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Jul.27.2021

Ibuprofen

Indications/Dosage

Labeled

  • arthralgia
  • common cold
  • dental pain
  • dysmenorrhea
  • fever
  • headache
  • juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
  • migraine
  • mild pain
  • moderate pain
  • musculoskeletal pain
  • osteoarthritis
  • rheumatoid arthritis
  • severe pain

Off-Label

  • cystic fibrosis
  • frostbite
† Off-label indication

For the treatment of rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)

Oral dosage (tablets or oral suspension)

Adults

300 mg PO 4 times daily or 400 to 800 mg PO 3 to 4 times daily. Max: 3,200 mg/day.[30569] [44120] [44121]

Children and Adolescents

30 to 50 mg/kg/day PO in 3 to 4 divided doses (Max: 800 mg/dose).[44121] [54023] [55102] [55106] [55107] Lower dose to smallest effective dose once clinical effect is attained. Patients with milder disease may be adequately treated with 20 mg/kg/day.[44121] [54023]

For the treatment of osteoarthritis

Oral dosage (tablets or suspension)

Adults

300 mg PO 4 times daily or 400 to 800 mg PO 3 to 4 times daily. Max: 3,200 mg/day.[30569] [44120] [44121]

For the treatment of dysmenorrhea

Oral dosage (prescription tablets containing 400 mg of ibuprofen or suspension containing 100 mg of ibuprofen per 5 mL)

Adults

400 mg PO every 4 to 6 hours as needed. Max: 3,200 mg/day.[30569]

Oral dosage (OTC tablets containing 200 mg of ibuprofen)

Adults

200 to 400 mg PO every 4 to 6 hours as needed. Max: 1,200 mg/day. Discontinue use if pain gets worse or lasts more than 10 days.[55095]

Children and Adolescents 12 to 17 years

200 to 400 mg PO every 4 to 6 hours as needed. Max: 1,200 mg/day. Discontinue use if pain gets worse or lasts more than 10 days.[55095]

For the treatment of moderate to severe pain as an adjunct to opioids

Intravenous dosage

Adults

400 to 800 mg IV every 6 hours as needed. Max: 3,200 mg/day.[35893]

Children and Adolescents 12 to 17 years

400 mg IV every 4 to 6 hours as needed. Max: 2,400 mg/day.[35893]

Infants and Children 6 months to 11 years

10 mg/kg/dose (Max: 400 mg/dose) IV every 4 to 6 hours as needed. Max: 40 mg/kg/day or 2,400 mg/day, whichever is less.[35893]

For the treatment of mild pain to moderate pain, including minor aches and pains associated with arthralgia, dental pain, headache, musculoskeletal pain (including backache), and/or the common cold

NOTE: Use weight to determine pediatric dosage when possible.[55086]

For the treatment of fever

NOTE: Use weight to determine pediatric dosage when possible.[55086]

Oral dosage (OTC tablets containing 200 mg of ibuprofen)

Adults

200 to 400 mg PO every 4 to 6 hours as needed. Max: 1,200 mg/day. Discontinue use if fever gets worse or lasts more than 3 days.[55095]

Children and Adolescents 12 to 17 years

200 to 400 mg PO every 4 to 6 hours as needed. Max: 1,200 mg/day. Discontinue use if fever gets worse or lasts more than 3 days.[55095]

Oral dosage (OTC tablets containing 100 mg of ibuprofen or suspension containing 100 mg of ibuprofen per 5 mL)

Children 11 years or weighing 72 to 95 pounds

300 mg PO every 6 to 8 hours as needed. Max: 1,200 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66830] [66831]

Children 9 to 10 years or weighing 60 to 71 pounds

250 mg PO every 6 to 8 hours as needed. Max: 1,000 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66830] [66831]

Children 6 to 8 years or weighing 48 to 59 pounds

200 mg PO every 6 to 8 hours as needed. Max: 800 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66830] [66831]

Children 4 to 5 years or weighing 36 to 47 pounds

150 mg PO every 6 to 8 hours as needed. Max: 600 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66830] [66831]

Children 2 to 3 years or weighing 24 to 35 pounds

100 mg PO every 6 to 8 hours as needed. Max: 400 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66830] [66831]

Oral dosage (OTC concentrated drops containing 50 mg of ibuprofen per 1.25 mL)

Children 12 to 23 months or weighing 18 to 23 pounds

75 mg PO every 6 to 8 hours as needed. Max: 300 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66832]

Infants 6 to 11 months or weighing 12 to 17 pounds

50 mg PO every 6 to 8 hours as needed. Max: 200 mg/day. Discontinue use if no relief within 24 hours or if fever gets worse or lasts more than 3 days.[66832]

Oral dosage (prescription suspension containing 100 mg of ibuprofen per 5 mL)

Infants and Children 6 months to 2 years

5 to 10 mg/kg/dose PO every 6 to 8 hours. Max: 40 mg/kg/day.[44121]

Intravenous dosage

Adults

400 mg IV once, then 400 mg IV every 4 to 6 hours or 100 to 200 mg IV every 4 hours as needed. Max: 3,200 mg/day.[35893]

Children and Adolescents 12 to 17 years

400 mg IV every 4 to 6 hours as needed. Max: 2,400 mg/day.[35893]

Infants and Children 6 months to 11 years

10 mg/kg/dose (Max: 400 mg/dose) IV every 4 to 6 hours as needed. Max: 40 mg/kg/day or 2,400 mg/day, whichever is less.[35893]

For patients with cystic fibrosis† to slow the rate of decline in lung function

Oral dosage

Adults

20 to 30 mg/kg/dose (Max: 1,600 mg/dose) PO twice daily adjusted to maintain a peak serum concentration of 50 to 100 mcg/mL.[24179] [54023] [55084]

Children and Adolescents 6 to 17 years

20 to 30 mg/kg/dose (Max: 1,600 mg/dose) PO twice daily adjusted to maintain a peak serum concentration of 50 to 100 mcg/mL.[24179] [54023] [55084] Guidelines recommend the chronic use of oral ibuprofen for CF patients 6 to 17 years who have an FEV1 more than 60% predicted.[51770] [56767]

For the treatment of frostbite†

Oral dosage

Adults

6 mg/kg/dose PO twice daily starting in the field and continuing until frostbite wound is healed or surgical management occurs. Max: 600 mg PO 4 times daily. Guidelines suggest ibuprofen to inhibit harmful prostaglandins, which can cause vasoconstriction, dermal ischemia, and further tissues damage.[66799]

For the acute treatment of migraine

Oral dosage

Adults

200 to 400 mg PO once.[64565] [66574] Guidelines classify aspirin as having established efficacy for the treatment of acute migraine.[64551] [64565]

Therapeutic Drug Monitoring

Maximum Dosage Limits

  • Adults

    3,200 mg/day PO/IV for Rx-only products; 1,200 mg/day PO for non-prescription use.

  • Geriatric

    3,200 mg/day PO/IV for Rx-only products; 1,200 mg/day PO for non-prescription use.

  • Adolescents

    17 years: 3,200 mg/day PO/IV for Rx-only products; 1,200 mg/day PO for non-prescription use.

    13 to 16 years: 50 mg/kg/day PO (Max: 3,200 mg/day) and 2,400 mg/day IV for Rx-only products; 1,200 mg/day PO for non-prescription use.

  • Children

    12 years: 50 mg/kg/day PO (Max: 3,200 mg/day) and 2,400 mg/day IV for Rx-only products; 40 mg/kg/day PO (Max: 1,200 mg/day) for non-prescription use.

    1 to 11 years: 50 mg/kg/day PO (Max: 3,200 mg/day) and 40 mg/kg/day IV (Max: 2,400 mg/day) for Rx-only products; 40 mg/kg/day PO (Max: 1,200 mg/day) for non-prescription use.

  • Infants

    6 to 11 months: 40 mg/kg/day PO/IV.

    1 to 5 months: Safety and efficacy have not been established.

  • Neonates

    Safety and efficacy have not been established.

Patients with Hepatic Impairment Dosing

Specific guidelines for dosage adjustments in hepatic impairment are not available; dosage reduction or initiation of ibuprofen therapy at the lower end of the usual dosage range is prudent in patients with moderate to severe hepatic impairment. Ibuprofen is metabolized in the liver, and its elimination half-life is significantly prolonged in patients with moderate to severe cirrhosis.[35603]

Patients with Renal Impairment Dosing

No dosage adjustment needed; however, ibuprofen has not been studied in patients with severe renal insufficiency. The use of ibuprofen is not recommended in patients with advanced renal disease.

 

Intermittent hemodialysis

No supplemental dosage is needed following dialysis.

† Off-label indication
Revision Date: 07/27/2021, 11:48:35 AM

References

24179 - Konstan MW, Byard PJ, Hoppel CL, et al. Effect of high-dose ibuprofen in patients with cystic fibrosis. N Engl J Med 1995;332:848-54.30569 - Ibuprofen tablets, USP (Rx-only) package insert. Montvale NJ: Ascend laboratories LLC; 2019 Jan.35603 - Li G, Treiber G, Maier K, et al. Disposition of ibuprofen in patients with liver cirrhosis Stereochemical considerations. Clin Pharmacokinet 1993;25:154-63.35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.44120 - IBU (ibuprofen) tablets package insert. Shreveport, LA: Dr. Reddy's Laboratories, Inc.; 2016 Jul.44121 - Ibuprofen oral suspension package insert. Allegan, MI: Perrigo New York Inc; 2017 Apr.51770 - Flume PA, O'Sullivan BP, Robinson KA, et al. Cystic fibrosis pulmonary guidelines: Chronic medications for maintenance of lung health. Am J Respir Crit Care Med 2007;176:957-969.54023 - Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs 2001;3:817-858.55084 - Lands LC, Milner R, Cantin AM, et al. High-dose ibuprofen in cystic fibrosis: Canadian safety and effectiveness trial. J Pediatr 2007;151:249-254.55086 - Dlugosz CK, Chater RW, Engle JP. Appropriate use of nonprescription analgesics in pediatric patients. J Pediatr Health Care 2006;20:316-325.55095 - Motrin IB (ibuprofen) tablets package insert (OTC). Fort Washington, PA: Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division; 2017 Apr.55102 - Giannini EH, Brewer EJ, Miller ML, et al. Ibuprofen suspension in the treatment of juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. J Pediatr 1990;117:645-652.55106 - Rose CD, Doughty RA. Pharmacological management of juvenile rheumatoid arthritis. Drugs 1992;43:849-863.55107 - Steans A, Manners PJ, Robinson IG. A multicentre, long-term evaluation of the safety and efficacy of ibuprofen syrup in children with juvenile chronic arthritis. Brit J Clin Pract 1990;44:172-175.56767 - Mogayzel PJ, Naureckas ET, Robinson KA. Cystic fibrosis pulmonary guidelines: chronic medications for maintenance of lung health. Am J Respir Crit Care Med 2013;187:680-689.64551 - American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache 2018;59:1-18.64565 - Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: The American Headache Society evidence assessment of migraine pharmacotherapies. Headache 2015;55:3-20.66574 - Advil Migraine (ibuprofen) capsule package insert. GlaxoSmithKline Consumer Healthcare Holdings (US) LLC; 2020 Nov.66799 - McIntosh SE, Freer L, Grissom CK, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of frostbite: 2019 update. Wilderness Environ Med 2019;30:S19-S32.66830 - Ibuprofen chewable tablet (Junior Strength Advil) package insert. Warren, NJ: GlaxoSmithKline Consumer Healthcare Holdings (US) LLC; 2020 Nov.66831 - Ibuprofen suspension (Children's Advil) package insert. Warren, NJ:GlaxoSmithKline Consumer Healthcare Holdings (US) LLC; 2021 Jul.66832 - Ibuprofen concentrated suspension/drops (Infants Advil) package insert. Warren, NJ: GlaxoSmithKline Consumer Healthcare Holdings (US) LLC; 2020 Nov.

How Supplied

Ibuprofen Chewable tablet

Advil Children's 50mg Chewable Tablet (00573-0177) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Chewable tablet

Motrin Children's 50mg Chewable Tablet (Grape) (50580-0907) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Chewable tablet

Motrin Children's 50mg Chewable Tablet (Orange) (50580-0205) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Chewable tablet

Advil Junior Strength 100mg Chewable Tablet (00573-0179) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Chewable tablet

Advil Junior Strength 100mg Chewable Tablet (Grape) (00573-0179) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Chewable tablet

CVS Junior Ibuprofen 100mg Chewable Tablet (Grape) (59779-0521) (CVS Health) (off market)

Ibuprofen Chewable tablet

CVS Junior Ibuprofen 100mg Chewable Tablet (Grape) (59779-0521) (CVS Health) nullCVS Junior Ibuprofen 100mg Chewable Tablet (Grape) package photo

Ibuprofen Chewable tablet

CVS Junior Ibuprofen 100mg Chewable Tablet (Orange) (59779-0461) (CVS Health) null

Ibuprofen Chewable tablet

GNP Junior Ibuprofen 100mg Chewable Tablet (Grape) (46122-0010) (AmerisourceBergen Corporation) null

Ibuprofen Chewable tablet

GNP Junior Ibuprofen 100mg Chewable Tablet (Orange) (24385-0546) (AmerisourceBergen Corporation) null

Ibuprofen Chewable tablet

GoodSense Junior Ibuprofen 100mg Chewable Tablet (00113-0461) (Goodsense a Division of Perrigo) nullGoodSense Junior Ibuprofen 100mg Chewable Tablet package photo

Ibuprofen Chewable tablet

Health Mart Junior Ibuprofen IB 100mg Chewable Tablet (62011-0334) (McKesson Corporation) null

Ibuprofen Chewable tablet

Health Mart Junior Strength Ibuprofen IB 100mg Chewable Tablet (Orange) (62011-0367) (McKesson Corporation) null

Ibuprofen Chewable tablet

Junior Ibuprofen 100mg Chewable Tablet (00904-5691) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Chewable tablet

Leader Junior Ibuprofen 100mg Chewable Tablet (Grape) (37205-0852) (Cardinal Health, Inc.) null

Ibuprofen Chewable tablet

Leader Junior Ibuprofen 100mg Chewable Tablet (Orange) (37205-0402) (Cardinal Health, Inc.) (off market)

Ibuprofen Chewable tablet

Leader Junior Ibuprofen 100mg Chewable Tablet (Orange) (70000-0240) (Cardinal Health, Inc.) null

Ibuprofen Chewable tablet

Motrin Children's 100mg Chewable Tablet (Grape) (00045-0909) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Chewable tablet

Motrin Children's 100mg Dye-Free Chewable Tablet (Grape) (00045-0932) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Chewable tablet

Motrin Junior 100mg Chewable Tablet (Grape) (00045-0909) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Chewable tablet

Motrin Junior 100mg Chewable Tablet (Orange) (00045-0494) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Chewable tablet

Publix Junior Ibuprofen 100mg Chewable Tablet (56062-0461) (Publix Super Markets, Inc) null

Ibuprofen Chewable tablet

RITE AID Junior Ibuprofen 100mg Chewable Tablet (null) (Rite Aid Corp) nullRITE AID Junior Ibuprofen 100mg Chewable Tablet package photo

Ibuprofen Chewable tablet

RITE AID Junior Ibuprofen 100mg Chewable Tablet (Grape) (null) (Rite Aid Corp) nullRITE AID Junior Ibuprofen 100mg Chewable Tablet (Grape) package photo

Ibuprofen Chewable tablet

Sunmark Junior Ibuprofen IB 100mg Chewable Tablet (49348-0639) (McKesson Corporation) null

Ibuprofen Chewable tablet

Top Care Junior Ibuprofen 100mg Chewable Tablet (36800-0461) (Topco Associates LLC) null

Ibuprofen Chewable tablet

Walgreens Junior Ibuprofen 100mg Chewable Tablet (Orange) (null) (Walgreens Co) null

Ibuprofen Oral capsule

Motrin IB 200mg Gelcap (50580-0770) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral capsule

Wal-Profen 200mg Capsule (00363-0038) (Walgreens Co) nullWal-Profen 200mg Capsule package photo

Ibuprofen Oral capsule, liquid filled

Advil 200mg Liqui-Gel (00573-0169) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral capsule, liquid filled

Advil 200mg Liqui-Gel (00573-0169) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral capsule, liquid filled

Advil 200mg Liqui-Gel (00573-0149) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral capsule, liquid filled

Advil 200mg Liqui-Gel Packet (00573-0149) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral capsule, liquid filled

Advil 200mg Migraine Capsule (00573-0168) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral capsule, liquid filled

Advil 200mg Minis Liqui-Gel (00573-1769) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0197) (CVS Health) (off market)

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59726-0120) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59726-0121) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (null) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0197) (CVS Health) (off market)CVS Ibuprofen 200mg Liquid Filled Softgel package photo

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0197) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0108) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0197) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Liquid Filled Softgel (59779-0197) (CVS Health) null

Ibuprofen Oral capsule, liquid filled

CVS Ibuprofen 200mg Softgel (59726-0122) (CVS Health) nullCVS Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

GNP Ibuprofen 200mg Softgel (24385-0499) (AmerisourceBergen Corporation) null

Ibuprofen Oral capsule, liquid filled

GNP Ibuprofen 200mg Softgel (46122-0580) (AmerisourceBergen Corporation) null

Ibuprofen Oral capsule, liquid filled

GNP Ibuprofen 200mg Softgel Capsule (46122-0530) (AmerisourceBergen Corporation) null

Ibuprofen Oral capsule, liquid filled

GNP Ibuprofen 200mg Softgel Capsule (46122-0530) (AmerisourceBergen Corporation) null

Ibuprofen Oral capsule, liquid filled

Health Mart Ibuprofen 200mg Softgel (62011-0016) (McKesson Corporation) null

Ibuprofen Oral capsule, liquid filled

Ibuprofen 200mg Liquid Caps (00904-5903) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral capsule, liquid filled

Ibuprofen 200mg Liquid Caps (00536-3603) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral capsule, liquid filled

Ibuprofen 200mg Liquid Caps (00536-1147) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Ibuprofen Oral capsule, liquid filled

Ibuprofen 200mg Liquid Capsule (69230-0146) (Camber Consumer Care, Inc.) null

Ibuprofen Oral capsule, liquid filled

Ibuprofen 200mg Liquid Capsule (72865-0132) (XL Care Pharmaceuticals, Inc) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (37205-0328) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (37205-0736) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (37205-0736) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (70000-0360) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (70000-0360) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Leader Ibuprofen 200mg Softgel (70000-0360) (Cardinal Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Midol 200mg Liquid Gel Capsule (12843-0536) (Bayer Corp Consumer Care Div) null

Ibuprofen Oral capsule, liquid filled

Premier Value Ibuprofen 200mg Softgel (null) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral capsule, liquid filled

Premier Value Ibuprofen 200mg Softgel (68016-0626) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral capsule, liquid filled

RITE AID Ibuprofen 200mg Softgel (null) (Rite Aid Corp) nullRITE AID Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

RITE AID Ibuprofen 200mg Softgel (null) (Rite Aid Corp) nullRITE AID Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Sunmark Ibuprofen 200mg Softgel (70677-0046) (McKesson Corporation) null

Ibuprofen Oral capsule, liquid filled

Today's Health Ibuprofen 200mg Softgel (null) (Today's Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Today's Health Ibuprofen 200mg Softgel (null) (Today's Health, Inc.) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0749) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0945) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0945) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0945) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0945) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-1610) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-1610) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-1610) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-1610) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-1610) (Walgreens Co) nullWalgreens Ibuprofen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0221) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0221) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0221) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0221) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0221) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Ibuprofen 200mg Softgel (00363-0222) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Walgreens Migraine Relief 200mg Softgel (00363-0240) (Walgreens Co) nullWalgreens Migraine Relief 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Wal-Profen 200mg Softgel (null) (Walgreens Co) null

Ibuprofen Oral capsule, liquid filled

Wal-Profen 200mg Softgel (null) (Walgreens Co) nullWal-Profen 200mg Softgel package photo

Ibuprofen Oral capsule, liquid filled

Wal-Profen 200mg Softgel (11917-0050) (Walgreens Co) nullWal-Profen 200mg Softgel package photo

Ibuprofen Oral drops, suspension

Advil Infants' Concentrated 50mg/1.25ml Drops (Grape) (00573-0173) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral drops, suspension

Advil Infants' Concentrated 50mg/1.25ml Drops (White Grape) (00573-0191) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral drops, suspension

Advil Infants' Concentrated 50mg/1.25mL Drops (White Grape) (00573-0191) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25ml Concentrated Drops (Berry) (59779-0057) (CVS Health) nullCVS Infants' Ibuprofen 50mg/1.25ml Concentrated Drops (Berry) package photo

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (59779-0255) (CVS Health) (off market)

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (null) (CVS Health) null

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (59779-1252) (CVS Health) (off market)

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (59779-1252) (CVS Health) null

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (59779-0995) (CVS Health) null

Ibuprofen Oral drops, suspension

CVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (59779-0313) (CVS Health) nullCVS Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) package photo

Ibuprofen Oral drops, suspension

Equaline Infants' Ibuprofen 50mg/1.25mL Drops (Berry) (41163-0057) (Albertson's, Inc) (off market)

Ibuprofen Oral drops, suspension

GNP Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (24385-0550) (AmerisourceBergen Corporation) null

Ibuprofen Oral drops, suspension

Ibuprofen 50mg/1.25ml Drops (00904-5463) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral drops, suspension

Infants' Ibuprofen 50mg/1.25ml Concentrated Suspension Drops (Berry) (45963-0125) (Teva/Actavis US) null

Ibuprofen Oral drops, suspension

Leader Infants' Ibuprofen 50mg/1.25ml Concentrated Drops (Berry) (37205-0646) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral drops, suspension

Leader Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (70000-0307) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral drops, suspension

Motrin Infants' 50mg/1.25ml Suspension Drops (Berry) (00045-0198) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral drops, suspension

Motrin Infants' 50mg/1.25ml Suspension Drops (Berry) (00045-0524) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral drops, suspension

