent therapy with NSAIDs, keep an eye out for any signs of nephrotoxicity, elevated serum cyclosporine concentrations, and systemic effects (like hypertension). |
|
Dabigatran Etexilate |
Nonsteroidal Anti-Inflammatory Drugs (Nonselective) may intensify Dabigatran Etexilate's adverse/toxic effects. In particular, there may be an elevated risk of bleeding. Management: Before combining dabigatran and nonsteroidal anti-inflammatory medications in any patient, a thorough risk-benefit analysis should be conducted (NSAIDs). If combined, keep a closer eye out for symptoms and signs in patients. |
|
Diclofenac (Systemic) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. Search for alternatives to using diclofenac and other nonsteroidal anti-inflammatory drugs together for management (NSAIDs). Diclofenac/misoprostol shouldn't be taken with other NSAIDs. |
|
Edoxaban |
The negative/toxic effects of edoxaban may be increased by nonsteroidal anti-inflammatory drugs (Nonselective). In particular, there may be an elevated risk of bleeding. Management: Prior to using edoxaban and nonsteroidal anti-inflammatory medications concurrently, all patients should undergo a thorough risk-to-benefit analysis (NSAIDs). If combined, keep a closer eye out for any indications or symptoms of bleeding in the patients. |
|
Enoxaparin |
Enoxaparin's anticoagulant action may be enhanced by nonsteroidal anti-inflammatory drugs. When starting enoxaparin, it is best to stop using nonsteroidal anti-inflammatory drugs (NSAIDs) first. If simultaneous administration must occur, keep a cautious eye out for any bleeding signs and symptoms. |
|
Enoxaparin |
Enoxaparin's anticoagulant impact may be strengthened by substances with antiplatelet properties. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If simultaneous administration must occur, keep a cautious eye out for any bleeding signs and symptoms. |
|
Heparin |
The anticoagulant effect of heparin may be enhanced by nonsteroidal anti-inflammatory drugs. If coadministration is necessary, reduce the dosage of heparin or nonsteroidal anti-inflammatory drugs (NSAIDs). |
|
Heparin |
The anticoagulant effect of heparin may be strengthened by substances with antiplatelet properties. If coadministration is necessary, reduce the dose of heparin or other medications with antiplatelet characteristics. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
Agents with poisonous or harmful effects may intensify their negative or hazardous effects. Bleeding could happen. Management: When at all possible, avoid combining. If used, keep a closer eye out for signs of bleeding. Two weeks before any type of surgery, dental work, or invasive procedure, stop using herbal remedies that have anticoagulant or antiplatelet effects. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. Bleeding could happen. Management: It is typically advised to avoid using these medications concurrently. When used concurrently, extra care must be taken to watch for any negative side effects, such as bleeding, bruising, or changed mental status brought on by CNS bleeds. |
|
Imatinib |
Imatinib's serum levels may drop if you take ibuprofen. Particularly, ibuprofen may lower imatinib intracellular concentrations, which would reduce clinical response. Treatment: If a patient is on imatinib therapy, think about using a different medication than ibuprofen. The research that is currently available indicates that other NSAIDs do not interact similarly. |
|
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 |
The serum content of lithium may increase when taking nonsteroidal anti-inflammatory drugs. |
|
Loop Diuretics |
The diuretic action of loop diuretics may be reduced by nonsteroidal anti-inflammatory drugs. Nonsteroidal Anti-Inflammatory Drugs may have a greater nephrotoxic effect when used with loop diuretics. Management: When using an NSAID at the same time as loop diuretics, watch out for signs of kidney damage or diminished therapeutic efficacy. Avoid using concurrently if you have cirrhosis or CHF. Bumetanide and indomethacin should not be used concurrently. |
|
Methotrexate |
The serum concentration of methotrexate may rise in response to non-steroidal anti-inflammatory drugs. Treatment: Whenever possible, an alternative anti-inflammatory therapy should be investigated, particularly if the patient is taking larger, antineoplastic doses of methotrexate. |
