NSAIDs: non- steroidal anti-inflammatory drugs.
(Interactions do not generally apply to topical NSAIDs.)
- ACE inhibitors: increased risk of renal impairment when given with NSAIDS, particularly in volume depleted individuals; also NSAIDs decrease the anti hypertensive actions of ACEi by pharmacodynamic antagonism.
- Aspirin: aspirin + NSAIDs can lead to increased side effects of NSAIDs. Ibuprofen decreases the anti-platelet effects of low dose aspirin by blocking the active site of platelet cyclooxygenase. Administer ibuprofen 8 hours before aspirin or at least 2-4 hours after aspirin. The effect of other NSAIDs on aspirin is not established.
- ARBS: increased risk of renal function impairment in elderly and volume depleted patients; should be monitored closely.
- Anti-coagulants: increased risk of bleeding.
- Beta-blockers: hypotensive actions of beta blockers are antagonized by NSAIDs. Both increases serum potassium.
- Corticosteroids: increased risk of GI ulceration.
- Diuretics: nephrotoxic effects of NSAIDS are augmented by diuretics.
- Quinolones: increased risk of convulsions when given together because of the displacement of GABA from receptors in brain.
- Tacrolimus: serious life threatening interaction, need to be monitored closely. Use an alternative if feasible. Concomitant administration increases risk of nephrotoxicity.
- Venlafaxine: increased risk of upper GI bleeding. Either, increases toxicity of the other by pharmacodynamic synergism.