Sumatriptan and naproxen (Treximet) is a combination of an NSAID and antimigraine medicine. It is used for the acute treatment of severe migraine episode that is not relieved with other commonly used pain medicines.
Sumatriptan and naproxen Uses:
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Migraine headache:
- Used for treating the acute attack of migraine headache with or without aura in adults and pediatric patients ≥12 years
Sumatriptan and naproxen (Treximet) Dose in Adults
Note: Be careful when prescribing; there are 2 different Treximet tablet strengths available.
Sumatriptan and naproxen (Treximet) Dose in the treatment of Migraine headache in adults:
- Oral: Sumatriptan 85 mg/naproxen 500 mg. May administer a 2nd dose if an adequate response does not occur at 2 hours (maximum: Sumatriptan 170 mg/naproxen 1,000 mg in 24 hours).
- Note: The safety has not been established of treating an average of >5 migraine headaches in a 30-day period has not been established.
Sumatriptan and naproxen (Treximet) Dose in Childrens
Note: Two different strengths of Treximet (sumatriptan/naproxen) tablets are available (10/60 mg, 85/500 mg) in 2 different strengths prescribe cautiously.
Sumatriptan and naproxen (Treximet) Dose in the treatment of Migraine headache:
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Children and Adolescents ≥12 to 17 years:
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Manufacturer's labeling:
- Oral: Administer 1 tab Sumatriptan 10 mg/naproxen 60 mg at onset of pain; maximum: Sumatriptan 85 mg/naproxen 500 mg per day. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals. Note: The safety has not been established of treating an average of >2 migraine headaches in a 30-day period.
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Alternate dosing:
- Oral: Administer 1 tab Sumatriptan 85mg/naproxen 500 mg at the onset of mild to moderate pain; in a study done over 600 pediatric patients accounting for over 12,000 doses for evaluation of dose; the pain-free response which was consistent and higher than placebo at 2 hours postdose was shown; patients were exposed to an average 2.5 doses per month in a long-term (12 months) open-label trial.
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Pregnancy Risk Factor C
- Studies on animal reproduction showed that adverse events are common.
- You can contact individual agents.
- GlaxoSmithKline sponsored a pregnancy registry that provided very little information about this combination's outcome.
Use during breastfeeding:
- Breast milk contains both sumatriptan as well as naproxen.
- The manufacturer recommends that a decision is made regarding whether to continue nursing or discontinue the drug.
- There are potential adverse reactions in nursing infants. This is in light of the importance of mother's treatment.
- You can also refer to individual agents.
Dose in kidney disease:
-
CrCl ≥30 mL/minute:
- No dosage adjustments provided in the manufacturer’s labeling (has not been studied); be cautious and monitor kidney function.
-
CrCl <30 mL/minute:
- Not recommended.
Dose in liver disease:
-
Mild to moderate impairment:
- Sumatriptan 10 mg/naproxen 60 mg per day.
-
Severe impairment:
- Contraindicated.
Side Effects of Treximet (Sumatriptan and naproxen):
-
Cardiovascular:
- Chest Discomfort
- Chest Pain
-
Central Nervous System:
- Dizziness
- Drowsiness
- Paresthesia
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Gastrointestinal:
- Nausea
- Sore Throat
- Dyspepsia
- Xerostomia
-
Neuromuscular & Skeletal:
- Jaw Pain
- Jaw Pressure
- Jaw Tightness
- Neck Pain
- Neck Pressure
- Neck Tightness
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Respiratory:
- Pharyngeal Edema
Contraindication to Treximet (Sumatriptan and naproxen):
- Hypersensitivity to sumatriptan or naproxen or any other component of the formulation; asthma or urticaria or allergic-type reactions to aspirin or other NSAIDs
- Angina pectoris, angina stenosa, history of myocardial injury, documented silent ischemia, is an example of ischemic coronary artery disease.