Motrin Infants' 50mg/1.25mL Suspension Drops (Berry) (00045-0524) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral drops, suspension

Motrin Infants' 50mg/1.25mL Suspension Drops (Berry) (00045-0198) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral drops, suspension

PediaCare Infants' Pain Reliever/Fever Reducer IB 50mg/1.25ml Concentrated Drops (Berry) (null) (Medtech Products, Inc a Prestige Brands Company) (off market)

Ibuprofen Oral drops, suspension

Premier Value Infants' Ibuprofen 50mg/1.25ml Concentrated Drops (Berry) (68016-0025) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral drops, suspension

Publix Infants' Profen IB 50mg/1.25ml Drops (Berry) (56062-0057) (Publix Super Markets, Inc) null

Ibuprofen Oral drops, suspension

RITE AID Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (null) (Rite Aid Corp) nullRITE AID Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) package photo

Ibuprofen Oral drops, suspension

RITE AID Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (null) (Rite Aid Corp) null

Ibuprofen Oral drops, suspension

Sunmark Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (49348-0374) (McKesson Corporation) null

Ibuprofen Oral drops, suspension

Sunmark Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (49348-0642) (McKesson Corporation) null

Ibuprofen Oral drops, suspension

Walgreens Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (00363-0057) (Walgreens Co) nullWalgreens Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) package photo

Ibuprofen Oral drops, suspension

Walgreens Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (00363-0255) (Walgreens Co) nullWalgreens Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) package photo

Ibuprofen Oral suspension

GoodSense Infants' Ibuprofen 50mg/1.25mL Concentrated Suspension (Berry) (00113-0057) (Goodsense a Division of Perrigo) null

Ibuprofen Oral suspension

Health Mart Infants' Ibuprofen 50mg/1.25mL Concentrated Suspension (Berry) (62011-0012) (McKesson Corporation) null

Ibuprofen Oral suspension

Health Mart Infants' Ibuprofen 50mg/1.25mL Concentrated Suspension (Berry) (62011-0004) (McKesson Corporation) null

Ibuprofen Oral suspension

Infants' Ibuprofen 50mg/1.25ml Concentrated Suspension (Berry) (45802-0057) (Perrigo Pharmaceuticals Company) null

Ibuprofen Oral suspension

Leader Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (37205-0436) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Leader Infants' Ibuprofen 50mg/1.25mL Concentrated Drops (Berry) (70000-0298) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Top Care Infants' Ibuprofen 50mg/1.25mL Concentrated Suspension (Berry) (36800-0057) (Topco Associates LLC) null

Ibuprofen Oral suspension

Top Care Infants' Ibuprofen 50mg/1.25mL Concentrated Suspension (Berry) (36800-0255) (Topco Associates LLC) null

Ibuprofen Oral suspension

Walgreens Infants' Ibuprofen 50mg/1.25mL Drops (00363-0057) (Walgreens Co) nullWalgreens Infants' Ibuprofen 50mg/1.25mL Drops package photo

Ibuprofen Oral suspension

Advil Children's 100mg/5ml Suspension (Fruit) (00573-0170) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral suspension

Advil Children's 100mg/5ml Suspension (Grape) (00573-0171) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral suspension

Advil Children's 100mg/5ml Suspension (Raspberry) (00573-0174) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral suspension

Advil Children's Fever 100mg/5mL Suspension (Bubble Gum) (00573-0207) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral suspension

Advil Children's Fever 100mg/5mL Suspension (Grape) (00573-0171) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral suspension

Advil Children's Fever 100mg/5mL Suspension (White Grape) (00573-0290) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral suspension

Advil Children's Fever Sugar-Free 100mg/5mL Suspension (Berry) (00573-0232) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5ml Suspension (Berry) (00536-1081) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5ml Suspension (Berry) (00472-1255) (Teva/Actavis US) (off market)

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5ml Suspension (Berry) (00472-1255) (Teva/Actavis US) (off market)Children's Ibuprofen 100mg/5ml Suspension (Berry) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (68001-0435) (BluePoint Laboratories) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (69230-0308) (Camber Consumer Care, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (69230-0311) (Camber Consumer Care, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (61269-0761) (H2-Pharma, LLC) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00904-5309) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) nullChildren's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00904-5309) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (45802-0897) (Perrigo Pharmaceuticals Company) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00121-1836) (Pharmaceutical Associates Inc Div Beach Products) nullChildren's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00121-0917) (Pharmaceutical Associates Inc Div Beach Products) nullChildren's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (68094-0494) (Precision Dose, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (68094-0600) (Precision Dose, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (68094-0037) (Precision Dose, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (51672-2130) (Taro Pharmaceuticals USA Inc) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00472-1261) (Teva/Actavis US) (off market)

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00472-1760) (Teva/Actavis US) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Berry) (00472-1761) (Teva/Actavis US) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Blue Raspberry) (00472-1764) (Teva/Actavis US) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Bubble Gum) (61269-0763) (H2-Pharma, LLC) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (69230-0310) (Camber Consumer Care, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (45802-0140) (Perrigo Pharmaceuticals Company) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (00472-1263) (Teva/Actavis US) (off market)

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (00472-1763) (Teva/Actavis US) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5ml Suspension (Fruit) (00904-5464) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Grape) (69230-0309) (Camber Consumer Care, Inc.) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Grape) (00904-5577) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Grape) (45802-0133) (Perrigo Pharmaceuticals Company) null

Ibuprofen Oral suspension

Children's Ibuprofen 100mg/5mL Suspension (Grape) (00121-0914) (Pharmaceutical Associates Inc Div Beach Products) nullChildren's Ibuprofen 100mg/5mL Suspension (Grape) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 200mg/10mL Suspension (Grape) (00121-1828) (Pharmaceutical Associates Inc Div Beach Products) nullChildren's Ibuprofen 200mg/10mL Suspension (Grape) package photo

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0897) (CVS Health) (off market)CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0685) (CVS Health) (off market)CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0897) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0897) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0685) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Berry) (59779-0685) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (59779-0166) (CVS Health) nullCVS Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) package photo

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (59779-0882) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (59779-0166) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Grape) (59779-0660) (CVS Health) (off market)CVS Children's Ibuprofen 100mg/5mL Suspension (Grape) package photo

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Grape) (null) (CVS Health) null

Ibuprofen Oral suspension

CVS Children's Ibuprofen 100mg/5mL Suspension (Grape) (59779-0660) (CVS Health) null

Ibuprofen Oral suspension

ElixSure IB 100mg/5ml Suspension (51672-2505) (TaroPharma ) (off market)

Ibuprofen Oral suspension

ElixSure IB 100mg/5mL Suspension (null) (Moberg Pharma NA formerly Alterna LLC) null

Ibuprofen Oral suspension

Equaline Children's Ibuprofen 100mg/5mL Suspension (Berry) (41163-0897) (Albertson's, Inc) (off market)

Ibuprofen Oral suspension

Equaline Children's Ibuprofen 100mg/5ml Suspension (Bubble Gum) (41163-0166) (Albertson's, Inc) (off market)

Ibuprofen Oral suspension

Equaline Children's Ibuprofen 100mg/5mL Suspension (Grape) (41163-0660) (Albertson's, Inc) (off market)

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Berry) (24385-0905) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Berry) (24385-0009) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Berry) (24385-0905) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (24385-0361) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (24385-0361) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Grape) (24385-0372) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Grape) (46122-0110) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GNP Children's Ibuprofen 100mg/5mL Suspension (Grape) (24385-0372) (AmerisourceBergen Corporation) null

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Berry) (00113-0897) (Goodsense a Division of Perrigo) null

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (00113-0166) (Goodsense a Division of Perrigo) (off market)

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (00113-0166) (Goodsense a Division of Perrigo) null

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Fruit) (00113-0623) (Goodsense a Division of Perrigo) null

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Grape) (00113-0660) (Goodsense a Division of Perrigo) (off market)

Ibuprofen Oral suspension

GoodSense Children's Ibuprofen 100mg/5mL Suspension (Grape) (00113-0660) (Goodsense a Division of Perrigo) null

Ibuprofen Oral suspension

Health Mart Children's Ibuprofen 100mg/5mL Suspension (Berry) (62011-0030) (McKesson Corporation) null

Ibuprofen Oral suspension

Health Mart Children's Ibuprofen 100mg/5mL Suspension (Berry) (62011-0214) (McKesson Corporation) null

Ibuprofen Oral suspension

Health Mart Children's Ibuprofen 100mg/5mL Suspension (Berry) (62011-0030) (McKesson Corporation) null

Ibuprofen Oral suspension

Health Mart Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (62011-0011) (McKesson Corporation) null

Ibuprofen Oral suspension

Health Mart Children's Ibuprofen 100mg/5mL Suspension (Grape) (62011-0010) (McKesson Corporation) null

Ibuprofen Oral suspension

HEB Ibuprofen Children's 100mg/5ml Suspension (Berry) (37808-0897) (H-E-B) null

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (45802-0952) (Perrigo Pharmaceuticals Company) nullIbuprofen 100mg/5ml Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (45802-0952) (Perrigo Pharmaceuticals Company) nullIbuprofen 100mg/5ml Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (10768-7019) (Perrigo Rx) nullIbuprofen 100mg/5ml Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (00121-4774) (Pharmaceutical Associates Inc Div Beach Products) (off market)

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (00472-1270) (Teva/Actavis US) (off market)Ibuprofen 100mg/5ml Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (66689-0009) (Vistapharm Inc) (off market)

Ibuprofen Oral suspension

Ibuprofen 100mg/5ml Suspension (50962-0475) (Xactdose Inc.) (off market)

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (59651-0032) (Aurobindo Pharma Limited) null

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (50383-0584) (Hi-Tech Pharmacal, a subsidiary of Akorn) (off market)

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (50383-0584) (Hi-Tech Pharmacal, a subsidiary of Akorn) (off market)

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (00121-4774) (Pharmaceutical Associates Inc Div Beach Products) null

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (00121-0918) (Pharmaceutical Associates Inc Div Beach Products) null

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (51672-1385) (Taro Pharmaceuticals USA Inc) nullIbuprofen 100mg/5mL Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (00472-1270) (Teva/Actavis US) (off market)Ibuprofen 100mg/5mL Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (00472-2002) (Teva/Actavis US) nullIbuprofen 100mg/5mL Suspension package photo

Ibuprofen Oral suspension

Ibuprofen 100mg/5mL Suspension (66689-0339) (Vistapharm Inc) null

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5ml Suspension (Berry) (37205-0643) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Berry) (37205-0848) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Berry) (70000-0263) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Blue Raspberry) (70000-0259) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5ml Suspension (Bubblegum) (37205-0282) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (70000-0264) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Fruit) (37205-0644) (Cardinal Health, Inc.) (off market)Leader Children's Ibuprofen 100mg/5mL Suspension (Fruit) package photo

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5ml Suspension (Grape) (37205-0283) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Grape) (37205-0660) (Cardinal Health, Inc.) null

Ibuprofen Oral suspension

Leader Children's Ibuprofen 100mg/5mL Suspension (Grape) (70000-0181) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral suspension

Motrin 100mg/5mL Suspension (00045-0448) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral suspension

Motrin 100mg/5mL Suspension (50580-0448) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Berry) (50580-0184) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Berry) (00045-0192) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)Motrin Children's 100mg/5ml Suspension (Berry) package photo

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Berry) (00045-0184) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral suspension

Motrin Children's 100mg/5mL Suspension (Berry) (00045-0192) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Bubblegum) (00045-0604) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Grape) (00045-0603) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral suspension

Motrin Children's 100mg/5ml Suspension (Tropical Punch) (00045-0215) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral suspension

PediaCare Children's Pain Reliever/Fever Reducer IB 100mg/5ml Suspension (Berry) (null) (Medtech Products, Inc a Prestige Brands Company) (off market)

Ibuprofen Oral suspension

Premier Value Children's Ibuprofen 100mg/5mL Suspension (Berry) (68016-0255) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral suspension

Premier Value Children's Ibuprofen 100mg/5mL Suspension (Berry) (68016-0261) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral suspension

Premier Value Children's Ibuprofen 100mg/5mL Suspension (Berry) (68016-0250) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral suspension

Premier Value Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (68016-0263) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral suspension

Premier Value Children's Ibuprofen 100mg/5mL Suspension (Grape) (68016-0262) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral suspension

Publix Children's Profen IB 100mg/5ml Suspension (Berry) (56062-0897) (Publix Super Markets, Inc) null

Ibuprofen Oral suspension

Publix Children's Profen IB 100mg/5ml Suspension (Bubblegum) (56062-0166) (Publix Super Markets, Inc) null

Ibuprofen Oral suspension

Quality Choice Children's Ibuprofen 100mg/5mL Suspension (Berry) (63868-0756) (Chain Drug Marketing Association) null

Ibuprofen Oral suspension

Quality Choice Children's Ibuprofen 100mg/5mL Suspension (Bubble Gum) (63868-0758) (Chain Drug Marketing Association) null

Ibuprofen Oral suspension

RITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) (null) (Rite Aid Corp) nullRITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

RITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) (null) (Rite Aid Corp) nullRITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

RITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) (null) (Rite Aid Corp) nullRITE AID Children's Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

RITE AID Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) (null) (Rite Aid Corp) nullRITE AID Children's Ibuprofen 100mg/5mL Suspension (Bubblegum) package photo

Ibuprofen Oral suspension

RITE AID Children's Ibuprofen 100mg/5mL Suspension (Grape) (null) (Rite Aid Corp) nullRITE AID Children's Ibuprofen 100mg/5mL Suspension (Grape) package photo

Ibuprofen Oral suspension

Sunmark Children's Ibuprofen 100mg/5mL Suspension (Berry) (49348-0229) (McKesson Corporation) null

Ibuprofen Oral suspension

Sunmark Children's Ibuprofen 100mg/5mL Suspension (Berry) (49348-0876) (McKesson Corporation) null

Ibuprofen Oral suspension

Sunmark Children's Ibuprofen 100mg/5mL Suspension (Bubble-Gum) (49348-0500) (McKesson Corporation) null

Ibuprofen Oral suspension

Sunmark Children's Ibuprofen 100mg/5mL Suspension (Grape) (49348-0499) (McKesson Corporation) null

Ibuprofen Oral suspension

Top Care Children's Ibuprofen 100mg/5ml Suspension (Berry) (null) (Topco Associates LLC) null

Ibuprofen Oral suspension

Top Care Children's Ibuprofen 100mg/5mL Suspension (Berry) (36800-0897) (Topco Associates LLC) null

Ibuprofen Oral suspension

Top Care Children's Ibuprofen 100mg/5ml Suspension (Bubblegum) (36800-0166) (Topco Associates LLC) null

Ibuprofen Oral suspension

Top Care Children's Ibuprofen 100mg/5mL Suspension (Grape) (36800-0660) (Topco Associates LLC) null

Ibuprofen Oral suspension

Walgreens Children's Dye-Free Ibuprofen 100mg/5mL Suspension (Berry) (00363-0806) (Walgreens Co) null

Ibuprofen Oral suspension

Walgreens Children's Dye-Free Ibuprofen 100mg/5mL Suspension (Berry) (00363-0806) (Walgreens Co) nullWalgreens Children's Dye-Free Ibuprofen 100mg/5mL Suspension (Berry) package photo

Ibuprofen Oral suspension

Walgreens Children's Ibuprofen 100mg/5ml Suspension (Berry) (11917-0005) (Walgreens Co) (off market)Walgreens Children's Ibuprofen 100mg/5ml Suspension (Berry) package photo

Ibuprofen Oral suspension

Walgreens Children's Ibuprofen 100mg/5mL Suspension (Berry) (00363-0897) (Walgreens Co) null

Ibuprofen Oral suspension

Walgreens Children's Ibuprofen 100mg/5mL Suspension (Bubble Gum) (00363-0166) (Walgreens Co) nullWalgreens Children's Ibuprofen 100mg/5mL Suspension (Bubble Gum) package photo

Ibuprofen Oral suspension

Walgreens Children's Ibuprofen 100mg/5mL Suspension (Grape) (00363-0660) (Walgreens Co) nullWalgreens Children's Ibuprofen 100mg/5mL Suspension (Grape) package photo

Ibuprofen Oral suspension

Children's Ibuprofen 200mg/10ml Suspension (Berry) (68094-0503) (Precision Dose, Inc.) null

Ibuprofen Oral tablet

Advil Junior Strength 100mg Tablet (00573-0175) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Advil Junior Strength 100mg Tablet (00573-0175) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Motrin Junior 100mg Caplet (00045-0498) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral tablet

Advil 200mg Caplet (00573-0160) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Caplet (00573-0161) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Gel Caplet (00573-0165) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0150) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0151) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0152) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0154) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0162) (GlaxoSmithKline Consumer Healthcare) (off market)

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0154) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0151) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

Advil 200mg Tablet (00573-0133) (GlaxoSmithKline Consumer Healthcare) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0292) (CVS Health) (off market)CVS Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (null) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0292) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0292) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0292) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0292) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0393) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0647) (CVS Health) nullCVS Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0647) (CVS Health) nullCVS Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (59779-0647) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Caplet (69842-0183) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0291) (CVS Health) nullCVS Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) (off market)CVS Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0291) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0074) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0604) (CVS Health) nullCVS Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0392) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0604) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0604) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0291) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen 200mg Tablet (59779-0291) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen Dye-Free 200mg Tablet (59779-0438) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen Dye-Free 200mg Tablet (null) (CVS Health) null

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Caplet (59779-0393) (CVS Health) (off market)CVS Ibuprofen IB 200mg Caplet package photo

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Caplet (null) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Caplet (59779-0393) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Caplet (59779-0517) (CVS Health) nullCVS Ibuprofen IB 200mg Caplet package photo

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Tablet (59779-0392) (CVS Health) nullCVS Ibuprofen IB 200mg Tablet package photo

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Tablet (null) (CVS Health) (off market)

Ibuprofen Oral tablet

CVS Ibuprofen IB 200mg Tablet (59779-0392) (CVS Health) null

Ibuprofen Oral tablet

Equaline Ibuprofen 200mg Caplet (41163-0297) (Albertson's, Inc) (off market)

Ibuprofen Oral tablet

Equaline Ibuprofen 200mg Tablet (41163-0604) (Albertson's, Inc) (off market)

Ibuprofen Oral tablet

Equaline Ibuprofen 200mg Tablet (41163-0647) (Albertson's, Inc) (off market)

Ibuprofen Oral tablet

Equaline Ibuprofen 200mg Tablet (41163-0114) (Albertson's, Inc) (off market)

Ibuprofen Oral tablet

Genpril 200mg Tablet (00182-2401) (Teva Pharmaceuticals USA) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Caplet (24385-0058) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (24385-0604) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (24385-0647) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (24385-0059) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (46122-0341) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (24385-0604) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (46122-0227) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (24385-0604) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (46122-0548) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GNP Ibuprofen 200mg Tablet (null) (AmerisourceBergen Corporation) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Caplet (00113-0647) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Caplet (00113-0517) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Tablet (00113-0669) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Tablet (00113-0995) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Tablet (00113-0604) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Tablet (00113-0628) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

GoodSense Ibuprofen 200mg Tablet (00113-0074) (Goodsense a Division of Perrigo) null

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Caplet (62011-0015) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Caplet (62011-0015) (McKesson Corporation) (off market)

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Tablet (62011-0013) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Tablet (62011-0014) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Tablet (62011-0039) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen 200mg Tablet (62011-0014) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen IB 200mg Caplet (62011-0213) (McKesson Corporation) (off market)

Ibuprofen Oral tablet

Health Mart Ibuprofen IB 200mg Tablet (62011-0222) (McKesson Corporation) null

Ibuprofen Oral tablet

Health Mart Ibuprofen IB 200mg Tablet (62011-0222) (McKesson Corporation) null

Ibuprofen Oral tablet

Ibu-200 200mg Tablet (00904-1747) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibu-200 200mg Tablet (00904-7914) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Caplet (00536-1089) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (65162-0565) (Akyma Pharmaceuticals, a subsidiary of Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (53746-0140) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (65162-0565) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00304-1710) (Balan, J.J. Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52735-0732) (Family Pharmacy) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52735-0750) (Family Pharmacy) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52735-0751) (Family Pharmacy) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52735-0758) (Family Pharmacy) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (57896-0941) (Geri-Care Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (57896-0540) (Geri-Care Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (53746-0135) (Interpharm Inc) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52189-0221) (Invamed Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00820-0133) (Logen Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-5323) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7912) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7914) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7915) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7914) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7915) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7915) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-7914) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) nullIbuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00904-6747) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (10135-0183) (Marlex Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (10135-0290) (Marlex Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (10135-0143) (Marlex Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (null) (Mason Vitamins) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (null) (Mason Vitamins) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (null) (Mason Vitamins) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (null) (Mason Vitamins) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (49348-0196) (McKesson Corporation) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (49348-0808) (McKesson Corporation) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (49348-0809) (McKesson Corporation) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (63739-0134) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (51079-0731) (Mylan Institutional LLC ) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (54629-0905) (National Vitamin Company Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (54629-0960) (National Vitamin Company Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (54629-0961) (National Vitamin Company Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00084-0052) (Natural Nutritionals Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00084-0054) (Natural Nutritionals Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (66267-0115) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (55289-0673) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (43063-0890) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (16103-0393) (Pharbest Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (52605-0114) (Polygen Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (17236-0565) (R&S Northeast, LLC, formerly Dixon-Shane Drug Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (10956-0678) (Reese Pharmaceutical Company) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (10956-0679) (Reese Pharmaceutical Company) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00122-0808) (Rexall Group) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00122-0847) (Rexall Group) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00122-0881) (Rexall Group) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (60814-0127) (Rexall Group) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (60814-0128) (Rexall Group) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-3939) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-3105) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-3105) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-3587) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-3587) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00536-1088) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00781-1349) (Sandoz Inc. a Novartis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00677-1090) (Sun Pharmaceutical Industries, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00677-1947) (Sun Pharmaceutical Industries, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00093-0483) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00093-0486) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00182-1039) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (50732-0133) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00182-8688) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (00364-2145) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (49483-0601) (Time Cap Laboratories Inc) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (47682-0100) (UniFirst First-Aid Corporation) null