|
PEMEtrexed |
The serum levels of PEMEtrexed may rise in response to ibuprofen. Treatment: Patients should abstain from ibuprofen for 2 days prior to, the day of, and 2 days after the administration of pemetrexed. This applies to patients with an estimated creatinine clearance of 45 to 79 mL/min. If coupled, keep an eye out for increased pemetrexed toxicity. |
|
Rivaroxaban |
Rivaroxaban's negative/toxic effects may be amplified by nonsteroidal anti-inflammatory drugs (Nonselective). In particular, there may be an elevated risk of bleeding. Management: Before combining rivaroxaban and nonsteroidal anti-inflammatory medications in any patient, a thorough risk-to-benefit analysis should be conducted (NSAIDs). If combined, keep a closer eye out for any indications or symptoms of bleeding in the patients. |
|
Salicylates |
Salicylates may have a more negative/toxic effect when combined with nonsteroidal anti-inflammatory drugs (Nonselective). The usage of this combination may raise your risk of bleeding. Salicylates' cardioprotective action may be reduced by nonsteroidal anti-inflammatory drugs (Nonselective). Salicylates may lower the serum level of non-steroidal anti-inflammatory drugs (NSAIDs) (Nonselective). Exceptions: Trisalicylate of magnesium and choline. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance nonsteroidal anti-inflammatory drugs' antiplatelet effect (Nonselective). Selective serotonin reuptake inhibitors' therapeutic effects may be lessened by nonsteroidal anti-inflammatory drugs (Nonselective). Management: Take NSAID substitutes into account. Keep an eye out for any signs of bleeding and decreased antidepressant effects. Whether COX-2-selective NSAIDs lower risk is unknown. |
|
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 |
The therapeutic benefit of Sincalide may be reduced by medications that affect gallbladder function. Prior to using sincalide to induce gallbladder contraction, you should think about stopping any medications that can impair gallbladder motility. |
|
Sodium Phosphates |
May intensify nonsteroidal anti-inflammatory drugs' nephrotoxic effects. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking NSAIDs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided. |
|
Tenofovir Products |
The nephrotoxic action of tenofovir products may be enhanced by nonsteroidal anti-inflammatory drugs. Management: Whenever possible, look for alternatives to these combinations. Tenofovir should not be taken with multiple NSAIDs or any NSAID that is taken in large doses. |
|
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 |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Aminolevulinic Acid (Systemic) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic). |
|
Dexibuprofen |
Nonsteroidal Anti-Inflammatory Drugs may intensify Dexibuprofen's negative/toxic effects. |
|
Dexketoprofen |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
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 |
Lobenguane 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) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Ketorolac (Systemic) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Macimorelin |
The diagnostic impact of Macimorelin may be diminished by nonsteroidal anti-inflammatory drugs. |
|
Mifamurtide |
The diagnostic impact of Macimorelin may be diminished by nonsteroidal anti-inflammatory drugs. |
|
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. Linezolid and Tedizolid are exceptions. |
|
Morniflumate |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Nonsteroidal Anti-Inflammatory Agents (NSAIs) may intensify their negative or harmful effects (COX-2 Selective). |
|
Omacetaxine |
Nonsteroidal Anti-Inflammatory Drugs may intensify Omacetaxine's negative/toxic effects. In particular, there may be an elevated risk for incidents involving bleeding. Management: Patients with a platelet count of less than 50,000/uL should not take omacetaxine and nonsteroidal anti-inflammatory medications (NSAIDs) at the same time. |
|
Pelubiprofen |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Phenylbutazone |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Talniflumate |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Tenoxicam |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Urokinase |