- Vasospasm in the coronary artery (including Prinzmetal's Angina, history of Coronay artery bypass surgery (CABG), etc.
- WPW syndrome and arrhythmias in association with other cardiac accessory conduction path disorders
- CVA history (stroke or TIA).
- Higher stroke risk in those with hemiplegic and basilar migraine history
- Peripheral Vascular Disease
- Ischemic bowel disease
- Hypertension uncontrolled
- Use of ergotamine-containing medication within 1 day
- Ergot-type medication (eg, dihydroergotamine, methysergide)
- Another 5-HT agonist
- Monoamine oxidase inhibitor (MAO)-A monoamine oxidase inhibitor may be administered in coadministration or within two weeks.
- The last trimester
- Hepatic function severely impaired
Warnings and precautions
-
Anaphylactoid reactions
- Anaphylactoid reactions can occur even in patients who have never been exposed to aspirin. Patients with the "aspirin trifecta" (bronchial asthma and aspirin intolerance) could be at greater risk.
- Do not use in patients who experience bronchospasm, asthma, rhinitis, or urticaria with nonsteroidal anti-inflammatory drug (NSAID) or aspirin therapy.
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Cardiovascular events: [US Boxed Warn]
- Negative cardiovascular events have been linked to NSAIDs, including stroke, myocardial injury, and heart failure.
- Patients with underlying or preexisting cardiac disease are at greater risk for developing adverse cardiac events.
- Before treatment can be initiated, patients must be assessed for any underlying heart disease, especially elderly patients.
- Patients with heart disease should avoid NSAIDs as they can cause fluid retention.
- Aspirin can be affected by NSAIDs administered in combination with it. Therefore, they should not be taken for longer than necessary.
- If necessary, patients may be prescribed alternative pain medication.
- Cerebrovascular events
- Cerebral/subarachnoid hemorrhage and stroke (may be fatal) have been observed with 5-HT agonist use.
- If a cerebrovascular emergency occurs, discontinue use.
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CNS effects
-
Patients should be aware that dizziness, drowsiness, blurred vision and other neurologic effects can occur, which may impair physical or mental capabilities.
- A complete ophthalmologic exam is required if blurred or reduced vision occurs.
- All patients undergoing long-term treatment should be evaluated periodically for vision.
-
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High blood pressure
- Patients with no history of hypertension have rarely experienced significant elevations in blood pressure.
- Patients with uncontrolled hypertension are contraindicated
-
GI events: [US Boxed Warning]
- NSAIDs, including ibuprofen, can increase the risk of gastrointestinal bleeding. Patients over 60 years old or with a history of peptic or gastrointestinal bleeding should not use the drug.
- Patients taking anticoagulants such as warfarin, aspirin, and corticosteroids with their medications are at greater risk for gastrointestinal bleeding.
- People who consume ethanol (three or more alcoholic drinks per week) could also experience gastrointestinal bleeding. To reduce the risk of GI hemorhage, it is important to use the lowest effective dose and for the shortest time.
- If patients develop symptoms such as melena or hematemesis, stomach cramps, hypotension, or stomach pain, they should stop receiving treatment immediately.
- Patients with a history or tendency to have lower gastrointestinal bleeding should not take non-aspirin anti-inflammatory drugs (NSAIDs) if they are prone to diverticulosis and telangiectasias.
- Headaches
- Acute migraine drugs (eg triptans, opioids or ergotamine) may cause headaches to worsen.
- This is known as medication overuse headache. It may be necessary to withdraw from the overuse setting.
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Hematologic effects
- It is possible to decrease platelet adhesion and aggregation.
- May prolong bleeding time.
- Patients who have coagulation disorders should be closely examined.
- Anemia may occur.
- Anemia should be checked in patients on long-term NSAID therapy.
- Rarely, NSAIDs have been linked to severe blood dyscrasias, such as thrombocytopenia, agranulocytosis and aplastic anemia.