Ibuprofen Oral tablet

Ibuprofen 200mg Tablet (11383-0068) (Weeks and Leo) null

Ibuprofen Oral tablet

Ibu-Tab 200mg Tablet (51641-0215) (Alra Laboratories Inc) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (37205-0341) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (37205-0605) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0176) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0176) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0175) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0176) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0288) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Caplet (70000-0176) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (37205-0345) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (37205-0350) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0308) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0175) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0175) (Cardinal Health, Inc.) (off market)

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0291) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0308) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0003) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0175) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Leader Ibuprofen 200mg Tablet (70000-0292) (Cardinal Health, Inc.) null

Ibuprofen Oral tablet

Midol Cramps and Body Aches Formula 200mg Tablet (12843-0143) (Bayer Corp Consumer Care Div) (off market)

Ibuprofen Oral tablet

Motrin IB 200mg Caplet (00045-0481) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral tablet

Motrin IB 200mg Caplet (00045-0481) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral tablet

Motrin IB 200mg Caplet (00045-0481) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) null

Ibuprofen Oral tablet

Motrin IB 200mg Tablet (00045-0463) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral tablet

Motrin Migraine Pain 200mg Caplet (50580-0119) (McNeil Consumer Healthcare Division of McNEIL-PPC, Inc.) (off market)

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Caplet (68016-0004) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Caplet (68016-0004) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Caplet (68016-0645) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0059) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0024) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0030) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0295) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0030) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0634) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0635) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Premier Value Ibuprofen 200mg Tablet (68016-0634) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Ibuprofen Oral tablet

Publix Ibuprofen 200mg Tablet (56062-0604) (Publix Super Markets, Inc) null

Ibuprofen Oral tablet

Quality Choice Ibuprofen IB 200mg Caplet (63868-0791) (Chain Drug Marketing Association) null

Ibuprofen Oral tablet

Quality Choice Ibuprofen IB 200mg Tablet (63868-0790) (Chain Drug Marketing Association) null

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Caplet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Caplet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Caplet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Caplet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Caplet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Caplet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Caplet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Caplet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

RITE AID Ibuprofen Pain Relief 200mg Tablet (null) (Rite Aid Corp) nullRITE AID Ibuprofen Pain Relief 200mg Tablet package photo

Ibuprofen Oral tablet

Select Brand Ibuprofen 200mg Caplet (15127-0335) (Select Brand) nullSelect Brand Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

Select Brand Ibuprofen 200mg Caplet (15127-0907) (Select Brand) null

Ibuprofen Oral tablet

Select Brand Ibuprofen 200mg Tablet (15127-0312) (Select Brand) nullSelect Brand Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

Select Brand Ibuprofen 200mg Tablet (15127-0905) (Select Brand) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0706) (McKesson Corporation) null

Ibuprofen Oral tablet

Sunmark Ibuprofen 200mg Tablet (49348-0927) (McKesson Corporation) null

Ibuprofen Oral tablet

Today's Health Ibuprofen 200mg Caplet (null) (Today's Health, Inc.) null

Ibuprofen Oral tablet

Today's Health Ibuprofen 200mg Tablet (null) (Today's Health, Inc.) null

Ibuprofen Oral tablet

Today's Health Ibuprofen 200mg Tablet (null) (Today's Health, Inc.) null

Ibuprofen Oral tablet

Top Care Ibuprofen 200mg Caplet (36800-0183) (Topco Associates LLC) null

Ibuprofen Oral tablet

Top Care Ibuprofen 200mg Caplet (36800-0517) (Topco Associates LLC) null

Ibuprofen Oral tablet

Top Care Ibuprofen 200mg Caplet (36800-0647) (Topco Associates LLC) null

Ibuprofen Oral tablet

Top Care Ibuprofen 200mg Tablet (36800-0604) (Topco Associates LLC) null

Ibuprofen Oral tablet

Top Care Ibuprofen 200mg Tablet (36800-0074) (Topco Associates LLC) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Caplet (00363-0393) (Walgreens Co) nullWalgreens Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Caplet (00363-0292) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Caplet (00363-0393) (Walgreens Co) nullWalgreens Ibuprofen 200mg Caplet package photo

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Caplet (11917-0049) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0392) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0438) (Walgreens Co) nullWalgreens Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0910) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0392) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0392) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (11917-0056) (Walgreens Co) nullWalgreens Ibuprofen 200mg Tablet package photo

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0291) (Walgreens Co) null

Ibuprofen Oral tablet

Walgreens Ibuprofen 200mg Tablet (00363-0909) (Walgreens Co) null

Ibuprofen Oral tablet

Wal-Profen 200mg Caplet (00363-0292) (Walgreens Co) nullWal-Profen 200mg Caplet package photo

Ibuprofen Oral tablet

Wal-Profen 200mg Caplet (00363-0292) (Walgreens Co) null

Ibuprofen Oral tablet

Wal-Profen 200mg Tablet (11917-0043) (Walgreens Co) nullWal-Profen 200mg Tablet package photo

Ibuprofen Oral tablet

Wal-Profen 200mg Tablet (00363-0291) (Walgreens Co) null

Ibuprofen Oral tablet

IBU 400mg Tablet (67877-0119) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

IBU 400mg Tablet (49884-0467) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

IBU 400mg Tablet (49884-0777) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (11788-0008) (AiPing Pharmaceiticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (65162-0568) (Akyma Pharmaceuticals, a subsidiary of Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (62584-0746) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (68084-0658) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (60687-0446) (American Health Packaging) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (53746-0131) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (53746-0464) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (65162-0568) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (65162-1101) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (69238-1101) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (65162-0464) (Amneal Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (67877-0119) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (67877-0119) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (67877-0294) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (67877-0319) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (59651-0360) (Aurobindo Pharma Limited) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (42291-0337) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (42291-0440) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (42582-0111) (Bi-Coastal Pharmaceutical Corp.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (10544-0625) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (10544-0030) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (10544-0213) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (10544-0201) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (51991-0720) (Breckenridge Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (53403-0537) (BV Pharbita) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (55111-0101) (Dr. Reddy's Laboratories, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (55111-0682) (Dr. Reddy's Laboratories, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (60429-0219) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (51407-0369) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (59762-7378) (Greenstone Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00839-7112) (HL Moore Drug Exchange) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (61808-0230) (Imiren Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (50742-0157) (Ingenus Pharmaceuticals, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (53746-0131) (Interpharm Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (68645-0220) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (68645-0474) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (68645-0529) (Legacy Pharmaceutical Packaging, LLC) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (68645-0561) (Legacy Pharmaceutical Packaging, LLC) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00904-1748) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00904-5185) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00904-5853) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00904-5853) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (63739-0672) (McKesson Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (63739-0135) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (63739-0442) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (58657-0680) (Method Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (51079-0281) (Mylan Institutional LLC ) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00378-0401) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00378-1401) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (66267-0116) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00603-4018) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (49884-0162) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00603-4021) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (55289-0590) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (43063-0308) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (55289-0590) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (43063-0843) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (43063-0872) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (43063-0872) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (72789-0185) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (45802-0184) (Perrigo Pharmaceuticals Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (10768-7373) (Perrigo Rx) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (52605-0121) (Polygen Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (17236-0568) (R&S Northeast, LLC, formerly Dixon-Shane Drug Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00781-1352) (Sandoz, Inc. a Novartis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00364-0765) (Schein Pharmaceutical Inc, an Actavis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (42543-0966) (Strides Pharma, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (64380-0809) (Strides Pharma., Inc.) null

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00677-1031) (Sun Pharmaceutical Industries, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00182-1809) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00172-4018) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (50111-0387) (Teva Pharmacueticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00591-4010) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00591-3464) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (00591-3663) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 400mg Tablet (49483-0602) (Time Cap Laboratories Inc) null

Ibuprofen Oral tablet

Ibu-Tab 400mg Tablet (51641-0214) (Alra Laboratories Inc) (off market)

Ibuprofen Oral tablet

Motrin 400mg Tablet (00009-7385) (Pfizer Inc.) (off market)

Ibuprofen Oral tablet

Ibren 600mg Tablet (38130-0053) (Emrex Economed Pharmaceuticals Inc) null

Ibuprofen Oral tablet

IBU 600mg Tablet (67877-0120) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

IBU 600mg Tablet (49884-0468) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

IBU 600mg Tablet (49884-0778) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (11788-0009) (AiPing Pharmaceiticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (65162-0569) (Akyma Pharmaceuticals, a subsidiary of Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (62584-0747) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (68084-0703) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (60687-0457) (American Health Packaging) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (53746-0132) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (53746-0465) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (65162-0569) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (65162-1102) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (69238-1102) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (65162-0465) (Amneal Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (67877-0120) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (67877-0120) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (67877-0295) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (67877-0320) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (59651-0361) (Aurobindo Pharma Limited) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (42291-0338) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (42291-0441) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (42582-0112) (Bi-Coastal Pharmaceutical Corp.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (10544-0014) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (10544-0015) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (10544-0214) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (10544-0430) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (51991-0730) (Breckenridge Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55111-0102) (Dr. Reddy's Laboratories, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55111-0683) (Dr. Reddy's Laboratories, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (60429-0220) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (51407-0370) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (59762-7379) (Greenstone Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (50742-0158) (Ingenus Pharmaceuticals, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (53746-0132) (Interpharm Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (68645-0221) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (68645-0475) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (68645-0530) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (68645-0562) (Legacy Pharmaceutical Packaging, LLC) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00904-5186) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00904-5854) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00904-5854) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (63739-0684) (McKesson Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (63739-0136) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (63739-0443) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (58657-0681) (Method Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55370-0534) (Mova Pharmaceuticals Corp) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (51079-0282) (Mylan Institutional LLC ) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00378-0601) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00378-1601) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (66267-0117) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (66267-0964) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00603-4019) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (49884-0163) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00603-4022) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55289-0142) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (43063-0352) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55289-0412) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (55289-0142) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (43063-0845) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (43063-0867) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (43063-0936) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (72789-0187) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (45802-0427) (Perrigo Pharmaceuticals Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (52605-0122) (Polygen Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (17236-0569) (R&S Northeast, LLC, formerly Dixon-Shane Drug Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (33358-0187) (RxChange Co.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00781-1362) (Sandoz, Inc. a Novartis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00364-0766) (Schein Pharmaceutical Inc, an Actavis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (42543-0965) (Strides Pharma, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (64380-0808) (Strides Pharma., Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00677-1032) (Sun Pharmaceutical Industries, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00172-3646) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00182-1810) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (50111-0388) (Teva Pharmacueticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00591-4011) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00591-3465) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (00591-3664) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 600mg Tablet (49483-0603) (Time Cap Laboratories Inc) null

Ibuprofen Oral tablet

Ibu-Tab 600mg Tablet (51641-0213) (Alra Laboratories Inc) (off market)

Ibuprofen Oral tablet

Motrin 600mg Tablet (00009-7386) (Pfizer Inc.) (off market)

Ibuprofen Oral tablet

IBU 800mg Tablet (67877-0121) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

IBU 800mg Tablet (49884-0469) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

IBU 800mg Tablet (49884-0779) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

IBU 800mg Tablet (55289-0140) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (11788-0010) (AiPing Pharmaceiticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (65162-0570) (Akyma Pharmaceuticals, a subsidiary of Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00047-0914) (Allergan USA, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (62584-0748) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (68084-0772) (American Health Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (60687-0468) (American Health Packaging) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (53746-0137) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (53746-0466) (Amneal Pharmaceuticals) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (65162-1103) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (69238-1103) (Amneal Pharmaceuticals LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (65162-0466) (Amneal Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (67877-0121) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (67877-0121) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (67877-0296) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (67877-0321) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (67877-0321) (Ascend Laboratories, LLC a Subsidiary of Alkem Laboratories Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (59651-0362) (Aurobindo Pharma Limited) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (42291-0339) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (42291-0428) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (42291-0442) (AvKARE, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (42582-0113) (Bi-Coastal Pharmaceutical Corp.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (10544-0071) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (10544-0024) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (10544-0431) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (10544-0613) (Blenheim Pharmacal, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (51991-0740) (Breckenridge Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55111-0103) (Dr. Reddy's Laboratories, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55111-0684) (Dr. Reddy's Laboratories, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (60429-0221) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (51407-0371) (Golden State Medical Supply, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (59762-7380) (Greenstone Ltd) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (61808-0130) (Imiren Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (50742-0159) (Ingenus Pharmaceuticals, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (53746-0137) (Interpharm Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (68645-0222) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (68645-0476) (Legacy Pharmaceutical Packaging, LLC) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (68645-0531) (Legacy Pharmaceutical Packaging, LLC) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (68645-0563) (Legacy Pharmaceutical Packaging, LLC) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00904-5187) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00904-5855) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00904-5855) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (63739-0691) (McKesson Packaging) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (63739-0137) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (63739-0444) (McKesson Packaging Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (58657-0682) (Method Pharmaceuticals) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55370-0535) (Mova Pharmaceuticals Corp) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (51079-0596) (Mylan Institutional LLC ) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00378-0801) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00378-1801) (Mylan Pharmaceuticals Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (66267-0118) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (66267-0963) (NuCare Pharmaceuticals Inc) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00603-4020) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (49884-0216) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00603-4023) (Par Pharmaceuticals, an Endo Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55289-0140) (PD-Rx Pharmaceuticals, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (43063-0013) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55289-0140) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (43063-0847) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (43063-0858) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (43063-0914) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (43063-0858) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (55289-0140) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (72789-0186) (PD-Rx Pharmaceuticals, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (52605-0123) (Polygen Pharmaceuticals LLC) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (17236-0570) (R&S Northeast, LLC, formerly Dixon-Shane Drug Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (33358-0188) (RxChange Co.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00781-1363) (Sandoz, Inc. a Novartis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00364-2137) (Schein Pharmaceutical Inc, an Actavis Company) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (42543-0964) (Strides Pharma, Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (64380-0807) (Strides Pharma., Inc.) null

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00677-1119) (Sun Pharmaceutical Industries, Inc.) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00182-1297) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00172-3648) (Teva Pharmaceuticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (50111-0451) (Teva Pharmacueticals USA) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00591-2137) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00591-3466) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (00591-3665) (Teva/Actavis US) (off market)

Ibuprofen Oral tablet

Ibuprofen 800mg Tablet (49483-0604) (Time Cap Laboratories Inc) null

Ibuprofen Oral tablet

Ibu-Tab 800mg Tablet (51641-0212) (Alra Laboratories Inc) (off market)

Ibuprofen Oral tablet

Motrin 800mg Tablet (00009-7387) (Pfizer Inc.) (off market)

Ibuprofen Oral tablet

Samson-8 800mg Tablet (61406-0374) (Ultras Pharmaceuticals Inc) null

Ibuprofen Solution for injection

Caldolor 400mg/4ml Solution for Injection (66220-0247) (Cumberland Pharmaceuticals) (off market)

Ibuprofen Solution for injection

Caldolor 800mg/8mL Solution for Injection (66220-0287) (Cumberland Pharmaceuticals) null

Ibuprofen Topical powder

EnovaRX - Ibuprofen 10% in Microderm External Cream Compounding Kit (76420-0980) (Enovachem Manufacturing) null

Ibuprofen Topical powder

EnovaRX - Ibuprofen 10% in Microderm External Cream Compounding Kit (76420-0981) (Enovachem Manufacturing) null

Description/Classification

Description

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) of the propionic acid chemical class. Ibuprofen is a racemic mixture of 2 isomers; however, only the l-isomer of ibuprofen has been shown to have clinical activity. Although d-isomer is considered inactive, it is slowly and incompletely converted to the l-isomer in adults and probably children and may serve as a circulating reservoir for the active drug. All NSAIDs carry an increased risk of serious gastrointestinal adverse effects including bleeding, ulceration, and perforation of the stomach or intestines and may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke. FDA approved labeling of both the OTC and prescription products stress dosing at the lowest effective ibuprofen dose for the shortest possible duration, as the risk for adverse effects may increase with increased use. A retrospective review by FDA Advisory Committees of short-term efficacy trials of a related non-prescription strength NSAID indicated that an increase in CV events was not apparent during the studies. However, it is important to note that CV risk was not the focus of the studies, and further information is needed to determine if a cause and effect relationship exists between non-prescription strength NSAID use and adverse cardiovascular outcomes. Specific populations are at an increased risk of NSAID-induced adverse events. The American Geriatrics Society recommends that NSAIDs (nonselective and COX-2 inhibitors) not be used to treat persistent pain in elderly patients except rarely, then only in patients who have failed other therapies and have a favorable benefits vs risks assessment; extreme caution, continued therapy evaluation, and concurrent PPI or misoprostol is advised with ibuprofen use in this population. Ibuprofen is indicated for the treatment of rheumatoid arthritis, osteoarthritis, and dysmenorrhea. It also is used for its antipyretic effects and for the alleviation of mild to moderate pain. In addition, clinical studies have demonstrated its effectiveness in the treatment of ankylosing spondylitis, gout, and psoriatic arthritis. Topical use has been studied in minor muscle pain treatment. See separate ibuprofen lysine monograph for discussion of NeoProfen, the intravenous formulation indicated to close a clinically significant patent ductus arteriosus in premature infants. Oral ibuprofen was approved by the FDA in 1974. In June 2009, the FDA approved an injectable ibuprofen (Caldolor) for pain and fever in hospitalized adults who are unable to take oral medications; in November 2015, intravenous use was approved in pediatric patients as young as 6 months.

Classifications

  • Compounding Agents and Supplies
    • Compounding Kits Miscellaneous
  • Musculo-Skeletal System
    • Antiinflammatory Agents and Antirheumatic Agents
      • Antiinflammatory and Antirheumatic Agents
        • Nonsteroidal Antiinflammatory Drugs/NSAIDs
Revision Date: 11/25/2015, 09:49:30 PM

References

Administration Information

General Administration Information

For storage information, see the specific product information within the How Supplied section.

Route-Specific Administration

Oral Administration

  • Administer orally with milk or food to minimize GI irritation.

Oral Liquid Formulations

  • Suspension: Shake well prior to use. Administer using an oral calibrated measuring device to ensure accurate dosing.

Injectable Administration

  • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. If visibly opaque particles, discolorations, or other foreign material are observed, the solution should not be used.
  • The patient must be well hydrated prior to administration to reduce the risk of renal adverse events.
  • Avoid administration of more than one NSAID at a time.[35893]

Intravenous Administration

  • This product MUST be diluted prior to administration.
  • Dilute to a final concentration of 4 mg/mL or less in compatible diluent (0.9% Sodium Chloride injection, Lactated Ringer's injection, or Dextrose 5% injection).
    • 100 mg dose: Dilute 1 mL ibuprofen in at least 100 mL diluent.
    • 200 mg dose: Dilute 2 mL ibuprofen in at least 100 mL diluent.
    • 400 mg dose: Dilute 4 mL ibuprofen in at least 100 mL diluent.
    • 800 mg dose: Dilute 8 mL ibuprofen in at least 200 mL diluent.
    • For pediatric weight-based dosing: ensure final concentration is 4 mg/mL or less.
  • Adult infusion time must be at least 30 minutes. Pediatric infusion time must be at least 10 minutes.
  • Storage: Diluted solutions are stable for 24 hours at ambient temperature (approximately 20 to 25 degrees C) and room lighting.[35893]

Clinical Pharmaceutics Information

From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database

Ibuprofen arginine

pH Range
pH near 7.4.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
Stability
Intact containers of ibuprofen injection concentrate stored as directed by the manufacturer are stable until the labeled expiration date. Infusion Solutions: Ibuprofen injection diluted to 4 mg/mL or less in dextrose 5%, sodium chloride 0.9%, or lactated Ringers' injection is stable for 24 hours at room temperature exposed to room light.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
Light Exposure
The manufacturer states that ibuprofen injection after dilution to 4 mg/mL or less at room temperature exposed to room light is stable for 24 hours.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
Stability Max
Maximum reported stability periods: In D5W- 24 hours at room temperature. In NS- 24 hours at room temperature. In LR- 24 hours at room temperature.
ReferencesAnon. Manufacturer's information and labeling. (Package insert).
Revision Date: 12/03/2015, 09:27:07 AMCopyright 2004-2021 by Lawrence A. Trissel. All Rights Reserved.

References

35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.