Urokinase's anticoagulant impact may be strengthened by substances with antiplatelet properties. |
|
Zaltoprofen |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
Pseudoephedrine and ibuprofen: Drug Interaction
|
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.) |
May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. |
|
Alcohol (Ethyl) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. |
|
Aliskiren |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction. |
|
Alkalinizing Agents |
May increase the serum concentration of Alpha-/Beta-Agonists (IndirectActing). |
|
Alpha1-Blockers |
May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists 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. |
|
Anticoagulants |
Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin. |
|
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 increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). |
|
Cephalothin |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. |
|
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. |
|
Lumacaftor |
Ibuprofen serum concentration can drop. |
|
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 |
Could intensify the hazardous or harmful effects of other sympathomimetics. |
|
Tacrolimus (Systemic) |
Nonsteroidal Anti-Inflammatory Drugs may intensify Tacrolimus' nephrotoxic effects (Systemic). |
|
Tedizolid |
May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. |
|
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 with antiplatelet properties. |
|
Tipranavir |
Agents with 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 reactions. The therapeutic effects of nonsteroidal anti-inflammatory drugs may be improved by tolperisone. |
|
Tricyclic Antidepressants (Tertiary Amine) |
May strengthen non-steroidal anti-inflammatory drug's antiplatelet effect (Nonselective). |
|
Urinary Acidifying Agents |
May lower the serum level of beta- and alpha-agonists (Indirect-Acting). |
|
Vancomycin |
The serum concentration of vancomycin may rise in response to non-steroidal anti-inflammatory drugs. |
|
Verteporfin |
Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents. |
|
Vitamin E (Systemic) |
Agents with antiplatelet properties may have an enhanced antiplatelet impact. |
|
Voriconazole |
Ibuprofen serum levels can rise. In particular, a rise in S-(+)-ibuprofen enantiomer concentrations is possible. |
|
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 |
|
|
Bemiparin |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Benzylpenicilloyl Polylysine |
Alpha-/Beta-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 |
Can make nonsteroidal anti-inflammatory drugs less absorbable. |
|
Cocaine (Topical) |
May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. |
|
CycloSPORINE (Systemic) |
Nonsteroidal Anti-Inflammatory Drugs may intensify CycloSPORINE's nephrotoxic impact (Systemic). The serum concentration of CycloSPORINE may rise in response to nonsteroidal anti-inflammatory drugs (NSAIDs) (Systemic). Nonsteroidal Anti-Inflammatory Agents' serum concentration may rise when CycloSPORINE (Systemic) is taken. Alternatives to nonsteroidal anti-inflammatory drugs should be considered for management (NSAIDs). During concurrent therapy with NSAIDs, keep an eye out for any signs of nephrotoxicity, elevated serum cyclosporine concentrations, and systemic effects (like hypertension). |
|
Dabigatran Etexilate |
Nonsteroidal Anti-Inflammatory Drugs (Nonselective) may intensify Dabigatran Etexilate's adverse/toxic effects. In particular, there may be an elevated risk of bleeding. Management: Before combining dabigatran and nonsteroidal anti-inflammatory medications in any patient, a thorough risk-benefit analysis should be conducted (NSAIDs). If combined, keep a closer eye out for any indications or symptoms of bleeding in the patients. |
|
Diclofenac (Systemic) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. Search for alternatives to using diclofenac and other nonsteroidal anti-inflammatory drugs together for management (NSAIDs). Diclofenac/misoprostol shouldn't be taken with other NSAIDs. |
|
Edoxaban |