- Hepatotoxicity:
- Use has been associated with transaminase elevations.
- Patients with abnormal LFT should be closely examined.
- Rare but sometimes fatal hepatic reactions have been linked to NSAIDs.
- Stop taking any medication if you notice signs or symptoms of hepatic diseases or other manifestations.
-
Hyperkalemia:
- NSAIDs may increase hyperkalemia risk, especially in elderly people, diabetics, and those with renal disease.
- Monitor potassium closely.
-
Toxicity in the renal system:
- NSAID use may compromise existing renal function.
- NSAIDs may lead to a dose-dependent decrease in prostaglandin synthesis. This may be due to reduced renal blood flow, which can cause renal decompensation (usually reversible).
- Patients with impaired renal function, hypovolemia and heart failure, as well as those who take diuretics & ACE inhibits, are more at risk for renal toxicity.
- Rehydrate the patient before you start therapy.
- Pay attention to your renal function.
- Long-term NSAID usage may cause renal papillary necrosis &/or other injuries.
-
Reactions to skin:
- NSAIDs can cause severe skin adverse reactions, including exfoliative dermatitis (SJS), Stevens-Johnson syndromes (SJS) and toxic epidermal necrolysiss (TEN).
- It may happen without notice.
- Stop using the product immediately if you develop skin rash or other hypersensitivity.
-
Vasospasm-related events
- Five-HT agonists have been shown to cause peripheral vascular ischemia, GI vascular ischemia infarction and infarction, as well as Raynaud syndrome.
-
Visual effects
- The use of 5-HT agonists has been associated with partial and permanent vision loss, as well as temporary and permanent blindness.
-
Asthma
- Asthma patients should be cautious when using NSAIDs. Patients with asthma who are sensitive to aspirin may experience worsening symptoms.
- Bariatric surgery
- Gastric ulceration
- Patients undergoing bariatric surgery should avoid non-selective NSAIDs peri-operatively due to the possibility of developing perforations or anastomotic lesions.
- For short periods of time, patients may be prescribed intravenous ketorolac or celecoxib (etoricoxib), to manage pain.
- Gastric ulceration
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Coronary artery disease
- Contraindicated for patients with documented CAD or history of CABG.
- Should not be given in patients with multiple risk factors for CAD (eg, hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of CAD, menopause, male >40 years of age).
- Patients with suspected CAD need to be referred for cardiovascular evaluation. If the cardiovascular evaluation is satisfactory, the patient should be given the first dose at the healthcare provider's office. ECG monitoring should also be considered.
- All patients should be evaluated on a regular basis for their cardiovascular health.
-
Heart failure/edema:
- Fluid retention, edema and peripheral edema can occur. Use with caution in cases of heart failure or edematous states.
-
Inhibition of the liver function:
- Be careful.
-
Renal impairment
- Patients with advanced renal disease should be avoided.
- Stop using if you have persistent or worsening abnormal kidney function tests.
-
Seizure disorders:
- Patients with seizure disorders or patients with low seizure thresholds should be cautious.
- Seizures have been reported in patients who received sumatriptan, even if they had never experienced seizures.