Adverse Reactions

Mild

  • abdominal pain
  • alopecia
  • anorexia
  • anxiety
  • asthenia
  • cough
  • diaphoresis
  • diarrhea
  • diplopia
  • dizziness
  • drowsiness
  • dyspepsia
  • ecchymosis
  • emotional lability
  • epistaxis
  • eructation
  • fever
  • flatulence
  • gynecomastia
  • headache
  • infection
  • injection site reaction
  • insomnia
  • maculopapular rash
  • malaise
  • menorrhagia
  • nausea
  • paresthesias
  • photosensitivity
  • polyuria
  • pruritus
  • purpura
  • pyrosis (heartburn)
  • rash
  • rhinitis
  • syncope
  • tinnitus
  • tremor
  • urticaria
  • vertigo
  • vomiting
  • weight gain
  • weight loss
  • xerophthalmia
  • xerostomia

Moderate

  • amblyopia
  • anemia
  • blurred vision
  • bullous rash
  • cataracts
  • chest pain (unspecified)
  • confusion
  • conjunctivitis
  • constipation
  • cystitis
  • depression
  • dysphagia
  • dyspnea
  • dysuria
  • edema
  • elevated hepatic enzymes
  • eosinophilia
  • esophagitis
  • fluid retention
  • gastritis
  • glossitis
  • hallucinations
  • hematuria
  • hepatitis
  • hyperglycemia
  • hypernatremia
  • hypertension
  • hyperuricemia
  • hypoglycemia
  • hypokalemia
  • hyponatremia
  • hypotension
  • infertility
  • jaundice
  • leukopenia
  • lymphadenopathy
  • melena
  • metabolic acidosis
  • neutropenia
  • palpitations
  • peripheral edema
  • photophobia
  • platelet dysfunction
  • prolonged bleeding time
  • pseudotumor cerebri
  • respiratory depression
  • scotomata
  • sinus tachycardia
  • stomatitis
  • thrombocytopenia
  • thrombocytosis
  • urinary retention
  • wheezing
  • withdrawal

Severe

  • agranulocytosis
  • anaphylactoid reactions
  • angioedema
  • aplastic anemia
  • apnea
  • arrhythmia exacerbation
  • aseptic meningitis
  • azotemia
  • bradycardia
  • bronchospasm
  • coma
  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  • erythema multiforme
  • esophageal stricture
  • esophageal ulceration
  • exfoliative dermatitis
  • GI bleeding
  • GI perforation
  • glomerulonephritis
  • hearing loss
  • heart failure
  • hematemesis
  • hemolytic anemia
  • hepatic failure
  • hepatic necrosis
  • hyperkalemia
  • interstitial nephritis
  • lupus-like symptoms
  • myocardial infarction
  • nephrotic syndrome
  • odynophagia
  • oliguria
  • optic neuritis
  • pancreatitis
  • pancytopenia
  • peptic ulcer
  • proteinuria
  • renal failure (unspecified)
  • renal papillary necrosis
  • renal tubular necrosis
  • seizures
  • serum sickness
  • Stevens-Johnson syndrome
  • stroke
  • thromboembolism
  • toxic epidermal necrolysis
  • vasculitis
  • visual impairment

The most frequent type of adverse reaction reported with orally administered ibuprofen is gastrointestinal (GI). In controlled trials, the overall incidence of GI adverse reactions associated with oral ibuprofen was about half that seen in aspirin- or indomethacin-treated patients. Severe GI effects occur in patients taking ibuprofen with a frequency of less than 1% and include peptic ulcer (gastric or duodenal ulcer with GI bleeding and/or GI perforation), gastrointestinal hemorrhage, and melena. Inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine can be fatal and may occur at any time, with or without warning symptoms. Only 20% of patients who develop a serious upper GI event is symptomatic. The risk of severe GI events is increased by the presence of the following factors: history of peptic ulcer disease or GI bleed, smoking, alcohol usage, concomitant usage of anticoagulants, or oral corticosteroids, older age, poor general health status, and NSAID duration of use. Upper GI ulcers, gross bleeding, or perforation occur in approximately 1% of patients treated for 3 to 6 months, and in about 2 to 4% of patients treated for one year. Gastrointestinal bleeding or erosive gastritis can be minor or life-threatening and may result from a combination of direct irritant action on the stomach mucosa and an increased bleeding time, due to changes in platelet aggregation. Older patients appear to be greater affected by GI ulceration or bleeding; most fatal GI events occur in older or debilitated patients. Occult GI bleeding occurs in many patients and is not necessarily correlated with GI distress. Although the amount of blood lost is usually not significant, patients may become anemic as a result of iron deficiency. Patients on prolonged therapy should undergo regular blood monitoring. Nausea, vomiting, dyspepsia, and flatulence have been reported in 1 to 10% of patients receiving oral ibuprofen and in patients treated with intravenous ibuprofen for post-operative pain at similar rates to those receiving placebo. In pediatric intravenous ibuprofen trials, nausea and vomiting were among the most common adverse events, occurring at an incidence > 2%.[35893] Other adverse GI effects reported in 1 to 10% of patients receiving oral ibuprofen include abdominal pain, bloating, constipation, diarrhea, epigastric pain, and pyrosis (heartburn). Abdominal distress, indigestion, decreased appetite, and abdominal cramps were reported in > 1% and < 3% of ibuprofen-treated patients. Xerostomia and gingival ulcer were reported with ibuprofen in < 1% of patients. Duodenitis, glossitis, hematemesis, eructation, hepatorenal syndrome, appetite changes, and rectal bleeding may also occur. Use the lowest effective dose of ibuprofen for the shortest possible duration. Discontinue ibuprofen if a serious GI adverse event is suspected.[44120] [44121]

Rare cases of esophagitis have been reported in patients receiving ibuprofen tablets.[44121] Ibuprofen-induced esophagitis is characterized by sudden onset odynophagia, pyrosis (heartburn), retrosternal pain, and dysphagia. Severe complications such as esophageal ulceration, esophageal stricture, bleeding, and perforation have been reported rarely. Risk factors for ibuprofen-induced esophageal effects include taking the medication without water and at night. Symptoms usually resolve within days to weeks after stopping the medication.

Pancreatitis has been reported in < 1% of patients receiving oral ibuprofen.[44120] [44121]

Amblyopia, xerophthalmia, and altered vision (blurred vision, visual impairment, scotomata, and changes in color vision) have been reported with a probable causal relationship in < 1% of patients receiving oral ibuprofen. If a patient develops visual changes, ibuprofen should be discontinued and an ophthalmologic examination with central visual fields and color vision testing should be performed. Vision generally improves when the drug is discontinued. The mechanism for visual disturbances is unclear. Conjunctivitis, diplopia, optic neuritis and cataracts have been reported in < 1% of patients taking ibuprofen; however, a causal relationship is unknown. Tinnitus has been reported in 1—10% and hearing loss in < 1% of ibuprofen-treated patients.[44120] [44121] A prospective analysis examining the association between analgesic use and the risk of hearing loss was conducted in 62,261 women 31—48 years of age at study enrollment who were originally enrolled in the Nurses' Health Study II. Self-reported hearing loss and analgesic use (including acetaminophen, aspirin, and NSAIDs) were examined over 14 years. During 764,247 person-years of follow-up, 10,012 cases of hearing loss were reported. After adjustment for confounders, ibuprofen use >= 2 days per week was independently associated with an increased risk of hearing loss, with the relative risk of hearing loss increasing with increasing frequency of use. Ibuprofen use 2—3, 4—5, or >= 6 days per week was associated with relative risks of 1.13 (95% CI 1.06—1.19), 1.21 (95% CI 1.11—1.32), and 1.24 (95% CI 1.14—1.35), respectively, with a p trend of < 0.0001. Of note, those with more frequent use of ibuprofen were older, had higher body mass indices, were more likely to be past or current smokers, have hypertension, or have diabetes.[53720] In a similar study of male patients, the association between professionally diagnosed hearing loss and analgesic use (including acetaminophen, aspirin, and NSAIDs) was prospectively analyzed in 26,917 patients 40—74 years at study enrollment over 18 years. During 369,079 person-years of follow-up, 3488 cases of hearing loss were reported. After adjustment for confounders, the hazard ratio (HR) for NSAID (e.g., ibuprofen) associated hearing loss was 1.21 (95% CI 1.11—1.33, p = 0.1) in patients who were regular users of the drug (>= 2 times weekly) compared to those with less use. Men who regularly used NSAIDs for >= 4 years were 33% (18—49%) more likely to develop hearing loss than those with shorter use. Regular users < 50 years of age were 61% more likely to develop hearing loss compared to non-regular users; regular users 50—59 years had a 32% higher risk of hearing loss, and regular users >= 60 years had a 16% higher risk.[53719] These studies do suggest association; however, data are based on patient reporting of the outcomes. Information regarding noise exposure and analgesic doses was not provided.[53719] [53720] Ibuprofen or NSAID related ototoxicity may result from several mechanisms, including reduced cochlear blood flow, impairment of outer hair cell function, or inhibition of prostaglandin forming cyclooxygenase.[53720] As a true long-term association may exist, counsel patients to minimize long-term treatment with ibuprofen as much as possible.

Ibuprofen has been associated with acute renal failure (unspecified) in patients with pre-existing significantly impaired renal function, decreased creatinine clearance, polyuria, azotemia, cystitis, and hematuria in less than 1% of patients. Abnormal renal function is among the most frequently reported adverse events with ibuprofen or other NSAIDs, occurring in approximately 1% to 10% of patients. It is well known that vasodilatory renal prostaglandins and the potent vasoconstrictor angiotensin II work in concert to maintain renal blood flow. Inhibition of renal prostaglandins by NSAIDs can cause renal insufficiency. This problem can manifest as hyperkalemia, hyperuricemia, or azotemia. Hyperkalemia and other increases in serum potassium concentrations have been reported in patients without renal impairment taking NSAIDs, likely due to a hyporeninemic-hypoaldosteronism state.[35893] Renal papillary necrosis has been reported in less than 1% of ibuprofen-treated patients, and has been associated with long-term administration of NSAIDs. With some NSAIDS, nephrotic syndrome, proteinuria, and interstitial nephritis have been reported. Dysuria, oliguria, glomerulonephritis, and renal tubular necrosis have also been reported with the use of ibuprofen. Inhibition of prostaglandin synthesis by NSAIDs potentiates water reabsorption. Fluid retention and edema (peripheral edema) have been reported in 1% to 10% of patients receiving ibuprofen.[44120] [44121] Urinary retention (3% to 5%) and increased blood urea (10%) have been reported during adult IV ibuprofen clinical trials.[35893] Hyponatremia due to water intoxication has been reported with NSAID use.[33608] [33609] [33610] Monitoring of the patient's fluid status and serum creatinine and blood urea nitrogen concentrations is recommended.

Like all NSAIDs, ibuprofen-induced increases in water retention and decreases in renal perfusion may exacerbate pre-existing cardiovascular complications, including hypertension (less than 1%) and congestive heart failure (specifically in patients with marginal cardiac function, less than 1%).[44120] [44121] Further, NSAIDs may increase the risk of serious cardiovascular thromboembolism, myocardial infarction, and stroke, which can be fatal. Estimates of increased relative risk range from 10% to 50% or more, based on the drug and dose studied. The risk may increase with increased exposure, as measured in dose or duration. Significant cardiovascular risk has been observed within days to weeks of NSAID initiation. The relative increase in cardiovascular thrombotic events over baseline appears to be similar in patients with or without cardiovascular disease or risk factors for cardiovascular disease; however, patients with known cardiovascular disease or risk factors may be at greater risk because of a higher baseline risk of events.[59937] In observational studies, data demonstrated that patients treated with NSAIDs in the post-MI period were at increased risk of reinfarction, CV-related death, and all-cause mortality; the incidence of death in the first year post-MI in NSAID-treated patients was 20 per 100 person years compared to 12 per 100 person years in non-NSAID exposed patients. An increased relative risk of death in NSAID users was observed across 4 years of follow-up. A meta-analysis of randomized, controlled trials demonstrated an approximate 2-fold increase in hospitalizations for heart failure among nonselective- and COX-2 selective NSAID-treated patients compared to placebo.[35893] Other cardiovascular events reported in ibuprofen-treated patients include: palpitations (less than 1%; probable causal relationship), arrhythmia exacerbation (less than 1%), sinus tachycardia (less than 1%), sinus bradycardia (less than 1%), syncope, hypotension, and vasculitis. Some patients have experienced chest pain (unspecified) during postmarketing use of ibuprofen. Inform patients of the signs and symptoms of CV events, and advise them to seek medical help immediately if such signs or symptoms occur.[44120] [44121] [44130]

Borderline elevated hepatic enzymes have been reported in up to 15% of patients receiving NSAID therapy; elevated hepatic enzymes have been reported in <= 10% of ibuprofen-treated patients. These abnormalities may persist, progress, or be transient. One percent of patients in clinical trials with NSAIDs had elevations of ALT or AST greater than or equal to 3 times normal values. Rarely, NSAIDs have been associated with hepatotoxicity including jaundice (< 1%), hepatitis (< 1%), hepatic necrosis, and hepatic failure. Ongoing monitoring is recommended in patients who develop signs or symptoms of liver dysfunction and/or with abnormal LFTs. Discontinue ibuprofen in patients with evidence of new onset liver disease.[44120][44121]

Ibuprofen has been shown to cause platelet dysfunction; however, this effect is transient and reversible. Prolonged bleeding time is among the most frequently reported adverse events that occur with ibuprofen or other NSAIDs (1% to 10%). The incidence of neutropenia is less than 1% for oral therapy and 7% to 13% for parenteral therapy. Anemia has been reported in 1% to 10% of patients treated with oral ibuprofen or other NSAIDs, and in 17% to 20% of adult patients and more than 2% of pediatric patients treated with parenteral ibuprofen. Other hematologic effects (less than 1%) due to oral ibuprofen include agranulocytosis, aplastic anemia, hemolytic anemia (sometimes Coombs positive), thrombocytopenia with or without purpura, eosinophilia, decreases in hemoglobin and hematocrit, and bleeding episodes including epistaxis and menorrhagia. Ecchymosis, leukopenia, purpura, stomatitis, lymphadenopathy, and pancytopenia have been reported with oral ibuprofen. Patients taking parenteral ibuprofen also experienced hypoalbuminemia (3% to 10% ibuprofen vs. 4% placebo) and thrombocythemia/thrombocytosis (3% to 10%).[35893] [44120] [44121]

Pruritus has been reported in 1—10% of patients taking oral ibuprofen or other NSAIDs and was cited as the most common cause of drug discontinuation in parenteral ibuprofen clinical trials (< 1%). Rash (unspecified), including maculopapular rash, has been reported in 1—10% of patients taking oral ibuprofen. Of patients taking oral ibuprofen, other dermatologic reactions occur less frequently (< 1%), including bullous rash, urticaria, erythema multiforme, Stevens-Johnson syndrome, alopecia, photosensitivity reactions, vesiculobullous eruptions, toxic epidermal necrolysis, and diaphoresis (no incidence reported). Exfoliative dermatitis, a serious and potentially fatal skin reaction, has been reported with other NSAIDs and may occur with ibuprofen. Patients should be instructed to discontinue the medication and contact their health care provider if erythema, rash, blisters, or related skin reactions develop.[44120] [44121]

Ibuprofen may cause bronchospasm, dyspnea, and wheezing in patients with asthma. The proposed mechanism of nonsteroidal antiinflammatory drug-sensitive asthma is excessive production of cysteinyl leukotrienes. A single exposure could induce lung function deterioration, as the reaction is not thought to be of an allergic hypersensitivity nature. Likewise, subsequent exposures should not result in escalating bronchospasm severity. Other respiratory-related adverse reactions that have been reported rarely include: apnea, respiratory depression, pneumonia, and rhinitis.[44120] [44121] Cough (3% or less) and bacterial pneumonia (3% to 10%) were reported with parenteral ibuprofen-treated patients during adult trials for postoperative pain and fever, respectively.[35893]

Dizziness, headache, and nervousness have been reported in 1 to 10% of patients taking ibuprofen or other NSAIDs [44120] [44121]; patients receiving parenteral ibuprofen in clinical trials experienced dizziness and headache. In pediatric intravenous ibuprofen trials, headache was among the most common adverse events, occurring at an incidence > 2%.[35893] Overuse of drugs for treating acute migraines, including ibuprofen, may lead to headache exacerbation (medication overuse headache). Patients may experience migraine-like daily headaches or a significant increase in migraine attack frequency. Withdrawal of the overused drug and treatment of withdrawal symptoms (e.g., transient worsening of headache) may be necessary. Patients should be informed of the risks of medication overuse (e.g., use of a single agent or a combination of drugs for at least 10 days per month) and encouraged to keep a written record of headache frequency and drug use.[57799]

Aseptic meningitis has been reported in < 1% of patients taking ibuprofen.[44120] [44121] Ibuprofen has been the most common NSAID implicated in this adverse reaction; however, cases have been reported with sulindac, naproxen, tolmetin, diclofenac, ketoprofen, rofecoxib, and piroxicam. No cases of aseptic meningitis were reported among patients receiving intravenous ibuprofen in clinical trials. Aseptic meningitis from one NSAID does not preclude use of another NSAID; most patients can be treated with another drug without incident. However, one patient with Sjogren's syndrome experienced aseptic meningitis after receipt of naproxen, ibuprofen, and rofecoxib at different times; aseptic meningitis developed about a week after each drug exposure, and the symptoms abated roughly 2 days following each drug cessation.[27710] The occurrence of aseptic meningitis is not related to NSAID chemical class or prostaglandin inhibition. A Type III or IV immunological hypersensitivity reaction is the proposed mechanism of action. Drug-induced aseptic meningitis usually occurs shortly after drug initiation but can occur after years of drug usage. Although NSAID-induced aseptic meningitis is primarily reported in patients with systemic lupus erythematosus (SLE), healthy patients and patients with other disease states such as ankylosing spondylitis, connective tissue disease, osteoarthritis, and rheumatoid arthritis have developed NSAID-induced aseptic meningitis. Symptoms of aseptic meningitis include feeling confused, somnolence, general feeling of illness, severe headache, nausea, nuchal rigidity, and photophobia. As aseptic meningitis is a diagnosis of exclusion, the suspected drug should be discontinued and not restarted unless a rechallenge is desired.

Oral ibuprofen has been associated infrequently (< 1%; without causal relationship) with the development of pseudotumor cerebri (benign intracranial hypertension).[44120]

CNS-related adverse reactions with a probable causal relationship reported in < 1% of ibuprofen-treated patients include: depression, insomnia, confusion, emotional lability, and drowsiness. Those reactions reported in < 1% of patients where the causal relationship to ibuprofen has not been established include: paresthesias, hallucinations, and dream abnormalities. Other CNS-related adverse reactions that have been reported occasionally or rarely include anxiety, asthenia, malaise, tremor, vertigo, seizures and coma.[44120][44121]

Fever, infection, and sepsis have been reported in patients receiving ibuprofen.[44121]

Allergic reactions with a probable causal relationship to ibuprofen that include a syndrome of abdominal pain, fever, chills, nausea, vomiting, anaphylaxis (anaphylactoid reactions), and bronchospasm have been reported in less than 1% of patients. Other allergic reactions without an established causal relationship to ibuprofen reported in less than 1% of patients include serum sickness, lupus erythematosus syndrome (lupus-like symptoms), Henoch-Schonlein vasculitis, and angioedema.[44120] [44121]

Decreased appetite (anorexia) has been reported in 1% to 3% of patients taking ibuprofen during clinical trials. Gynecomastia, hypoglycemia, and metabolic acidosis have been reported with ibuprofen in less than 1% of patients, although a causal relationship has not been established. Weight changes (weight gain, weight loss) and hyperglycemia have also been reported.[44120] [44121] Metabolic abnormalities including hypokalemia (19% or less), hypoproteinemia (10% to 13%), and hypernatremia (7% to 10%) were reported during adult clinical trials for parenteral ibuprofen.[35893]

In pediatric intravenous ibuprofen trials, infusion site pain (injection site reaction) was among the most common adverse events, occurring at an incidence > 2%.[35893]

NSAIDs, such as ibuprofen, may delay or prevent prostaglandin-mediated rupture of ovarian follicles, which has been associated with reversible infertility. Small studies of women treated with NSAIDs demonstrated a reversible delay in ovulation. Consider withdrawal of NSAIDs in women who have difficulties conceiving or who are undergoing infertility evaluation.[35893]

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), a multi-organ hypersensitivity reaction, has occurred with NSAIDs. Some of these events have been life-threatening or fatal. DRESS typically presents as fever, rash, and/or lymphadenopathy in conjunction with other organ system involvement including hepatitis, nephritis, hematologic abnormalities, myocarditis, or myositis sometimes resembling an acute viral infection. Eosinophilia is often present. Early manifestations such as fever and lymphadenopathy may be present without evidence of a rash. Discontinue the NSAID in patients presenting with such signs and symptoms in whom an alternative etiology cannot be identified.[35893]

Revision Date: 05/11/2021, 12:14:27 PM

References

27710 - Ashwath ML, Katner HP. Recurrent aseptic meningitis due to different non-steroidal anti-inflammatory drugs including rofecoxib. Postgrad Med J 2003;79:295-6.33608 - Rault RM. Case report: hyponatremia associated with nonsteroidal anti-inflammatory drugs. Am J Med Sci 1993;305:318-20.33609 - Petersson I, Nilsson G, Hansson BG, et al. Water intoxication associated with non-steroidal anti-inflammatory drug therapy. Acta Med Scand 1987;221:221-3.33610 - Blum M, Aviram A. Ibuprofen induced hyponatraemia. Rheumatol Rehabil 1980;19:258-9.35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.44120 - IBU (ibuprofen) tablets package insert. Shreveport, LA: Dr. Reddy's Laboratories, Inc.; 2016 Jul.44121 - Ibuprofen oral suspension package insert. Allegan, MI: Perrigo New York Inc; 2017 Apr.44130 - Duexis (ibuprofen and famotidine) tablets package insert. Deerfield, IL: Horizon Medicines, LLC.; 2021 Apr.53719 - Curhan SG, Eavey R, Shargorodsky J, et al. Analgesic use and the risk of hearing loss in men. Am J Med 2010;123:231-237.53720 - Curhan SG, Shargorodsky J, Eavey R, et al. Analgesic use and the risk of hearing loss in women. Am J Epidemiol 2012;176:544-554.57799 - American Headache Society. Silberstein SD. Medication Overuse Headache. Retrieved from the World Wide Web August 19, 2014. http://www.americanheadachesociety.org/assets/1/7/Stephen_Silberstein_-_Medication_Overuse_Headache.pdf59937 - US Food and Drug Administration (FDA). Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDS): Drug Safety Communication - association with heart attacks or strokes. Retrieved July 9, 2015. Available on the World Wide Web at: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM453941.pdf

Contraindications/Precautions

Absolute contraindications are italicized.