The negative/toxic effects of edoxaban may be increased by nonsteroidal anti-inflammatory drugs (Nonselective). In particular, there may be an elevated risk of bleeding. Management: Prior to using edoxaban and nonsteroidal anti-inflammatory medications concurrently, all patients should undergo a thorough risk-to-benefit analysis (NSAIDs). If combined, keep a closer eye out for any indications or symptoms of bleeding in the patients. |
|
Enoxaparin |
Enoxaparin's anticoagulant action may be enhanced by nonsteroidal anti-inflammatory drugs. When starting enoxaparin, it is best to stop using nonsteroidal anti-inflammatory drugs (NSAIDs) first. If simultaneous administration must occur, keep a cautious eye out for any bleeding signs and symptoms. |
|
Enoxaparin |
Enoxaparin's anticoagulant impact may be strengthened by substances with antiplatelet properties. When feasible, stop using antiplatelet medications before starting enoxaparin. If simultaneous administration must occur, keep a cautious eye out for any bleeding signs and symptoms. |
|
Heparin |
The anticoagulant effect of heparin may be enhanced by nonsteroidal anti-inflammatory drugs. If coadministration is necessary, reduce the dosage of heparin or nonsteroidal anti-inflammatory drugs (NSAIDs). |
|
Heparin |
The anticoagulant effect of heparin may be strengthened by substances with antiplatelet properties. If coadministration is necessary, reduce the dose of heparin or other medications with antiplatelet characteristics. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
Agents with poisonous or harmful effects may intensify their negative or hazardous effects. Bleeding could happen. Management: When at all possible, avoid combining. If used, keep a closer eye out for signs of bleeding. Two weeks before any type of surgery, dental work, or invasive procedure, stop using herbal remedies that have anticoagulant or antiplatelet effects. |
|
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. Bleeding could happen. Management: It is typically advised to avoid using these medications concurrently. When used concurrently, extra care must be taken to watch for any negative side effects, such as bleeding, bruising, or changed mental status brought on by CNS bleeds. |
|
Imatinib |
Imatinib's serum levels may drop if you take ibuprofen. Particularly, ibuprofen may lower imatinib intracellular concentrations, which would reduce clinical response. Treatment: If a patient is on imatinib therapy, think about using a different medication than ibuprofen. The research that is currently available indicates that other NSAIDs do not interact similarly. |
|
Linezolid |
Could make sympathomimetics' hypertensive effects stronger. Reduce the first doses of sympathomimetic drugs and closely monitor individuals on linezolid for an augmented pressor response. There are currently no suggestions for specific dose adjustments. |
|
Lithium |
The serum content of lithium may increase when taking nonsteroidal anti-inflammatory drugs. |
|
Loop Diuretics |
The diuretic action of loop diuretics may be reduced by nonsteroidal anti-inflammatory drugs. Nonsteroidal Anti-Inflammatory Drugs may have a greater nephrotoxic effect when used with loop diuretics. Management: When using an NSAID at the same time as loop diuretics, watch out for signs of kidney damage or diminished therapeutic efficacy. Avoid using concurrently if you have cirrhosis or CHF. Bumetanide and indomethacin should not be used concurrently. |
|
Methotrexate |
The serum concentration of methotrexate may rise in response to non-steroidal anti-inflammatory drugs. Treatment: Whenever possible, an alternative anti-inflammatory therapy should be investigated, particularly if the patient is taking larger, antineoplastic doses of methotrexate. |
|
PEMEtrexed |
The serum levels of PEMEtrexed may rise in response to ibuprofen. Treatment: Patients should abstain from ibuprofen for 2 days prior to, the day of, and 2 days after the administration of pemetrexed. This applies to patients with an estimated creatinine clearance of 45 to 79 mL/min. If coupled, keep an eye out for increased pemetrexed toxicity. |
|
Rivaroxaban |
Rivaroxaban's negative/toxic effects may be amplified by nonsteroidal anti-inflammatory drugs (Nonselective). In particular, there may be an elevated risk of bleeding. Management: Before combining rivaroxaban and nonsteroidal anti-inflammatory medications in any patient, a thorough risk-to-benefit analysis should be conducted (NSAIDs). If combined, keep a closer eye out for any indications or symptoms of bleeding in the patients. |