Sumatriptan and naproxen: 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. |
|
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. |
|
Antiemetics (5HT3 Antagonists) |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
Antipsychotic Agents |
Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
Beta-Blockers |
|
|
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. |
|
Cephalothin |
Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. |
|
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. |
|
Drospirenone |
Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone. |
|
Droxidopa |
Serotonin 5-HT1D Receptor Agonists may enhance the hypertensive effect of Droxidopa. |
|
Eplerenone |
Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. |
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Fat Emulsion (Fish Oil Based) |
May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. |
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Felbinac |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Glucosamine |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
|
Haloperidol |
Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion. |
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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. |
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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. |
|
Metaxalone |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
Methylphenidate |
May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased. |
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Metoclopramide |
Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. |
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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. |
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Naftazone |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents. |
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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. |
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Opioid Agonists |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
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. |
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Pentoxifylline |
May enhance the antiplatelet effect of Agents with Antiplatelet Properties. |
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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. |
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Probenecid |
May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. |
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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). |
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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. |
|
Serotonin Modulators |
May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. |
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Serotonin/Norepinephrine Reuptake Inhibitors |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Tacrolimus (Systemic |
Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic). |
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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. |
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Thrombolytic Agents |
Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. |
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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. |
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TraMADol |
Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
Tricyclic Antidepressants (Tertiary Amine) |
May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
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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. |
|
Risk Factor D (Consider therapy modification) |
|
|
Apixaban |
Naproxen may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Naproxen may increase the serum concentration of Apixaban. |
|
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 bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. |
|
Bile Acid Sequestrants |
May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents. |
|
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. |
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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. |
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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. |
|
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. |
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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. |
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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. |
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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. |
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Vitamin K Antagonists (eg, warfarin) |
Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists. |
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Risk Factor X (Avoid combination) |
|
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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). |
|
Dapoxetine |
May enhance the adverse/toxic effect of Serotonin Modulators. |
|
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 |
May enhance the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists. Serotonin 5-HT1D Receptor Agonists may enhance the vasoconstricting effect of Ergot Derivatives. Exceptions: Nicergoline. |
|
Floctafenine |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
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. |
|
Methylene Blue |
May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. |
|
Mifamurtide |
Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide. |
|
Monoamine Oxidase Inhibitors |
May decrease the metabolism of Serotonin 5-HT1D Receptor Agonists. Management: If MAO inhibitor therapy is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. |
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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. |
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Pelubiprofen |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
|
Phenylbutazone |
May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. |
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Serotonin 5-HT1D Receptor Agonists |
May enhance the adverse/toxic effect of SUMAtriptan. |
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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. |
Monitor:
- CBC (if hemoglobin is =10 g upon initiation, continue to monitor hemoglobin regularly during long-term treatment)
- Chemistry profile (periodically in long-term therapy).
- LFTs
- RFTs (urine output and serum BUN)
- BP (at initiation, and during therapy).
- Fluid retention symptoms and signs
- Periodic ophthalmic examination (with any vision problems that may arise from long-term therapy).
- Signs of bleeding (occult and gross blood loss).
- Headache severity
- If you notice signs or symptoms that suggest angina, it is important to perform a cardiovascular assessment before starting 5-HT-3 agonists-naive patients who have multiple cardiovascular risk factors (eg: increased age, diabetes and hypertension, smoking, obesity, strong family history, CAD).
- Patients with multiple cardiovascular risk factors should monitor their ECG after the first dose.
- If they have negative cardiovascular evaluations, it is worth considering periodic cardiovascular evaluations for these patients.
How to administer Treximet (Sumatriptan and naproxen)?
Oral: May be administered with or without relation to a meal. The tablet should be swallowed as a whole; not to be divided, crushed, or chewed.
Mechanism of action of Treximet (Sumatriptan and naproxen):
Sumatriptan is a selective agonist of serotonin (5 HT-1B, 5-HT-1D receptors), which acts on intracranial blood vessels (and sensory nerves in the trigeminal systems); causes vasoconstriction and decreases neurogenic inflammation that are associated with antidromic neuronal transmitting.
This results in migraine relief Naproxen:
- Reversibly inhibits COX-1 and 2 (COX-1, 2) enzymes. This results in decreased production of prostaglandin precursors
- Antipyretic, analgesic and anti-inflammatory properties
- Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation & decreasing proinflammatory cytokine levels.
See individual agents.
International Brand Names of Sumatriptan and naproxen:
- Treximet
- Migralife
- Sumatospire
Sumatriptan and naproxen Brand Names in Pakistan:
|
Sumatriptan + Naproxen Tablets in Pakistan |
|
| Suminap | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Sumoxen | Atco Laboratories Limited |
 Injection.webp)