  • coronary artery bypass graft surgery (CABG)
  • NSAID hypersensitivity
  • salicylate hypersensitivity
  • acute bronchospasm
  • acute myocardial infarction
  • alcoholism
  • angina
  • anticoagulant therapy
  • asthma
  • bone marrow suppression
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cardiomyopathy
  • cerebrovascular disease
  • chemotherapy
  • coagulopathy
  • coronary artery disease
  • corticosteroid therapy
  • Crohn's disease
  • dehydration
  • diabetes mellitus
  • edema
  • geriatric
  • GI bleeding
  • GI disease
  • GI perforation
  • heart failure
  • hematological disease
  • hemophilia
  • hepatic disease
  • hypertension
  • hypovolemia
  • immunosuppression
  • infertility
  • myocardial infarction
  • nasal polyps
  • neutropenia
  • peptic ulcer disease
  • peripheral vascular disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • rheumatoid arthritis
  • stroke
  • surgery
  • systemic lupus erythematosus (SLE)
  • tachycardia
  • thrombocytopenia
  • thromboembolism
  • tobacco smoking
  • ulcerative colitis
  • urticaria

Ibuprofen is contraindicated in patients with salicylate hypersensitivity or NSAID hypersensitivity who have experienced asthma, urticaria, or other allergic reactions (e.g., anaphylactic reactions and serious skin reactions) after taking ibuprofen, aspirin, or other NSAIDs. Severe, rarely fatal, anaphylactoid reactions to ibuprofen have been reported. Ibuprofen should not be used in patients with aspirin-sensitive asthma or the aspirin triad because of the approximate 5% cross-sensitivity that occurs between aspirin and NSAIDs. The triad typically occurs in patients with asthma who experience rhinitis with or without nasal polyps, or who experience severe, potentially fatal acute bronchospasm after taking aspirin or other NSAIDs. The use of NSAIDs, including ibuprofen, may cause serious and potentially fatal skin reactions including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Patients should be instructed to discontinue the medication and contact their health care provider if erythema, rash, blisters, or related skin reactions develop.[35893] Cautious use of ibuprofen is recommended in patients with asthma. Of 100 children 6 to 18 years of age with mild or moderate persistent asthma, 2% experienced a drop in forced expiratory volume in 1 second (FEV1) of more than 20% and 4% experienced a FEV1 decrease of greater than 15% within 1 hour of ibuprofen ingestion. None of these children had exposure to ibuprofen prior to the study, and none experienced a decline in lung function after placebo.[31475]

Chronic use of ibuprofen can result in gastritis, ulceration with or without GI perforation, and/or GI bleeding, which can occur at any time, often without preceding symptoms. Serious and fatal GI adverse reactions including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine have been reported in patients receiving NSAIDs. Therefore, use ibuprofen with caution, if at all, in patients with a history of or active GI disease, including peptic ulcer disease or GI bleeding. Use with caution in patients with other factors known to increase GI bleeding risk including: concomitant oral corticosteroid therapy, anticoagulant therapy, antiplatelet drug use (including low-dose aspirin), chemotherapy, longer duration of NSAID therapy, tobacco smoking, alcoholism or use of alcohol, older age, poor general health status, ulcerative colitis, or Crohn's disease. Most spontaneous reports of fatal GI reactions are in elderly or debilitated patients; special care should be taken in treating this population. Consider alternative (non-NSAID) therapy in at-risk patients. Use this medication for the shortest effective duration and inform patients to promptly report signs and symptoms of GI ulcer or bleeding. Use the lowest effective dosage for the shortest possible duration, and avoid use of more than 1 NSAID at a time. If a serious GI adverse event is suspected, promptly begin evaluation and treatment; discontinue ibuprofen until a serious GI event is ruled out. In the setting of low-dose aspirin for cardiac prophylaxis, monitor patients closely for GI bleeding.[35893]

Use ibuprofen with caution in patients with hepatic disease. Severe hepatic reactions have occurred during treatment with ibuprofen, and patients with hepatic impairment are at an increased risk for developing these complications. Ibuprofen elimination may be prolonged in patients with hepatic impairment. Discontinue ibuprofen if elevated hepatic enzymes persist or worsen, or if signs or symptoms of hepatic disease, such as jaundice, develop. In addition, patients with advanced liver disease are at increased risk for GI bleeding.[35893]

Due to the role of prostaglandins in renal function and hemodynamics, patients with renal disease or heart failure should be closely monitored during ibuprofen therapy. Avoid ibuprofen use in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. Congestive heart failure and hypertension can be exacerbated by ibuprofen. A meta-analysis of randomized, controlled trials demonstrated an approximately 2-fold increase in hospitalizations for heart failure among non-selective and COX-2 selective-treated patients compared to placebo.[35893] In patients with hypertension, monitor blood pressure during the initiation of NSAID treatment and throughout therapy. A meta-analysis demonstrated that the effect of NSAIDs on blood pressure is the greatest in hypertensive individuals receiving antihypertensive medication. Normotensive patients receiving antihypertensive therapy had higher increases in blood pressure than subjects with uncontrolled hypertension or normotensive subjects receiving no hypertensive therapy.[27388] Patients with renal impairment, renal failure, hepatic disease, diabetes mellitus, systemic lupus erythematosus, or congestive heart failure, rheumatoid arthritis, edema, extracellular volume depletion (i.e., hypovolemia or dehydration), sepsis; those taking diuretics or nephrotoxic drugs; and older patients are at the highest risk for complications related to suboptimal renal perfusion. Patients must be properly hydrated prior to administration of parenteral ibuprofen to reduce the risk of renal adverse events.[35893]

Ibuprofen is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft surgery (CABG). An increased incidence of myocardial infarction and stroke was found through analysis of data regarding the use of a COX-2 selective NSAID for the treatment of pain in the first 10 to 14 days after CABG surgery. Ibuprofen, like all nonsteroidal anti-inflammatory drugs (NSAIDs), may cause an increased risk of serious cardiovascular thromboembolism, myocardial infarction, and stroke, which can be fatal. The FDA has warned that the risk of myocardial infarction or stroke can occur as early as the first weeks of using a NSAID, and risk may increase with higher doses and longer duration of use. NSAIDs may increase the risk of a cardiovascular thrombotic event in patients with or without underlying heart disease or risk factors for heart disease. Patients with known heart disease or risk factors appear to have a greater likelihood of an event following NSAID use, likely due to a higher baseline risk. Current evidence is insufficient to determine if the risk of an event is higher or lower for any particular NSAID compared to other NSAIDs. There is no consistent evidence that concomitant use of aspirin mitigates the increased risk for cardiovascular thrombotic events.[44130] [59937] Clinical practice guidelines state NSAIDs should not be administered to patients presenting with and hospitalized for ST-elevation myocardial infarction (STEMI) due to increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture associated with their use.[44130] [55688] Observational data from a national registry demonstrated that patients treated with NSAIDs in the post-MI period were at increased risk of reinfarction, cardiovascular-related death, and all-cause mortality beginning the first week of treatment. An increased relative risk of death in NSAID users continued during the follow-up period of 4 years. Data demonstrate that patients treated with NSAIDs were more likely to die in the first year following a myocardial infarction compared to those not treated with NSAIDs.[44130] Caution is recommended when administering ibuprofen to patients with cardiac disease, cardiomyopathy, cardiac arrhythmias (e.g., tachycardia), significant coronary artery disease (including acute myocardial infarction, angina, or history of myocardial infarction), peripheral vascular disease, cerebrovascular disease (e.g., stroke, transient ischemic attack), hypertension, pre-existing renal disease, or fluid retention. Closely monitor blood pressure during ibuprofen receipt. Use the lowest effective dose for the shortest duration possible to minimize the potential risk for an adverse cardiovascular event. Inform patients to seek immediate medical attention if they experience any signs or symptoms of a cardiovascular thrombotic event.[59937]

Ibuprofen should be used cautiously in patients with preexisting hematological disease (e.g., coagulopathy or hemophilia) or thrombocytopenia due to the effect of the drug on platelet function and vascular response to bleeding. Ibuprofen should also be used with caution in patients undergoing surgery when a high degree of hemostasis is required. NSAIDs should be used with caution in patients with immunosuppression or neutropenia. NSAIDs may mask the signs of infection such as fever or pain in patients with bone marrow suppression. Patients with coagulopathy are also at increased risk for GI bleeding.[35893]

If ibuprofen therapy is undertaken in a geriatric patient, use the lowest effective ibuprofen dose for the shortest possible duration; monitor treatment closely. Due to body system frailties, geriatric patients are at an increased risk of NSAID-related adverse events. Chronic use of ibuprofen can result in gastritis, ulceration with or without perforation, and GI bleeding, which can occur at any time, often without preceding symptoms. Patients of advanced age do not tolerate GI ulceration or bleeding well, and most cases of reported fatal GI events occur in this population. Elderly patients are also more prone to complications related to suboptimal renal perfusion and cardiovascular events.[30569] [45740] According to the Beers Criteria, NSAIDs are considered potentially inappropriate medications (PIMs) for use in geriatric patients. NSAIDs may cause new or worsening gastric and duodenal ulcers, and there is an increased risk of GI bleeding and peptic ulcer disease in high-risk groups including those above 75 years of age, or those taking oral or parenteral corticosteroids, anticoagulants, or antiplatelet medications. The risk of ulcers, gross bleeding, or perforation is cumulative with continued use. Avoid the chronic use of NSAIDs in high-risk geriatric patients, unless other alternatives are not effective, and the patient can take a gastroprotective agent. Avoid the use of NSAIDs in patients with a history of gastric or duodenal ulcers, unless other alternatives are not effective and the patient can take a gastroprotective agent. The use of a gastroprotective agent, like a proton pump inhibitor or misoprostol, reduces but does not eliminate, GI risks. NSAIDs can also increase blood pressure and induce kidney injury. Avoid use of NSAIDs in geriatric patients with the following conditions due to the potential for symptom exacerbation or adverse effects: symptomatic heart failure (fluid retention, symptom exacerbation) or chronic kidney disease Stage 4 or higher (CrCl less than 30 mL/minute) (acute kidney injury, further decline of renal function). Use with caution in patients with asymptomatic heart failure.[63923] The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, NSAIDs should be reserved for symptoms and inflammatory conditions for which lower risk analgesics (e.g., acetaminophen) have either failed or are not clinically indicated. NSAIDs may cause GI bleeding in patients with a prior history of, or with increased risk for, GI bleeding. Also, NSAIDs may cause or worsen renal failure, increase blood pressure, or exacerbate heart failure. Some NSAIDs, such as ibuprofen, may reduce the cardioprotective effect of aspirin.[60742]

Avoid ibuprofen use during the third trimester of pregnancy (starting at 30 weeks of gestation) due to the risk of premature closure of the fetal ductus arteriosus and persistent pulmonary hypertension in the neonate.[35893] If NSAID treatment is deemed necessary between 20 to 30 weeks of pregnancy, limit use to the lowest effective dose and shortest duration possible. Consider ultrasound monitoring of amniotic fluid if NSAID treatment extends beyond 48 hours. Discontinue the NSAID if oligohydramnios occurs and follow up according to clinical practice. Use of NSAIDs around 20 weeks gestation or later in pregnancy may cause fetal renal dysfunction leading to oligohydramnios, and in some cases, neonatal renal impairment. These adverse outcomes are seen, on average, after days to weeks of treatment, although oligohydramnios has been infrequently reported as soon as 48 hours after NSAID initiation. Oligohydramnios is often, but not always, reversible with treatment discontinuation. Complications of prolonged oligohydramnios may include limb contractures and delayed lung maturation. In some postmarketing cases of impaired neonatal renal function, invasive procedures such as exchange transfusion or dialysis were required.[66040] Observational data regarding embryofetal risks of NSAID use during the first trimester is inconclusive. There are no adequate and well-controlled studies of ibuprofen in pregnant women.[35893]

NSAIDs, such as ibuprofen, may pose a reproductive risk by delaying or preventing prostaglandin-mediated rupture of ovarian follicles, which has been associated with reversible infertility. Small studies of women treated with NSAIDs demonstrated a reversible delay in ovulation. Consider withdrawal of NSAIDs in women who have difficulties conceiving or who are undergoing infertility evaluation.[35893]

Because exposure to a nursing infant is low, especially after single or intermittent doses, ibuprofen is considered a preferred analgesic/anti-inflammatory for women who are breast-feeding.[60365] After oral administration, ibuprofen is present in breast milk at relative infant doses of 0.06% to 0.6% of the maternal weight-adjusted daily dose. There are no reports of adverse effects on milk production or on the breast-fed infant.[35893] In a study of milk samples from 13 women who took an ibuprofen regimen of approximately 1 g daily, the relative infant dose was less than 0.38% of the mean maternal weight-adjusted dose. The relative infant dose was highest when the milk protein content was highest during the colostral phase.[60362]

Patients with systemic lupus erythematosus (SLE) and related connective tissue diseases may be at increased risk of developing aseptic meningitis with fever and coma during ibuprofen therapy. This condition has been observed on rare occasions in patients on ibuprofen and has been reported in patients who do not have an underlying chronic disease. If signs or symptoms of meningitis develop, consider the possibility that it is related to ibuprofen use.[35893]

Revision Date: 10/15/2020, 06:54:52 PM

References

27388 - Frishman WH. Effects of nonsteroidal anti-inflammatory drug therapy on blood pressure and peripheral edema. Am J Cardiol 2002;89(suppl):18D-25D.30569 - Ibuprofen tablets, USP (Rx-only) package insert. Montvale NJ: Ascend laboratories LLC; 2019 Jan.31475 - Debley JS, Carter ER, Gibson RL, et al. The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled bronchoprovocation challenge study. J Pediatr 2005;147:233-38.35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.44130 - Duexis (ibuprofen and famotidine) tablets package insert. Deerfield, IL: Horizon Medicines, LLC.; 2021 Apr.45740 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals Inc.; 2019 Feb.55688 - O'Gara P, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362-e425.59937 - US Food and Drug Administration (FDA). Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDS): Drug Safety Communication - association with heart attacks or strokes. Retrieved July 9, 2015. Available on the World Wide Web at: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM453941.pdf60362 - Rigourd V, de Villepin B, Amirouche A, et al. Ibuprofen concentrations in human mature milk-first data about pharmacokinetics study in breast milk with AOR-10127 "Antalait" study. Ther Drug Monit 2014;36:590-596.60365 - National Institutes of Health (NIH). Ibuprofen monograph. LactMed: Drugs and Lactation Database. Available at http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~5sALjQ:1 . Accessed December 4, 2015.60742 - Health Care Financing Administration. Interpretive Guidelines for Long-term Care Facilities. Title 42 CFR 483.25(l) F329: Unnecessary Drugs. Revised 2015.63923 - The American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;00:1-21.66040 - Food and Drug Administration MedWatch. Nonsteroidal anti-inflammatory drugs (NSAIDs): Drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later. Available at: https://www.fda.gov/safety/medical-product-safety-information/nonsteroidal-anti-inflammatory-drugs-nsaids-drug-safety-communication-avoid-use-nsaids-pregnancy-20. Accessed October 15, 2020.

Mechanism of Action

Ibuprofen competitively inhibits both cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, by blocking arachidonate binding resulting in analgesic, antipyretic, and anti-inflammatory pharmacologic effects. The enzymes COX-1 and COX-2 catalyze the conversion of arachidonic acid to prostaglandin G2 (PGG2), the first step of the synthesis prostaglandins and thromboxanes that are involved in rapid physiological responses. COX isoenzymes are also responsible for a peroxidase reaction, which is not affected by NSAIDs. In addition, NSAIDs do not suppress leukotriene synthesis by lipoxygenase pathways. COX-1 is constitutively expressed in almost all tissues, while COX-2 appears to only be constitutively expressed in the brain, kidney, bones, reproductive organs, and some neoplasms (e.g., colon and prostate cancers). COX-1 is responsible for prostaglandin synthesis in response to stimulation by circulating hormones, as well as maintenance of normal renal function, gastric mucosal integrity, and hemostasis. However, COX-2 is inducible in many cells in response to certain mediators of inflammation (e.g., interleukin-1, tumor necrosis factor, lipopolysaccharide, mitogens, and reactive oxygen intermediates).

•Anti-inflammatory Activity: The anti-inflammatory mechanism of ibuprofen is due to decreased prostaglandin synthesis via inhibition of COX-1 and COX-2. It appears that the anti-inflammatory effects may be primarily due to inhibition of the COX-2 isoenzyme. However, COX-1 is expressed at some sites of inflammation. COX-1 is expressed in the joints of rheumatoid arthritis or osteoarthritis patients, especially the synovial lining, and it is the primary enzyme of prostaglandin synthesis in human bursitis. Ibuprofen is slightly more selective for COX-1 than COX-2.

•Analgesic Activity: Ibuprofen is effective in cases where inflammation has caused sensitivity of pain receptors (hyperalgesia). It appears prostaglandins, specifically prostaglandins E and F, are responsible for sensitizing the pain receptors; therefore, ibuprofen has an indirect analgesic effect by inhibiting the production of further prostaglandins and does not directly affect hyperalgesia or the pain threshold.

•Antipyretic Activity: Ibuprofen promotes a return to a normal body temperature set point in the hypothalamus by suppressing the synthesis of prostaglandins, specifically PGE2, in circumventricular organs in and near the hypothalamus. Ibuprofen may mask fever in some patients, especially with high or chronic dosing.

•GI Effects: Gastrointestinal side effects of ibuprofen are primarily contributed to COX-1 inhibition; however, potential role of COX-2 inhibition in the GI tract has not been fully elucidated.

•Platelet Effects: The inhibition of platelet aggregation seen with ibuprofen is due to dose-dependent inhibition of COX-1 in platelets leading to decreased levels of platelet thromboxane A2 and an increase in bleeding time (see Adverse Reactions). The inhibition of platelet aggregation is reversible within 24 hours of discontinuation of ibuprofen. This differs from aspirin, which irreversibly binds to COX-1 in platelets inhibiting this enzyme for the life of the cell.

•Renal Effects: In the kidney, prostaglandins, produced by both COX-1 and COX-2, are important regulators of sodium and water reabsorption through PGE2 and of renal function and hemodynamics via PGI2 in response to vasoconstrictive factors (e.g., endothelin-1, a factor that increases peripheral vascular resistance) and through effects on the renin-angiotensin system. In conditions where renal blood flow is dependent upon prostaglandin synthesis, administration of NSAIDs can result in significant decreases in renal blood flow leading to acute renal failure. In addition, alterations in sodium and water reabsorption may worsen in increased blood pressure, which can be significant in selected individuals.

Revision Date: 08/14/2015, 03:08:37 PM

References

Pharmacokinetics

Ibuprofen is administered orally and intravenously. The volume of distribution (either oral or parenterally administered) is dependent on patient age and body temperature. Ibuprofen is highly protein-bound (about 90 to 99%); at serum concentrations more than 20 mcg/mL, protein binding is saturated and becomes nonlinear.[35893]

 

Ibuprofen is a racemate, and, on average, 60% of R-ibuprofen is converted to S-ibuprofen. S-ibuprofen is metabolized via hepatic oxidation by cytochrome P450 (CYP) 2C9 to inactive metabolites. CYP2C9 is polymorphic; CYP2C9(1) is the wild-type, and CYP2C9(2) and CYP2C9(3) are the most common variants. The variant CYP2C9(3) allele decreases enzyme activity to a greater extent than does CYP2C9(2), but clearance of racemic ibuprofen was reduced among all variant genotypes as compared with the wild-type (1/1). Higher S-ibuprofen concentrations led to greater inhibition of COX-1 (reduced thromboxane B2 concentrations) and greater inhibition of COX-2 (reduced prostaglandin E2 concentrations). Importantly, both thromboxane B2 and prostaglandin E2 concentrations were reduced the most among patients with the CYP2C9 genotypes (3/3), (1/3), (2/3), and (2/2).[34462] Plasma half-life of both oral and parenteral forms is between 2 and 4 hours. Ibuprofen is excreted in the urine: 50 to 60% as metabolites and approximately 10% as unchanged drug. Some biliary excretion may occur. Excretion is usually complete within 24 hours of administration.

 

Affected cytochrome P450 isoenzymes: CYP2C9

Route-Specific Pharmacokinetics

Oral Route

The bioavailability of ibuprofen is similar among the different oral dosage forms at approximately 80%, but the time to reach peak concentrations differs and is roughly 120, 62, and 47 minutes after administration of tablets, chewable tablets, or suspension, respectively. Administration of oral products immediately following a meal has a minimal effect on overall bioavailability; however, it decreases the Cmax and delays Tmax.[30569]

 

A linear dose-response is noted for single ibuprofen oral doses up to 800 mg. With single doses up to 10 mg/kg, a dose response relationship exists in febrile children. There is also a correlation between the reduction of fever and drug concentration over time. In children, the antipyretic effect of oral therapy begins within 1 hour and peaks within 2 to 4 hours. The analgesic effect is similarly acute in nature. In treatment for inflammation, a few days to 2 weeks is generally required before a therapeutic response occurs.

Intravenous Route

Intravenous administration more than doubles the Cmax as compared to oral administration in animal study.[35892]

Special Populations

Hepatic Impairment

The elimination half-life of ibuprofen is significantly prolonged in patients with moderate to severe cirrhosis.

Renal Impairment

Prospective studies of ibuprofen in patients with renal failure have not been conducted; however, dosage reduction is recommended in patients with chronic renal failure.

Pediatrics

The volume of distribution of ibuprofen (either oral or parenterally administered) is dependent on patient age and body temperature. With single oral doses up to 10 mg/kg, a dose response relationship exists in febrile children. There is also a correlation between the reduction of fever and drug concentration over time. In children, the antipyretic effect of oral therapy begins within 1 hour and peaks within 2 to 4 hours. The analgesic effect is similarly acute in nature. The pharmacokinetic parameters of intravenous (IV) ibuprofen were determined in a study of 42 febrile pediatric patients. Median Tmax occurred at the end of infusion and elimination half-life was shorter in pediatric patients compared to adults (1.5 to 1.8 hours vs. 2.2 to 2.4 hours).[35893]

 

Children and Adolescents 6 to 16 years

Mean pharmacokinetic parameters of ibuprofen 10 mg/kg IV in 25 febrile patients 6 to 16 years of age were as follows: Vd = 10.3 L (226.8 mL/kg); AUC = 80.7 mcg/mL x hour; Cmax = 61.9 mcg/mL; Tmax = 10 minutes; half-life = 1.55 hours; clearance = 4,878.5 mL/hour (109.2 mL/kg/hour).[35893]

 

Children 2 to 5 years

Mean pharmacokinetic parameters of ibuprofen 10 mg/kg IV in 12 febrile patients 2 to 5 years of age were as follows: Vd = 3.7 L (227.2 mL/kg); AUC = 79.2 mcg/mL x hour; Cmax = 64.2 mcg/mL; Tmax = 12 minutes; half-life = 1.5 hours; clearance = 1,967.3 mL/hour (130.1 mL/kg/hour).[35893]

 

Infants and Children 6 months to less than 2 years

Mean pharmacokinetic parameters of ibuprofen 10 mg/kg IV in 5 febrile patients 6 months to less than 2 years of age were as follows: Vd = 2.8 L (311.2 mL/kg); AUC = 71.1 mcg/mL x hour; Cmax = 59.2 mcg/mL; Tmax = 10 minutes; half-life = 1.8 hours; clearance = 1,172.5 mL/hour (133.7 mL/kg/hour).[35893]

Revision Date: 11/25/2015, 10:05:07 PM

References

30569 - Ibuprofen tablets, USP (Rx-only) package insert. Montvale NJ: Ascend laboratories LLC; 2019 Jan.34462 - Kirchheiner J, Meineke I, Freytag G, et al. Enantiospecific effects of cytochrome P450 2C9 amino acid variants on ibuprofen pharmacokinetics and on the inhibition of cyclooxygenases 1 and 2. Clin Pharmacol Ther 2002;72:62-75.35892 - Breuhaus BA, DeGraves FJ, Honore EK, et al. Pharmacokinetics of ibuprofen after intravenous and oral administration and assessment of safety of administration to healthy foals. Am J Vet Res 1999;60:1066-73.35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.