|
Salicylates |
Salicylates may have a more negative/toxic effect when combined with nonsteroidal anti-inflammatory drugs (Nonselective). The usage of this combination may raise your risk of bleeding. Salicylates' cardioprotective action may be reduced by nonsteroidal anti-inflammatory drugs (Nonselective). Salicylates may lower the serum level of non-steroidal anti-inflammatory drugs (NSAIDs) (Nonselective). Exceptions: Trisalicylate of magnesium and choline. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance nonsteroidal anti-inflammatory drugs' antiplatelet effect (Nonselective). Selective serotonin reuptake inhibitors' therapeutic effects may be lessened by nonsteroidal anti-inflammatory drugs (Nonselective). Management: Take NSAID substitutes into account. Keep an eye out for any signs of bleeding and decreased antidepressant effects. Whether COX-2-selective NSAIDs lower risk is unknown. |
|
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 |
The therapeutic benefit of Sincalide may be reduced by medications that affect gallbladder function. Prior to using sincalide to induce gallbladder contraction, you should think about stopping any medications that can impair gallbladder motility. |
|
Sodium Phosphates |
May intensify nonsteroidal anti-inflammatory drugs' nephrotoxic effects. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking NSAIDs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided. |
|
Tenofovir Products |
The nephrotoxic action of tenofovir products may be enhanced by nonsteroidal anti-inflammatory drugs. Management: Whenever possible, look for alternatives to these combinations. Tenofovir should not be taken with multiple NSAIDs or any NSAID that is taken in large doses. |
|
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 |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Aminolevulinic Acid (Systemic) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic). |
|
Dexibuprofen |
Nonsteroidal Anti-Inflammatory Drugs may intensify Dexibuprofen's negative/toxic effects. |
|
Dexketoprofen |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
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) |
Nonsteroidal Anti-Inflammatory Agents may intensify their negative or harmful effects. |
|
Ketorolac (Systemic) |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Macimorelin |
The diagnostic impact of Macimorelin may be diminished by nonsteroidal anti-inflammatory drugs. |
|
Mifamurtide |
Nonsteroidal Anti-Inflammatory Drugs may reduce Mifamurtide's therapeutic impact. |
|
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. Linezolid and Tedizolid are exceptions. |
|
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 response to the treatment. Persistent ow worsening symptoms should alert the patient to seek expert advice.
How to administer Bisolfren (Pseudoephedrine and ibuprofen)?
- Oral: May be administered with food or milk if stomach upset occurs.
Mechanism of action of Bisolfren (Pseudoephedrine and ibuprofen):
Ibuprofen:
- Reversibly inhibits COX-1 and 2 (COX-1, 2) enzymes. This results in decreased production of prostaglandin precursors.
Pseudoephedrine:
- Direct stimulation of alpha-adrenergic respiratory mucosa receptors, causing vasoconstriction.
See individual agents (Ibuprofen and Pseudoephedrine)
International Brands of Pseudoephedrine and ibuprofen:
- Advil Cold & Sinus
- Advil Cold & Sinus Daytime
- Children's Advil Cold
- Sudafed Sinus Advance
- Advil Cold & Flu
- Advil Cold & Sinus
- Advil Cold and Sinus
- Advil Cold-Sinus
- Arinac
- Bisolfren
- Brenfed
- Dayflu N
- Dristan Sinus
- Niofen Flu
- Nurofen Cold & Flu
- Nurofen Cold and Flu
- Nurofen Sinus and Pain
- Rhinureflex
- Sapofen Cold & Flu
- Sapofen Plus
- Sinuphene
Pseudoephedrine and ibuprofen Brand Names in Pakistan:
Pseudoephedrine and ibuprofen Syrup 100 mg/5ml |
|
| Arinac | Abbott Laboratories (Pakistan) Limited. |
| Fedrin | Davis Pharmaceutical Laboratories |
| Neonac | Neo Medix |
| Texcol Sinus | Raazee Theraputics (Pvt) Ltd. |
Pseudoephedrine and ibuprofen Suspension 100 mg/5ml |
|
| Enac | Eros Pharmaceuticals |
| Iburin Plus | Hamaz Pharmaceutical (Pvt) Ltd. |
| Prophed | Macter International (Pvt) Ltd. |
| Rovinac | Rock Pharmaceuticals |
 Injection.webp)