NSAIDs and its drug interactions


NSAIDs: non- steroidal anti-inflammatory drugs.

(Interactions do not generally apply to topical NSAIDs.)



  1. 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.


  1. 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.


  1. ARBS: increased risk of renal function impairment in elderly and volume depleted patients; should be monitored closely.


  1. Anti-coagulants: increased risk of bleeding.


  1. Beta-blockers: hypotensive actions of beta blockers are antagonized by NSAIDs. Both increases serum potassium.


  1. Corticosteroids: increased risk of GI ulceration.


  1. Diuretics: nephrotoxic effects of NSAIDS are augmented by diuretics.


  1. Quinolones: increased risk of convulsions when given together because of the displacement of GABA from receptors in brain.


  1. Tacrolimus: serious life threatening interaction, need to be monitored closely. Use an alternative if feasible. Concomitant administration increases risk of nephrotoxicity.


  1. Venlafaxine: increased risk of upper GI bleeding. Either, increases toxicity of the other by pharmacodynamic synergism.

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