Pregnancy/Breast-feeding

pregnancy

Avoid ibuprofen use during the third trimester of pregnancy (starting at 30 weeks of gestation) due to the risk of premature closure of the fetal ductus arteriosus and persistent pulmonary hypertension in the neonate.[35893] If NSAID treatment is deemed necessary between 20 to 30 weeks of pregnancy, limit use to the lowest effective dose and shortest duration possible. Consider ultrasound monitoring of amniotic fluid if NSAID treatment extends beyond 48 hours. Discontinue the NSAID if oligohydramnios occurs and follow up according to clinical practice. Use of NSAIDs around 20 weeks gestation or later in pregnancy may cause fetal renal dysfunction leading to oligohydramnios, and in some cases, neonatal renal impairment. These adverse outcomes are seen, on average, after days to weeks of treatment, although oligohydramnios has been infrequently reported as soon as 48 hours after NSAID initiation. Oligohydramnios is often, but not always, reversible with treatment discontinuation. Complications of prolonged oligohydramnios may include limb contractures and delayed lung maturation. In some postmarketing cases of impaired neonatal renal function, invasive procedures such as exchange transfusion or dialysis were required.[66040] Observational data regarding embryofetal risks of NSAID use during the first trimester is inconclusive. There are no adequate and well-controlled studies of ibuprofen in pregnant women.[35893]

breast-feeding

Because exposure to a nursing infant is low, especially after single or intermittent doses, ibuprofen is considered a preferred analgesic/anti-inflammatory for women who are breast-feeding.[60365] After oral administration, ibuprofen is present in breast milk at relative infant doses of 0.06% to 0.6% of the maternal weight-adjusted daily dose. There are no reports of adverse effects on milk production or on the breast-fed infant.[35893] In a study of milk samples from 13 women who took an ibuprofen regimen of approximately 1 g daily, the relative infant dose was less than 0.38% of the mean maternal weight-adjusted dose. The relative infant dose was highest when the milk protein content was highest during the colostral phase.[60362]

Revision Date: 10/15/2020, 06:54:52 PM

References

35893 - Caldolor (ibuprofen) injection package insert. Nashville, TN: Cumberland Pharmaceuticals; 2021 Apr.60362 - Rigourd V, de Villepin B, Amirouche A, et al. Ibuprofen concentrations in human mature milk-first data about pharmacokinetics study in breast milk with AOR-10127 "Antalait" study. Ther Drug Monit 2014;36:590-596.60365 - National Institutes of Health (NIH). Ibuprofen monograph. LactMed: Drugs and Lactation Database. Available at http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~5sALjQ:1 . Accessed December 4, 2015.66040 - Food and Drug Administration MedWatch. Nonsteroidal anti-inflammatory drugs (NSAIDs): Drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later. Available at: https://www.fda.gov/safety/medical-product-safety-information/nonsteroidal-anti-inflammatory-drugs-nsaids-drug-safety-communication-avoid-use-nsaids-pregnancy-20. Accessed October 15, 2020.

Interactions

Level 1 (Severe)

  • Cidofovir
  • Ketorolac

Level 2 (Major)

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Aldesleukin, IL-2
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amlodipine; Celecoxib
  • Apixaban
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Bacitracin
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  • Betrixaban
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  • Bismuth Subsalicylate
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  • Bleomycin
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  • Busulfan
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  • Colistimethate, Colistin, Polymyxin E
  • Cytarabine, ARA-C
  • Dabigatran
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  • Dasatinib
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Level 3 (Moderate)

  • Abciximab
  • Acebutolol
  • Acetohexamide
  • Acyclovir
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  • Aliskiren
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  • Aliskiren; Valsartan
  • Alpha-blockers
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  • Aminolevulinic Acid
  • Amlodipine; Benazepril
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  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ
  • Amphotericin B
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  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enoxaparin
  • Entecavir
  • Epoprostenol
  • Eprosartan
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Eptifibatide
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  • Escitalopram
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  • Ethacrynic Acid
  • Ethiodized Oil
  • Fenoldopam
  • Fluconazole
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Fondaparinux
  • food
  • Formoterol; Mometasone
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Furosemide
  • Galantamine
  • Gentamicin
  • Ginkgo, Ginkgo biloba
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide
  • Glipizide; Metformin
  • Glyburide
  • Glyburide; Metformin
  • Gold
  • Guanabenz
  • Guanfacine
  • Heparin
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydralazine
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocortisone
  • Iloprost
  • Immune Globulin IV, IVIG, IGIV
  • Indapamide
  • Inotersen
  • Iodipamide Meglumine
  • Iodixanol
  • Iohexol
  • Ionic Contrast Media
  • Iopamidol
  • Iopromide
  • Ioversol
  • Ioxaglate Meglumine; Ioxaglate Sodium
  • Irbesartan
  • Isosulfan Blue
  • Kanamycin
  • Labetalol
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Leflunomide
  • Lepirudin
  • Levobetaxolol
  • Levobunolol
  • Levomilnacipran
  • Lisinopril
  • Lithium
  • Losartan
  • Magnesium Salts
  • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
  • Mecamylamine
  • Methyldopa
  • Methylprednisolone
  • Methylsulfonylmethane, MSM
  • Metoprolol
  • Mifepristone
  • Milnacipran
  • Minoxidil
  • Moexipril
  • Mometasone
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Neostigmine
  • Nitroprusside
  • Non-Ionic Contrast Media
  • Olmesartan
  • Oritavancin
  • Paroxetine
  • Penbutolol
  • Pentosan
  • Perindopril
  • Perindopril; Amlodipine
  • Pexidartinib
  • Phenoxybenzamine
  • Phentermine; Topiramate
  • Phentolamine
  • Photosensitizing agents (topical)
  • Physostigmine
  • Pindolol
  • Platelet Inhibitors
  • Pneumococcal Vaccine, Polyvalent
  • Polyethylene Glycol; Electrolytes
  • Polyethylene Glycol; Electrolytes; Ascorbic Acid
  • Potassium
  • Prasugrel
  • Prazosin
  • Prednisolone
  • Prednisone
  • Propranolol
  • Pyridostigmine
  • Quinapril
  • Quinolones
  • Ramipril
  • Reserpine
  • Reteplase, r-PA
  • Riluzole
  • Rivastigmine
  • Sacubitril; Valsartan
  • Selective serotonin reuptake inhibitors
  • Sertraline
  • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Sodium Sulfate; Magnesium Sulfate; Potassium Chloride
  • Sotalol
  • Spironolactone
  • Streptokinase
  • Streptomycin
  • Sulfinpyrazone
  • Sulfonylureas
  • Tacrine
  • Tacrolimus
  • Telbivudine
  • Telmisartan
  • Tenecteplase
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Terazosin
  • Thiazide diuretics
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Timolol
  • Tinzaparin
  • Tirofiban
  • tobacco
  • Tobramycin
  • Tolazamide
  • Tolbutamide
  • Topiramate
  • Torsemide
  • Trandolapril
  • Trandolapril; Verapamil
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Triamcinolone
  • Triamterene
  • Urea
  • Urokinase
  • Valacyclovir
  • Valsartan
  • Vasodilators
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Voclosporin
  • Vorapaxar
  • Voriconazole
  • Vortioxetine
  • Warfarin

Level 4 (Minor)

  • Amiodarone
  • Aprepitant, Fosaprepitant
  • Cefotaxime
  • Cholestyramine
  • Drospirenone
  • Drospirenone; Estetrol
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Elexacaftor; tezacaftor; ivacaftor
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Fenofibric Acid
  • Foscarnet
  • Ganciclovir
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ivacaftor
  • Levomefolate
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Mesalamine, 5-ASA
  • Neomycin
  • Telavancin
  • Tezacaftor; Ivacaftor
  • Valganciclovir
  • Vancomycin
  • Zafirlukast
Abciximab: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Acebutolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Acetaminophen; Aspirin, ASA; Caffeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Acetohexamide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Acyclovir: (Moderate) Monitor patients for signs of worsening renal function during coadministration of acyclovir and nonsteroidal antiinflammatory drugs. Coadministration may increase the risk for drug-induced nephrotoxicity. [34408] [56268] Adefovir: (Moderate) Chronic coadministration of adefovir with nephrotoxic drugs, such as nonsteroidal antiinflammatory drugs may increase the risk of developing nephrotoxicity even in patients who have normal renal function. The use of adefovir with NSAIDs may be done cautiously. As stated in the current adefovir prescribing information, 'Ibuprofen (800 mg PO three times daily), when given concomitantly with adefovir dipivoxil, increased the adefovir Cmax by 33% and AUC by 23%, as well as urinary recovery. The increase appears to be due to higher oral bioavailability, not a reduction in renal clearance of adefovir.' In an in vitro investigation, the antiviral effect of adefovir was unaltered and the renal proximal tubule accumulation of adefovir was inhibited by the presence of a NSAID. Adefovir is efficiently transported by the human renal organic anion transporter 1, and the presence of this transporter appears to mediate the accumulation of the drug in renal proximal tubules. The in vitro study suggests that the use of a NSAID with adefovir may potentially reduce the nephrotoxic potential of adefovir. Of course, NSAIDs are associated with nephrotoxicity of their own; therefore, further data on the interaction between NSAIDs and adefovir in humans are needed. [27615] Aldesleukin, IL-2: (Major) Aldesleukin, IL-2 may cause nephrotoxicity. Concurrent administration of drugs possessing nephrotoxic effects, such as nonsteroidal antiinflammatory agents (NSAIDs), with Aldesleukin, IL-2 may increase the risk of kidney dysfunction. In addition, reduced kidney function secondary to Aldesleukin, IL-2 treatment may delay elimination of concomitant medications and increase the risk of adverse events from those drugs. [41853] Aliskiren: (Moderate) NSAIDs may attenuate the antihypertensive effects of aliskiren by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of aliskiren may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking aliskiren. [30489] [33200] Aliskiren; Amlodipine: (Moderate) NSAIDs may attenuate the antihypertensive effects of aliskiren by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of aliskiren may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking aliskiren. [30489] [33200] Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) NSAIDs may attenuate the antihypertensive effects of aliskiren by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of aliskiren may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking aliskiren. [30489] [33200] Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) NSAIDs may attenuate the antihypertensive effects of aliskiren by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of aliskiren may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking aliskiren. [30489] [33200] Aliskiren; Valsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] (Moderate) NSAIDs may attenuate the antihypertensive effects of aliskiren by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of aliskiren may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking aliskiren. [30489] [33200] Alpha-blockers: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Alteplase: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Altretamine: (Major) Altretamine causes mild to moderate dose-related myelosuppression. Due to the thrombocytopenic effects of altretamine, an additive risk of bleeding may be seen in patients receiving concomitant NSAIDs. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [4661] [5170] Ambenonium Chloride: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Amikacin: (Moderate) It is possible that additive nephrotoxicity may occur in patients who receive nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with other nephrotoxic agents, such as amikacin. [28370] [30110] [30268] Amiloride: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Aminolevulinic Acid: (Moderate) Agents that inhibit prostaglandin synthesis such as nonsteroidal antiinflammatory drugs (NSAIDs), could decrease the efficacy of photosensitizing agents used in photodynamic therapy. Avoidance of NSAIDs before and during photodynamic therapy may be advisable. [42968] Aminosalicylate sodium, Aminosalicylic acid: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Amiodarone: (Minor) Amiodarone inhibits CYP2C9. Caution is recommended when administering amiodarone with CYP2C9 substrates including ibuprofen. The metabolism of ibuprofen may be decreased. [28001] [28896] Amlodipine; Benazepril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Amlodipine; Celecoxib: (Major) Avoid concomitant use of celecoxib with any other NSAID due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [28317] [35893] Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Amlodipine; Olmesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Amlodipine; Telmisartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Amlodipine; Valsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Amphotericin B cholesteryl sulfate complex (ABCD): (Moderate) Concurrent use of amphotericin B and other nephrotoxic medications, including nonsteroidal antiinflammatory drugs (NSAIDs), may enhance the potential for drug-induced renal toxicity. Monitor renal function carefully during concurrent therapy. Amphotericin B dosage reduction may be necessary if renal impairment occurs. [28333] [30268] Amphotericin B lipid complex (ABLC): (Moderate) Concurrent use of amphotericin B and other nephrotoxic medications, including nonsteroidal antiinflammatory drugs (NSAIDs), may enhance the potential for drug-induced renal toxicity. Monitor renal function carefully during concurrent therapy. Amphotericin B dosage reduction may be necessary if renal impairment occurs. [28333] [30268] Amphotericin B liposomal (LAmB): (Moderate) Concurrent use of amphotericin B and other nephrotoxic medications, including nonsteroidal antiinflammatory drugs (NSAIDs), may enhance the potential for drug-induced renal toxicity. Monitor renal function carefully during concurrent therapy. Amphotericin B dosage reduction may be necessary if renal impairment occurs. [28333] [30268] Amphotericin B: (Moderate) Concurrent use of amphotericin B and other nephrotoxic medications, including nonsteroidal antiinflammatory drugs (NSAIDs), may enhance the potential for drug-induced renal toxicity. Monitor renal function carefully during concurrent therapy. Amphotericin B dosage reduction may be necessary if renal impairment occurs. [28333] [30268] Anagrelide: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Angiotensin II receptor antagonists: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Angiotensin-converting enzyme inhibitors: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Antithrombin III: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Antithymocyte Globulin: (Moderate) An increased risk of bleeding may occur when NSAIDs are used with agents that cause clinically significant thrombocytopenia, such as antithymocyte globulin. Patients receiving these drugs together should be monitored closely for bleeding. [41851] Apixaban: (Major) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Aprepitant, Fosaprepitant: (Minor) Use caution if ibuprofen and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of ibuprofen. After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. Ibuprofen is a CYP2C9 substrate and aprepitant is a CYP2C9 inducer. Administration of a CYP2C9 substrate, tolbutamide, on days 1, 4, 8, and 15 with a 3-day regimen of oral aprepitant (125 mg/80 mg/80 mg) decreased the tolbutamide AUC by 23% on day 4, 28% on day 8, and 15% on day 15. The AUC of tolbutamide was decreased by 8% on day 2, 16% on day 4, 15% on day 8, and 10% on day 15 when given prior to oral administration of aprepitant 40 mg on day 1, and on days 2, 4, 8, and 15. The effects of aprepitant on tolbutamide were not considered significant. When a 3-day regimen of aprepitant (125 mg/80 mg/80 mg) given to healthy patients on stabilized chronic warfarin therapy (another CYP2C9 substrate), a 34% decrease in S-warfarin trough concentrations was noted, accompanied by a 14% decrease in the INR at five days after completion of aprepitant. [30676] [34453] [34454] [34462] [40027] Aprotinin: (Moderate) The manufacturer recommends using aprotinin cautiously in patients that are receiving drugs that can affect renal function, such as NSAIDs, as the risk of renal impairment may be increased. [5204] Argatroban: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Arsenic Trioxide: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia. Notable interactions may occur with myelosuppressive antineoplastic agents. Patients receiving ibuprofen concurrently with antineoplastic agents should be monitored closely for bleeding. [4694] [6303] Aspirin, ASA: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Butalbital; Caffeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Butalbital; Caffeine; Codeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Caffeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Caffeine; Dihydrocodeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Caffeine; Orphenadrine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Carisoprodol: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Carisoprodol; Codeine: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Dipyridamole: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Aspirin, ASA; Omeprazole: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Oxycodone: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Aspirin, ASA; Pravastatin: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Atenolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Atenolol; Chlorthalidone: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Atropine; Edrophonium: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Azathioprine: (Moderate) NSAIDs should be used with caution in patients receiving immunosuppressives as they may mask fever, pain, swelling and other signs and symptoms of an infection. [6144] Azelastine; Fluticasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Azilsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Azilsartan; Chlorthalidone: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Bacitracin: (Major) Avoid concurrent use of bacitracin with nonsteroidal antiinflammatory drugs. Coadministration may increase the risk for drug-induced nephrotoxicity. [31047] [56268] Beclomethasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Benazepril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Bendroflumethiazide; Nadolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Beta-blockers: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Betamethasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Betaxolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Betrixaban: (Major) Monitor patients closely and promptly evaluate any signs or symptoms of bleeding if betrixaban and nonsteroidal antiinflammatory drugs (NSAIDs) are used concomitantly. Coadministration of betrixaban and NSAIDs may increase the risk of bleeding. [62037] Bexarotene: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Bismuth Subsalicylate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Bismuth Subsalicylate; Metronidazole; Tetracycline: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Bisoprolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Bisphosphonates: (Moderate) Exercise caution when administering an NSAID with a bisphosphonate. Monitor for the presence of GI complaints, including potential GI ulceration and bleeding, as well as renal function, during combined use. Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with esophageal and/or gastric irritation, GI ulceration. a risk of nephrotoxicity, and decreased bone mineral density. Bisphosphonates may cause GI adverse events and occasionally, renal dysfunction. Though patients receiving intravenously administered bisphosphonates have a decreased incidence of GI adverse effects as compared to those taking orally administered bisphosphonates, nephrotoxicity is possible, and GI events are rarely reported. [28644] [28655] [29352] [29558] [31027] [31826] [40021] [40288] [52249] Bivalirudin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Bleomycin: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Brimonidine; Timolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Budesonide: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Budesonide; Formoterol: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Budesonide; Glycopyrrolate; Formoterol: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Bumetanide: (Moderate) If a nonsteroidal anti-inflammatory drug (NSAID) and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Patients taking diuretics and NSAIDs concurrently are at higher risk of developing renal insufficiency. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDs have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [48492] Bupivacaine; Meloxicam: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [29611] [35893] Busulfan: (Major) Due to the thrombocytopenic effects of busulfan, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [4736] [5170] Calcium Phosphate, Supersaturated: (Moderate) Concomitant use of medicines with potential to alter renal perfusion or function such as nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of acute phosphate nephropathy in patients taking sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous. [32159] [32160] Calcium-channel blockers: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Candesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Cannabidiol: (Moderate) Consider a dose reduction of ibuprofen as clinically appropriate, if adverse reactions occur when administered with cannabidiol. Increased ibuprofen exposure is possible. Ibuprofen is a CYP2C9 substrate. In vitro data predicts inhibition of CYP2C9 by cannabidiol potentially resulting in clinically significant interactions. [34453] [34454] [34462] [63309] Capecitabine: (Moderate) Monitor for an increase in ibuprofen-related adverse reactions (e.g., fluid retention, GI irritation, renal dysfunction) if coadministration with capecitabine is necessary; adjust the dose of ibuprofen if necessasry. Ibuprofen is a CYP2C9 substrate and capecitabine is a weak CYP2C9 inhibitor. [34453] [34454] [34462] [44458] Capreomycin: (Major) Because capreomycin is primarily eliminated by the kidney, coadministration with other potentially nephrotoxic drugs, including nonsteroidal antiinflammatory drugs (NSAIDs), may increase serum concentrations of either drug. Theoretically, the chronic coadministration of these drugs may increase the risk of developing nephrotoxicity, even in patients who have normal renal function. Monitor patients for changes in renal function if these drugs are coadministered. [44155] Captopril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Captopril; Hydrochlorothiazide, HCTZ: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Cardiac glycosides: (Moderate) Coadministration of digoxin and indomethacin increases the serum concentration of digoxin by 40%. Measure serum digoxin concentrations before initiating indomethacin. Reduce digoxin concentrations by decreasing the digoxin dose by approximately 15-30% or by modifying the dosing frequency and continue monitoring. In addition, concomitant use of other nonsteroidal antiinflammatory drugs (NSAIDs), including COX-2 inhibitors, with digoxin may result in increased serum concentrations of digoxin. Increased serum digoxin concentrations have been reported in patients who received digoxin and diclofenac sodium or ibuprofen. NSAIDs may cause a significant deterioration in renal function. A decline in glomerular filtration or tubular secretion may impair the excretion of digoxin. Monitor patients during concomitant treatment for possible digoxin toxicity and reduce digoxin dose as necessary. [28272] Carmustine, BCNU: (Major) Due to the thrombocytopenic effects of carmustine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. These additive effects may not occur for at least 6 weeks after the administration of carmustine due to the delayed myelosuppressive effects of carmustine. [5170] [5946] Carteolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Carvedilol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Cefotaxime: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted. [28646] [29912] [57694] [57695] [58208] Celecoxib: (Major) Avoid concomitant use of celecoxib with any other NSAID due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [28317] [35893] Chlorambucil: (Major) Due to the thrombocytopenic effects of chlorambucil, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [4757] [5170] Chlorpropamide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Chlorthalidone; Clonidine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Cholestyramine: (Minor) As with other nonsteroidal anti-inflammatory drugs (NSAIDs), the absorption of ibuprofen can be delayed if cholestyramine is concomitantly administered. Staggering the administration times may minimize this interaction. [44130] Choline Salicylate; Magnesium Salicylate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Cholinesterase inhibitors: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Ciclesonide: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Cidofovir: (Contraindicated) The concomitant administration of cidofovir and nonsteroidal antiinflammatory drugs (NSAIDs) is contraindicated due to the potential for increased nephrotoxicity. NSAIDs should be discontinued 7 days prior to beginning cidofovir. [28388] Cilostazol: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Citalopram: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Cladribine: (Major) Due to the thrombocytopenic effects of cladribine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7226] Clofarabine: (Major) Due to the thrombocytopenic effects of clofarabine, an additive risk of bleeding may be seen in patients receiving concomitant NSAIDs. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7557] Clonidine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Clopidogrel: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Colchicine; Probenecid: (Major) Probenecid can decrease the renal clearance of nonsteroidal antiinflammatory agents (NSAIDs). Reduction of the NSAID dose may be necessary when it is used together with probenecid. [5071] Colistimethate, Colistin, Polymyxin E: (Major) The administration of colistimethate sodium may increase the risk of developing nephrotoxicity, even in patients who have normal renal function. Nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when used concurrently. Monitor patients for changes in renal function if these drugs are coadministered. Since colistimethate sodium is eliminated by the kidney, coadministration with other potentially nephrotoxic drugs, including nonsteroidal antiinflammatory drugs (NSAIDs), may theoretically increase serum concentrations of either drug. [33636] Conjugated Estrogens; Bazedoxifene: (Moderate) In clinical evaluation, a single dose of ibuprofen 600 mg was given with a bazedoxifene 20 mg capsule in 12 postmenopausal women after an overnight fast. Co-administration increased the Cmax and AUC of bazedoxifene by 18% and 7%, respectively. The Cmax of ibuprofen increased by 6%, the AUC was unchanged. The clinical effect of this change is not known. However, co-administration of ibuprofen and conjugated estrogens; bazedoxifene may increase bazedoxifene efficacy and/or side effects. Use caution during coadministration and monitor patient closely. [56074] Corticosteroids: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Cortisone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Cyclosporine: (Moderate) Serum creatinine, potassium concentrations, and cyclosporine concentrations should be closely monitored when systemic cyclosporine is given with nonsteroidal antiinflammatory drugs (NSAIDs). Renal dysfunction associated with cyclosporine may be potentiated by concurrent usage of NSAIDs. The effects of NSAIDs on the production of renal prostaglandins may cause changes in the elimination of cyclosporine. Potentiation of renal dysfunction may especially occur in a dehydrated patient. Patients should be monitored for signs and symptoms of cyclosporine toxicity and infection, as NSAIDs may mask fever, pain, or swelling. Increased tear production was not seen in patients receiving ophthalmic NSAIDs or using punctual plugs concurrently with cyclosporine ophthalmic emulsion. [29198] [30496] Cytarabine, ARA-C: (Major) The main toxic effect of cytarabine, ARA-C is bone marrow suppression with leukopenia, thrombocytopenia and anemia. Due to the thrombocytopenic effects of cytarabine, an additive risk of bleeding may be seen in patients receiving concomitant NSAIDs. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. Dipyridamole can block membrane transport of cytarabine in tumor cells, therefore decreasing its antineoplastic activity. [5170] [7945] Dabigatran: (Major) Educate patients about the signs of increased bleeding and the need to report these signs to a healthcare provider immediately if coadministration of dabigatran and a nonsteroidal antiinflammatory drug (NSAID) is necessary. Dabigatran can cause significant and, sometimes, fatal bleeding. This risk may be increased by concurrent use of chronic NSAID therapy. [42121] Dacarbazine, DTIC: (Major) Leukopenia and thrombocytopenia are common toxicities of dacarbazine, DTIC. Due to the thrombocytopenic effects of dacarbazine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7996] Dactinomycin, Actinomycin D: (Major) An increased risk of bleeding may occur when NSAIDs are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Dalteparin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Danaparoid: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Dasatinib: (Major) Due to the thrombocytopenic and possible platelet inhibiting effects of dasatinib, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors (including aspirin), strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. Caution should be exercised if patients are required to take medications that inhibit platelet function or anticoagulants concomitantly with dasatinib. [32387] [5170] Deferasirox: (Moderate) Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including NSAIDs. In addition, coadministration of deferasirox with other potentially nephrotoxic drugs, including NSAIDs, may increase the acute renal failure. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly [31807] Deflazacort: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Denileukin Diftitox: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Desirudin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Desmopressin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia [10457] [10458] [5940] Desvenlafaxine: (Moderate) Platelet aggregation may be impaired by desvenlafaxine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Patients should be monitored for signs and symptoms of bleeding while taking desvenlafaxine with NSAIDs. [28275] [29934] Dexamethasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Diazoxide: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Dichlorphenamide: (Moderate) Use dichlorphenamide and ibuprofen together with caution as both drugs can cause metabolic acidosis. Concurrent use may increase the severity of metabolic acidosis. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment. If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. [44120] [44121] [60122] Diclofenac: (Major) Avoid concomitant use of diclofenac with any other NSAID due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30115] [35893] Diclofenac; Misoprostol: (Major) Avoid concomitant use of diclofenac with any other NSAID due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30115] [35893] Diflunisal: (Major) Avoid concomitant use of diflunisal with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [35893] [49143] Diphenhydramine; Naproxen: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Dipyridamole: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Docetaxel: (Major) Due to the thrombocytopenic effects of docetaxel, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors (including aspirin), strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [5235] Donepezil: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Donepezil; Memantine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] Dorzolamide; Timolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Doxazosin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Drospirenone: (Minor) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Other drugs that may have additive effects on serum potassium with drospirenone include chronic treatment with NSAIDs, and monitoring of serum potassium in the 1st month of concurrent therapy is recommended. [4716] Drospirenone; Estetrol: (Minor) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Other drugs that may have additive effects on serum potassium with drospirenone include chronic treatment with NSAIDs, and monitoring of serum potassium in the 1st month of concurrent therapy is recommended. [4716] Drospirenone; Estradiol: (Minor) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Other drugs that may have additive effects on serum potassium with drospirenone include chronic treatment with NSAIDs, and monitoring of serum potassium in the 1st month of concurrent therapy is recommended. [4716] Drospirenone; Ethinyl Estradiol: (Minor) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Other drugs that may have additive effects on serum potassium with drospirenone include chronic treatment with NSAIDs, and monitoring of serum potassium in the 1st month of concurrent therapy is recommended. [4716] Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Other drugs that may have additive effects on serum potassium with drospirenone include chronic treatment with NSAIDs, and monitoring of serum potassium in the 1st month of concurrent therapy is recommended. [4716] (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Drotrecogin Alfa: (Moderate) Caution should be used when drotrecogin alfa is used with any other drugs that affect hemostasis, including NSAIDs. These patients are at increased risk of bleeding during drotrecogin alfa therapy. [5205] Duloxetine: (Moderate) Platelet aggregation may be impaired by duloxetine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving Nonsteroidal antiinflammatory drugs (NSAIDs). Mmonitor for signs and symptoms of bleeding when duloxetine is coadministered with NSAIDs. [29934] Edoxaban: (Major) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Edrophonium: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Efavirenz; Emtricitabine; Tenofovir: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] Elexacaftor; tezacaftor; ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as ibuprofen. In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. [48524] Eltrombopag: (Moderate) Eltrombopag is a UDP-glucuronyltransferase inhibitor. NSAIDs are a substrate of UDP-glucuronyltransferases. The significance or effect of this interaction is not known; however, elevated concentrations of the NSAID are possible. Monitor patients for adverse reactions if eltrombopag is administered with an NSAID. [40392] Elvitegravir: (Moderate) The plasma concentrations of ibuprofen may be decreased when administered concurrently with elvitegravir. Patients may experience decreased analgesic or anti-inflammatory effects when these drugs are coadministered. Elvitegravir is a CYP2C9 inducer, while ibuprofen is a CYP2C9 substrate. [34454] [51664] [58001] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] (Moderate) The plasma concentrations of ibuprofen may be decreased when administered concurrently with elvitegravir. Patients may experience decreased analgesic or anti-inflammatory effects when these drugs are coadministered. Elvitegravir is a CYP2C9 inducer, while ibuprofen is a CYP2C9 substrate. [34454] [51664] [58001] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] (Moderate) The plasma concentrations of ibuprofen may be decreased when administered concurrently with elvitegravir. Patients may experience decreased analgesic or anti-inflammatory effects when these drugs are coadministered. Elvitegravir is a CYP2C9 inducer, while ibuprofen is a CYP2C9 substrate. [34454] [51664] [58001] Emtricitabine: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Emtricitabine; Tenofovir alafenamide: (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Emtricitabine; Tenofovir disoproxil fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as high-dose nonsteroidal antiinflammatory drugs (NSAIDs). Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and NSAIDs are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. [29746] [35893] [64014] Enalapril, Enalaprilat: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Enalapril; Felodipine: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Enoxaparin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Entecavir: (Moderate) The manufacturer of entecavir recommends monitoring for adverse effects when coadministered with NSAIDs. Entecavir is primarily eliminated by the kidneys; NSAIDs can affect renal function. Concurrent administration may increase the serum concentrations of entecavir and adverse events. [31230] Eplerenone: (Major) Monitor serum potassium and serum creatinine concentrations within 3 to 7 days of initiating coadministration of eplerenone and nonsteroidal antiinflammatory drugs (NSAIDs), and monitor blood pressure. The concomitant use of other potassium-sparing antihypertensives with NSAIDs has been shown to reduce the antihypertensive effect in some patients and result in severe hyperkalemia in patients with impaired renal function. Patients who develop hyperkalemia may continue eplerenone with proper dose adjustment; eplerenone dose reduction decreases potassium concentrations. [27990] Epoprostenol: (Moderate) NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways. [4087] Eprosartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Eptifibatide: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Eribulin: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Erlotinib: (Moderate) Monitor for symptoms of gastrointestinal (GI) perforation (e.g., severe abdominal pain, fever, nausea, and vomiting) if coadministration of erlotinib with nonsteroidal antiinflammatory drugs (NSAIDs) is necessary. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0.1% to 0.4%, including fatal cases. Patients receiving concomitant NSAIDs may be at increased risk of perforation. [30555] Escitalopram: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Esmolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Esomeprazole; Naproxen: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Estramustine: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Ethacrynic Acid: (Moderate) If a nonsteroidal anti-inflammatory drug (NSAID) and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Patients taking diuretics and NSAIDs concurrently are at higher risk of developing renal insufficiency. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDs have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [48492] Ethanol: (Major) Concomitant ingestion of ethanol with NSAIDs increases the risk of developing gastric irritation and GI mucosal bleeding. Ethanol is a mucosal irritant and NSAIDs decrease platelet aggregation. Routine ingestion of ethanol and NSAIDs can cause significant GI bleeding, which may or may not be overt. Even occasional concomitant use of NSAIDs and ethanol should be avoided. Chronic alcoholism is often associated with hypoprothrombinemia and this condition increases the risk of bleeding. Systemic exposure of NSAIDs that are primary substrates for CYP2C9, such as diclofenac, may be increased during use of ethanol, which is a dose-dependent inhibitor of CYP2C9. The effects of ethanol may also be substrate-dependent, since in vitro data have shown varying inhibitory effects on 2C9 substrates.The manufacturer of diclofenac; misoprostol recommends that the total daily dose of diclofenac not exceed 100 mg in patients receiving a CYP2C9 inhibitor. Patients should be warned regarding the potential for increased risk of GI bleeding if alcohol-containing beverages are taken concurrently with NSAIDs. [30115] [30427] [30569] [31949] Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Ethiodized Oil: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Etodolac: (Major) Avoid concomitant use of etodolac with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [35893] [45875] Fenofibric Acid: (Minor) At therapeutic concentrations, fenofibric acid is a mild-to-moderate inhibitor of CYP2C9. Concomitant use of fenofibric acid with CYP2C9 substrates, such as ibuprofen, has not been formally studied. Fenofibric acid may theoretically increase plasma concentrations of CYP2C9 substrates and could lead to toxicity for drugs that have a narrow therapeutic range. Monitor the therapeutic effect of ibuprofen during coadministration with fenofibric acid. [11310] [11311] [11319] [49952] Fenoldopam: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Fenoprofen: (Major) Avoid concomitant use of fenoprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30524] [35893] Flavocoxid, Flavocoxid; Citrated Zinc Bisglycinate: (Major) Flavocoxid exerts similar pharmacologic characteristics to other systemic NSAIDs. Additive pharmacodynamic effects, including a potential for additive adverse cardiac and GI effects, may be seen if flavocoxid is used with NSAIDs. In general, the concurrent use of flavocoxid and NSAIDs should be avoided. [8954] Floxuridine: (Major) Due to the thrombocytopenic effects of floxuridine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7446] Fluconazole: (Moderate) Fluconazole is an inhibitor of cytochrome P450 isoenzyme 2C9, which is the isoenzyme responsible for the metabolism of ibuprofen. Thus, increased plasma concentrations of ibuprofen are possible. If fluconazole is administered concurrently with ibuprofen, monitor for NSAID-related side-effects such as fluid retention, GI irritation, or renal dysfunction and adjust the ibuprofen dose, if needed. Among 12 healthy males, the mean systemic exposure of S-(+)-ibuprofen after a single dose of 400 mg of racemic ibuprofen was 67.4 +/- 16.2 mcghr/ml. In contrast, the mean systemic exposure was 122 +/- 32 mcghr/ml when ibuprofen was given 1 hour after the second fluconazole dose; fluconazole 400 mg was given on day 1 and 200 mg was given on day 2. In addition to increased systemic exposure, the maximum concentration and half-life of S-(+)-ibuprofen were all statistically significantly greater in the presence of fluconazole. Increased S-(+)-ibuprofen concentrations leads to increased inhibition of both COX-1 and COX-2, and impaired ibuprofen metabolism due to mutations in the CYP2C9 gene increases the risk of acute gastrointestinal bleeding. [29036] [34447] [34453] [34454] [34461] Fludarabine: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Fludrocortisone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Flunisolide: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Fluorouracil, 5-FU: (Major) Due to the thrombocytopenic effects of fluorouracil, 5-FU, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [5763] Fluoxetine: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Fluoxetine; Olanzapine: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Flurbiprofen: (Major) Avoid concomitant use of flurbiprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30241] [35893] Fluticasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Fluticasone; Salmeterol: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Fluticasone; Umeclidinium; Vilanterol: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Fluticasone; Vilanterol: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Fluvoxamine: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Fondaparinux: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Food: (Moderate) Administering nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with marijuana may limit some of marijuana's pharmacologic activities. Certain actions of marijuana require prostaglandin-mediated processes to occur; NSAIDs may interfere with these processes thereby decreasing marijuana's effect. Coadministration of indomethacin with marijuana has been shown to significantly decrease euphoria, tachycardia, and the intraocular pressure lowering activity of marijuana. [42294] Formoterol; Mometasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Foscarnet: (Minor) The risk of renal toxicity may be increased if foscarnet is used in conjuction with other nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor renal function carefully during concurrent therapy. [28377] [30268] Fosinopril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Furosemide: (Moderate) If a nonsteroidal anti-inflammatory drug (NSAID) and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Patients taking diuretics and NSAIDs concurrently are at higher risk of developing renal insufficiency. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDs have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [48492] Galantamine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Gallium Ga 68 Dotatate: (Major) Avoid use of mannitol and nonsteroidal anti-inflammatory drugs (NSAIDs), if possible. If use together is necessary, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Concomitant administration of nephrotoxic drugs, such as NSAIDs, increases the risk of renal failure after administration of mannitol. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [33007] [48492] Ganciclovir: (Minor) Concurrent use of nephrotoxic agents, such as NSAIDs, with ganciclovir should be done cautiously to avoid additive nephrotoxicity. Monitor renal function carefully if concomitant therapy is required. [32676] Garlic, Allium sativum: (Minor) Garlic, Allium sativum may produce clinically-significant antiplatelet effects; until more data are available, garlic should be used cautiously in patients receiving drugs with a known potential risk for bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). [25588] [63043] Gentamicin: (Moderate) It is possible that additive nephrotoxicity may occur in patients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with other nephrotoxic agents, such as gentamicin. [28370] [30110] [30268] Ginger, Zingiber officinale: (Minor) Patients receiving regular therapy with nonsteroidal antiinflammatory drugs (NSAIDs) should use ginger with caution, due to a theoretical risk of bleeding resulting from additive pharmacology related to the COX enzymes. However, clinical documentation of interactions is lacking. Several pungent constituents of ginger (Zingiber officinale) are reported to inhibit arachidonic acid (AA) induced platelet activation in human whole blood. The constituent (8)-paradol is the most potent inhibitor of COX-1 and exhibits the greatest anti-platelet activity versus other gingerol analogues. The mechanism of ginger-associated platelet inhibition may be related to decreased COX-1/Thomboxane synthase enzymatic activity. [28470] [29960] Ginkgo, Ginkgo biloba: (Moderate) Ginkgo is reported to inhibit platelet aggregation and several case reports describe bleeding complications with Ginkgo biloba, with or without concomitant drug therapy. Ginkgo should be used cautiously in patients receiving drugs that inhibit platelet aggregation or pose a risk for bleeding, such as NSAIDs. A case of fatal intracerebral bleeding has been reported with the combination of Ginkgo and the NSAID ibuprofen. A 71 year-old male had been taking a concentrated Ginkgo biloba extract (Gingium, Germany) 40 mg PO twice daily for a few years; 4 weeks prior to his death, he had started taking ibuprofen (600 mg daily) for osteoarthritic hip pain. The man was found comatose and CT scan revealed a massive intracerebral bleed; no other causative factors were identified. [25273] [28470] [28481] Glimepiride: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glimepiride; Pioglitazone: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glimepiride; Rosiglitazone: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glipizide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glipizide; Metformin: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glyburide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Glyburide; Metformin: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Gold: (Moderate) Due to the inhibition of renal prostaglandins by NSAIDs, concurrent use with other nephrotoxic agents, such as gold compounds, may lead to additive nephrotoxicity. Monitor renal function carefully during concurrent therapy. [30110] [30268] Guanabenz: (Moderate) NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways. [805] Guanfacine: (Moderate) NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways. [805] Heparin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Hyaluronidase, Recombinant; Immune Globulin: (Moderate) Immune Globulin (IG) products have been reported to be associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death. Patients predisposed to acute renal failure include patients receiving known nephrotoxic drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) and salicylates. Coadminister IG products at the minimum concentration available and the minimum rate of infusion practicable. Also, closely monitor renal function. [6859] [7020] [7823] Hydralazine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydralazine; Hydrochlorothiazide, HCTZ: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydralazine; Isosorbide Dinitrate, ISDN: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydrochlorothiazide, HCTZ; Irbesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Hydrochlorothiazide, HCTZ; Lisinopril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Hydrochlorothiazide, HCTZ; Losartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydrochlorothiazide, HCTZ; Metoprolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Hydrochlorothiazide, HCTZ; Olmesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Hydrochlorothiazide, HCTZ; Propranolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Hydrochlorothiazide, HCTZ; Quinapril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Hydrochlorothiazide, HCTZ; Spironolactone: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Hydrochlorothiazide, HCTZ; Telmisartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Hydrochlorothiazide, HCTZ; Triamterene: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Hydrochlorothiazide, HCTZ; Valsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Hydrocortisone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Ibritumomab Tiuxetan: (Major) During and after therapy, avoid the concomitant use of Yttrium (Y)-90 ibrutumomab tiuxetan with drugs that interfere with platelet function such as nonsteroidal antiinflammatory drugs (NSAIDs); the risk of bleeding may be increased. If coadministration with NSAIDs is necessary, monitor platelet counts more frequently for evidence of thrombocytopenia. [41826] Ibuprofen lysine: (Major) Because ibuprofen lysine exerts similar pharmacologic characteristics to other systemic NSAIDs, including COX-2 inhibitors, additive pharmacodynamic effects, including a potential increase for additive adverse GI effects, may be seen if ibuprofen lysine is used with other NSAIDs. In general, concurrent use of ibuprofen lysine and another NSAID should be avoided. [30115] [30569] Iloprost: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Imatinib: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Immune Globulin IV, IVIG, IGIV: (Moderate) Immune Globulin (IG) products have been reported to be associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death. Patients predisposed to acute renal failure include patients receiving known nephrotoxic drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) and salicylates. Coadminister IG products at the minimum concentration available and the minimum rate of infusion practicable. Also, closely monitor renal function. [6859] [7020] [7823] Indapamide: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [24233] [30489] [48492] Indomethacin: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [35893] [45886] Inotersen: (Moderate) Use caution with concomitant use of inotersen and nonsteroidal antiinflammatory drugs (NSAIDs) due to the risk of glomerulonephritis and nephrotoxicity as well as the potential risk of bleeding from thrombocytopenia. Consider discontinuation of NSAIDs in a patient taking inotersen with a platelet count of less than 50,000 per microliter. [63624] Interferon Alfa-2a: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Interferon Alfa-2b: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Interferon Alfa-2b; Ribavirin: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Iodipamide Meglumine: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] Iodixanol: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Iohexol: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Ionic Contrast Media: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] Iopamidol: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Iopromide: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Ioversol: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Ioxaglate Meglumine; Ioxaglate Sodium: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] Irbesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Isosulfan Blue: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as ibuprofen. In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. [48524] Ixabepilone: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [4694] [6303] Kanamycin: (Moderate) It is possible that additive nephrotoxicity may occur in patients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with other nephrotoxic agents, such as kanamycin. [28370] [30110] [30268] Ketoprofen: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30548] [35893] Ketorolac: (Contraindicated) Concomitant use of ketorolac with another NSAID is contraindicated. Increased adverse gastrointestinal effects are possible if ketorolac is used with other systemic nonsteroidal antiinflammatory drugs (NSAIDs), including COX-2 inhibitors. [28331] [30569] [35893] Labetalol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] Lansoprazole; Naproxen: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Leflunomide: (Moderate) In vitro studies indicate that the M1 metabolite of leflunomide inhibits cytochrome P450 2C9, the enzyme responsible for the metabolism of many NSAIDs. Leflunomide altered protein binding and thus, increased the free fraction of ibuprofen by 13% to 50%. The clinical significance of the interactions with NSAIDs is unknown. There was extensive concomitant use of NSAIDs in phase III clinical studies of leflunomide in the treatment of rheumatoid arthritis, and no clinical differential effects were observed. However, because some NSAIDs have been reported to cause hepatotoxic effects, some caution may be warranted in their use with leflunomide. [49634] Lepirudin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Levobetaxolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Levobunolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Levomefolate: (Minor) L-methylfolate should be used cautiously in patients taking high doses of ibuprofen. Plasma concentrations of L-methylfolate may be reduced when used concomitantly with high doses of ibuprofen. Monitor patients for decreased efficacy of L-methylfolate if these agents are used together. [35581] Levomilnacipran: (Moderate) Platelet aggregation may be impaired by SNRIs such as levomilnacipran due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Monitor for signs and symptoms of bleeding in patients taking levomilnacipran and NSAIDs. [55469] Lisinopril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Lithium: (Moderate) Lithium levels should be monitored when patients initiate or discontinue nonsteroidal antiinflammatory drugs. In some cases, lithium toxicity has resulted from interactions between an NSAID and lithium. Indomethacin and piroxicam have been reported to significantly increase steady-state plasma lithium concentrations. There is also evidence that other NSAIDs, including the selective cyclooxygenase-2 (COX-2) inhibitors, have the same effect. In a study conducted in healthy subjects, mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 twice daily with celecoxib 200 mg twice daily as compared to subjects receiving lithium alone. It is thought that prostaglandins are involved in the renal clearance of lithium and that NSAIDs interfere with lithium excretion. Typically, increased lithium levels develop over 5 to 10 days after adding a NSAID and return to pretreatment levels within 7 days of stopping the NSAID. [28654] [29606] Lomustine, CCNU: (Major) Due to the bone marrow suppressive and thrombocytopenic effects of lomustine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7668] Losartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Lumacaftor; Ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as ibuprofen. In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. [48524] (Minor) Lumacaftor; ivacaftor may alter the systemic exposure of ibuprofen. If used together, a dose adjustment of ibuprofen may be required to obtain the desired therapeutic effect and/or avoid adverse effects. Do not exceed the recommended maximum dose. Ibuprofen is a CYP2C9 substrate, and in vitro studies suggest that lumacaftor; ivacaftor has the potential to induce or inhibit CYP2C9. [34453] [34454] [34462] [59891] Lumacaftor; Ivacaftor: (Minor) Lumacaftor; ivacaftor may alter the systemic exposure of ibuprofen. If used together, a dose adjustment of ibuprofen may be required to obtain the desired therapeutic effect and/or avoid adverse effects. Do not exceed the recommended maximum dose. Ibuprofen is a CYP2C9 substrate, and in vitro studies suggest that lumacaftor; ivacaftor has the potential to induce or inhibit CYP2C9. [34453] [34454] [34462] [59891] Macimorelin: (Major) Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as nonsteroidal antiinflammatory drugs (NSAIDs). Healthcare providers are advised to discontinue NSAID therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. [62723] Magnesium Salicylate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Magnesium Salts: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [41573] Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [41573] Mannitol: (Major) Avoid use of mannitol and nonsteroidal anti-inflammatory drugs (NSAIDs), if possible. If use together is necessary, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Concomitant administration of nephrotoxic drugs, such as NSAIDs, increases the risk of renal failure after administration of mannitol. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [33007] [48492] Mecamylamine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Mechlorethamine, Nitrogen Mustard: (Major) Mechlorethamine, nitrogen mustard is highly toxic and is associated with lymphocytopenia, granulocytopenia, and thrombocytopenia. Due to the thrombocytopenic effects of mechlorethamine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7997] Meclofenamate Sodium: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30574] [35893] Mefenamic Acid: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30570] [35893] Meloxicam: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [29611] [35893] Mesalamine, 5-ASA: (Minor) The concurrent use of mesalamine with known nephrotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of nephrotoxicity. [11423] Methotrexate: (Major) Do not administer nonsteroidal anti-inflammatory drugs (NSAIDs) before or concomitantly with high doses of methotrexate, such as used in the treatment of osteosarcoma. Concomitant administration of some NSAIDs with high dose methotrexate therapy has been reported to elevate and prolong serum methotrexate concentrations, resulting in deaths from severe hematologic and gastrointestinal toxicity. Use caution when NSAIDs are administered concomitantly with lower doses of methotrexate as they have been reported to reduce the tubular secretion of methotrexate in an animal model and may enhance its toxicity. Despite potential interactions, patients with rheumatoid arthritis (RA) are often receiving concurrent treatment with NSAIDs without apparent problems. However, these doses are lower than those used in psoriasis or malignancy; higher methotrexate doses may lead to unexpected toxicity in combination with NSAIDs. NSAIDs may be continued in patients with RA receiving treatment with methotrexate, although the possibility of increased toxicity has not been fully explored. [56263] [57771] [60517] [61900] [66594] Methoxsalen: (Major) Preclinical data suggest agents that inhibit prostaglandin synthesis such as ibuprofen could decrease the efficacy of photosensitizing agents used in photodynamic therapy. Avoidance of ibuprofen before and during photodynamic therapy may be advisable. [29878] Methyldopa: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Methylprednisolone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Methylsulfonylmethane, MSM: (Moderate) Patients taking methylsulfonylmethane, MSM have reported increased bruising or blood in the stool. These effects have not been confirmed in published medical literature or during clinical studies. Use methylsulfonylmethane, MSM with caution in patients who are taking drugs with the potential for additive bleeding, including nonsteroidal antiinflammatory drugs (NSAIDs). During an available, published clinical trials in patients with osteoarthritis, patients with bleeding disorders or using anticoagulants or platelet inhibiting drugs were excluded from enrollment. Patients who choose to consume methylsulfonylmethane, MSM while receiving NSAIDs should be observed for potential bleeding. [32984] [32986] Metoprolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Mifepristone: (Moderate) Mifepristone significantly increased exposure of drugs metabolized by CYP2C8/2C9 in interaction studies. Therefore, when mifepristone is used chronically, as in the treatment of Cushing's syndrome, use caution with coadministered CYP2C8/2C9 substrates, including the NSAIDs. Use the lowest doses of the substrate and patients should be monitored closely for adverse reactions. [48697] Milnacipran: (Moderate) Platelet aggregation may be impaired by milnacipran due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Monitor for signs and symptoms of bleeding in patients taking milnacipran and NSAIDs. [28275] [29934] Minoxidil: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Mitoxantrone: (Major) Due to the thrombocytopenic effects of mitoxantrone, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [41139] Moexipril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Mometasone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Nabumetone: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [31941] [35893] Nadolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Naproxen: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Naproxen; Pseudoephedrine: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Naproxen; Sumatriptan: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [32122] [35893] Nebivolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Nebivolol; Valsartan: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Nelarabine: (Major) Due to the thrombocytopenic effects of nelarabine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [8493] Neomycin: (Minor) It is possible that additive nephrotoxicity may occur in patients who receive NSAIDs concurrently with other nephrotoxic agents, such as aminoglycosides. [5046] [5062] Neostigmine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Nitroprusside: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Non-Ionic Contrast Media: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent. [28692] [28702] Olmesartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Omacetaxine: (Major) Avoid the concomitant use of omacetaxine and nonsteroidal antiinflammatory drugs (NSAIDs) when the platelet count is less than 50,000 cells/microliter due to an increased risk of bleeding. [52213] Oritavancin: (Moderate) Ibuprofen is metabolized by CYP2C9; oritavancin is a weak CYP2C9 inhibitor. Coadministration may result in elevated ibuprofen plasma concentrations. If these drugs are administered concurrently, monitor patients for NSAID-induced toxicity, such as nausea, GI bleeding, or renal dysfunction. [11310] [11311] [11319] [57741] Oxaprozin: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30565] [35893] Paclitaxel: (Major) Due to the thrombocytopenic effects of paclitaxel, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5938] Paroxetine: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Pegaspargase: (Major) Due to the thrombocytopenic effects of pegaspargase, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7466] Pemetrexed: (Major) Avoid administration of ibuprofen for 2 days before, the day of, and 2 days after administration of pemetrexed in patients with a creatinine clearance (CrCL) between 45 mL/min and 79 mL/min. If concomitant use is unavoidable, monitor these patients more frequently for myelosuppression, renal, and gastrointestinal toxicity. Pemetrexed is an OAT3 substrate and ibuprofen is an OAT3 inhibitor. Concomitant use inhibited the uptake of pemetrexed in OAT3-expressing cell cultures with an average [Iu]/IC50 ratio of 0.38, resulting in increased pemetrexed exposure. In vitro data predict that other NSAIDs would not inhibit the uptake of pemetrexed by OAT3, and thus would not increase the AUC of pemetrexed to a clinically significant extent. In patients with normal renal function (CrCL greaster than 80 mL/min), ibuprofen increased the AUC of pemetrexed by approximately 20%. [28376] Penbutolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Pentamidine: (Major) Avoid concurrent or sequential use of pentamidine with ibuprofen. Coadministration may increase the risk for drug-induced nephrotoxicity. Closely monitor renal function if coadministration is unavoidable. [28879] Pentosan: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Pentostatin: (Major) Due to the thrombocytopenic effects of pentostatin, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [5512] Perindopril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Perindopril; Amlodipine: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Pexidartinib: (Moderate) Monitor for evidence of hepatotoxicity if pexidartinib is coadministered with ibuprofen. Avoid concurrent use in patients with increased serum transaminases, total bilirubin, or direct bilirubin (more than ULN) or active liver or biliary tract disease. [63549] [64535] Phenoxybenzamine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Phentermine; Topiramate: (Moderate) Concurrent use of topiramate and drugs that affect platelet function such as NSAIDs may increase the risk of bleeding. In a pooled analysis of placebo-controlled trials, bleeding was more frequently reported in patients receiving topiramate (4.5%) compared to placebo (2 to 3%). In those with severe bleeding events, patients were often taking drugs that cause thrombocytopenia or affect platelet function or coagulation. [28378] Phentolamine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Photosensitizing agents (topical): (Moderate) Agents that inhibit prostaglandin synthesis such as nonsteroidal antiinflammatory drugs (NSAIDs), could decrease the efficacy of photosensitizing agents used in photodynamic therapy. Avoidance of NSAIDs before and during photodynamic therapy may be advisable. [42968] Physostigmine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Pindolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Piroxicam: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [29613] [35893] Platelet Inhibitors: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Pneumococcal Vaccine, Polyvalent: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. [39165] Polyethylene Glycol; Electrolytes: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [41573] Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [41573] Polymyxin B: (Major) The chronic coadministration of systemic polymyxins may increase the risk of developing nephrotoxicity, even in patients who have normal renal function. Nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when used concurrently. Monitor patients for changes in renal function if these drugs are coadministered. Since Polymyxin B is eliminated by the kidney, coadministration with other potentially nephrotoxic drugs, including nonsteroidal antiinflammatory drugs (NSAIDs), may theoretically increase serum concentrations of either drug. [28447] Polymyxins: (Major) The administration of colistimethate sodium may increase the risk of developing nephrotoxicity, even in patients who have normal renal function. Nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when used concurrently. Monitor patients for changes in renal function if these drugs are coadministered. Since colistimethate sodium is eliminated by the kidney, coadministration with other potentially nephrotoxic drugs, including nonsteroidal antiinflammatory drugs (NSAIDs), may theoretically increase serum concentrations of either drug. [33636] Potassium: (Moderate) Closely monitor serum potassium in patients receiving potassium supplements and concomitant nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may cause potassium retention by reducing renal synthesis of prostaglandin E and impairing the renin-angiotensin system. [53793] Pralatrexate: (Major) Renal elimination accounts for approximately 34% of the overall clearance of pralatrexate. Concomitant administration of drugs that undergo substantial renal clearance, such as nonsteroidal antiinflammatory drugs (NSAIDs), may result in delayed clearance of pralatrexate. [36890] Prasugrel: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Prazosin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Prednisolone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Prednisone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Probenecid: (Major) Probenecid can decrease the renal clearance of nonsteroidal antiinflammatory agents (NSAIDs). Reduction of the NSAID dose may be necessary when it is used together with probenecid. [5071] Procarbazine: (Major) Due to the thrombocytopenic effects of procarbazine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [5356] Propranolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Pyridostigmine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Quinapril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Quinolones: (Moderate) Use quinolones and nonsteroidal anti-inflammatory drugs (NSAIDs) concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. [28423] [28424] [28764] [29947] [43411] [65562] Ramipril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Reserpine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Reteplase, r-PA: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Riluzole: (Moderate) Monitor for signs and symptoms of hepatic injury during coadministration of riluzole and ibuprofen. Concomitant use may increase the risk for hepatotoxicity. Discontinue riluzole if clinical signs of liver dysfunction are present. [29747] [44120] [44121] [63549] Rivaroxaban: (Major) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Rivastigmine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Romidepsin: (Major) An increased risk of bleeding may occur when NSAIDs, such as ibuprofen, are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [37292] Sacubitril; Valsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Salicylates: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Salsalate: (Major) Concomitant use of analgesic doses of aspirin with ibuprofen is generally not recommended due to the increased risk of bleeding, including GI bleeding. Concurrent use of aspirin with NSAIDs may significantly increase the incidence of GI adverse reactions and does not produce greater therapeutic effect compared to the use of NSAIDs alone. The use of ibuprofen with other salicylates can also lead to additive GI toxicity. For patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider the use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or a non-NSAID analgesic. After discontinuation of ibuprofen in patients taking low-dose aspirin, there may be an increased risk of cardiovascular events due to ibuprofen interference with the antiplatelet effect of aspirin. A decrease in antiplatelet activity (53%) was observed at 24 hours after 6 days of ibuprofen 400 mg/day given 2 hours before immediate-release aspirin 81 mg/day. An interaction was still observed, but minimized, when ibuprofen 400 mg/day was given as early as 8 hours before immediate-release aspirin (90.7%). There was no interaction when ibuprofen 400 mg/day was given 2 hours after the immediate-release aspirin dose (99.2%). In a study with enteric-coated aspirin, subjects given aspirin 81 mg/day with ibuprofen 400 mg 3 times daily (2, 7, and 12 hours after aspirin dose) for 6 days, there was an interaction with antiplatelet activity at 24 hours after the day 6 aspirin dose (67%). An in vitro study has shown that the antagonism of aspirin platelet inhibition probably involves competition at platelet-derived COX-1 and is related to the NSAIDs' ability to inhibit COX-1 mediated thromboxane B2 production in platelets. Clinically, the interaction may be more dramatic with routine as compared with intermittent ibuprofen usage. Quantification of the risk was determined by the analysis of retrospective data, which may be inaccurate and incomplete. However, a trend towards a greater risk of a second myocardial infarction in the year after the initial event among adults taking daily aspirin was associated with a greater length of ibuprofen exposure. [27367] [28502] [28982] [32213] [35893] Selective serotonin reuptake inhibitors: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Sertraline: (Moderate) The combined use of selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal antiinflammatory drugs (NSAIDs) may increase the risk of bleeding, including an upper GI bleed. SSRIs may inhibit serotonin uptake by platelets, augmenting the antiplatelet effects of NSAIDs. Additionally, NSAIDs impair the gastric mucosa defenses by inhibiting prostaglandin formation. A cohort study in more than 26,000 patients found that SSRI use alone increased the risk for serious GI bleed by 3.6-fold; when an SSRI was combined with NSAIDs, the risk was increased by more than 12.2-fold. The absolute risk of GI bleed from concomitant therapy with NSAIDs and a SSRI was low (17/4107 patients). [27414] [32127] Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Concomitant use of medicines with potential to alter renal perfusion or function such as nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of acute phosphate nephropathy in patients taking sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous. [32159] [32160] Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Moderate) Use caution when prescribing sodium picosulfate; magnesium oxide; anhydrous citric acid in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [51258] Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). [41573] Sotalol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Spironolactone: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Streptokinase: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Streptomycin: (Moderate) It is possible that additive nephrotoxicity may occur in patients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with other nephrotoxic agents, such as streptomycin. [28370] [30110] [30268] Streptozocin: (Major) An increased risk of bleeding may occur when NSAIDs are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [6757] Sulfinpyrazone: (Moderate) Sulfinpyrazone is an inhibitor of CYP2C9 and may lead to increased plasma levels of NSAIDs. During concurrent therapy, monitor for potential NSAID-induced toxicity, such as GI irritation or bleeding. [4718] [6482] Sulfonylureas: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Sulindac: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [28340] [35893] Tacrine: (Moderate) NSAIDs may cause additive pharmacodynamic GI effects with cholinesterase inhibitors, leading to gastrointestinal intolerance. Patients receiving concurrent NSAIDs should be monitored closely for symptoms of active or occult gastrointestinal bleeding. While NSAIDs appear to suppress microglial activity, which in turn may slow inflammatory neurodegenerative processes important for the progression of Alzheimer's disease (AD), there are no clinical data at this time to suggest that NSAIDs alone or as combined therapy with AD agents result in synergistic effects in AD. [27344] Tacrolimus: (Moderate) Monitor patients for signs of worsening renal function during coadministration of tacrolimus and nonsteroidal antiinflammatory drugs. Coadministration may increase the risk for drug-induced nephrotoxicity. [28611] Telavancin: (Minor) Concurrent or sequential use of telavancin with drugs that inhibit renal prostaglandins such as nonsteroidal antiinflammatory drugs (NSAIDS) may lead to additive nephrotoxicity. Closely monitor renal function and adjust telavancin doses based on calculated creatinine clearance. [36615] [7020] Telbivudine: (Moderate) Drugs that alter renal function such as NSAIDs may alter telbivudine plasma concentrations because telbivudine is eliminated primarily by renal excretion. Monitor renal function before and during telbivudine treatment. [5423] [9671] Telmisartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Temozolomide: (Major) Myelosuppression, primarily neutropenia and thrombocytopenia, is the dose-limiting toxicity of temozolomide. Due to the thrombocytopenic effects of temozolomide, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, ASA, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7578] Tenecteplase: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Teniposide: (Major) Dose-limiting bone marrow suppression is the most significant toxicity associated with teniposide, and may include thrombocytopenia. An additive risk of bleeding may be seen in patients receiving concomitant NSAIDs. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. Salicylates also displace protein-bound teniposide in fresh human serum to a small but significant extent. Because of the extremely high binding of teniposide to plasma proteins, these small decreases in binding could cause substantial increases in plasma free drug concentrations that could result in potentiation of teniposide toxicity, including bone marrow suppression. [5170] [7726] Tenofovir Alafenamide: (Moderate) Avoid administering tenofovir-containing medications concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine clearance, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [30268] [60269] [60688] Tenofovir, PMPA: (Moderate) Avoid administering tenofovir, PMPA concurrently with or recently after a nephrotoxic agent, such as high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs). Cases of acute renal failure, some requiring hospitalization and renal replacement therapy, have been reported after high-dose or multiple NSAIDs were initiated in patients who appeared stable on tenofovir. Consider alternatives to NSAIDs in patients at risk for renal dysfunction. If these drugs must be coadministered, carefully monitor the estimated creatinine creatinine, serum phosphorus, urine glucose, and urine protein prior to, and periodically during, treatment. [28193] [30268] Terazosin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Tezacaftor; Ivacaftor: (Minor) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as ibuprofen. In vitro studies showed ivacaftor to be a weak inhibitor of CYP2C9. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. [48524] Thiazide diuretics: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Thioguanine, 6-TG: (Major) Due to the thrombocytopenic effects of thioguanine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants, NSAIDs, platelet inhibitors, including aspirin, strontium-89 chloride, and thrombolytic agents. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [5853] Thrombolytic Agents: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Ticagrelor: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Ticlopidine: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Timolol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Tinzaparin: (Moderate) An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs). Monitor clinical and laboratory response closely during concurrent use. [29732] [40621] [49946] Tirofiban: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Tobacco: (Moderate) Concomitant use of nonsteroidal antiinflammatory drugs (NSAIDs) with tobacco smoking may enhance the risk of gastrointestinal (GI) side effects. Tobacco smoking may independently increase the risk of peptic ulcer and GI bleeding, and thus may increase the risk with NSAID usage. Patients using tobacco and NSAIDs concurrently should be monitored closely for GI adverse reactions. [28327] [30496] Tobramycin: (Moderate) It is possible that additive nephrotoxicity may occur in patients who receive nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently with other nephrotoxic agents, such as tobramycin. [28370] [30110] [30268] Tolazamide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Tolbutamide: (Moderate) NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. If NSAIDs are administered or discontinued in patients receiving oral antidiabetic agents, patients should be monitored for hypoglycemia or loss of blood glucose control. No clinically significant interaction between sulindac at daily doses of 400 mg and oral hypoglycemic agents has been observed. Sulindac, its sulfide metabolite, and sulfonylureas are highly bound to protein. Sulindac could displace the sulfonylureas, altering hypoglycemic activity. Careful patient monitoring is recommended to ensure that no change in their diabetes medicine dosage is required. A sulfonylurea dose adjustment may be needed, especially if sulindac doses greater than 400 mg daily are used or if the drug combination is used in patients with renal impairment or other metabolic defects that might increase sulindac blood concentrations. [24711] [29374] [51000] Tolmetin: (Major) Avoid concomitant use of ibuprofen with any other NSAID, including COX-2 inhibitors, due to the risk of additive serious NSAID toxicities including but not limited to GI bleeding, GI perforation, or peptic ulcers. [30242] [35893] Topiramate: (Moderate) Concurrent use of topiramate and drugs that affect platelet function such as NSAIDs may increase the risk of bleeding. In a pooled analysis of placebo-controlled trials, bleeding was more frequently reported in patients receiving topiramate (4.5%) compared to placebo (2 to 3%). In those with severe bleeding events, patients were often taking drugs that cause thrombocytopenia or affect platelet function or coagulation. [28378] Torsemide: (Moderate) If a nonsteroidal anti-inflammatory drug (NSAID) and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. Patients taking diuretics and NSAIDs concurrently are at higher risk of developing renal insufficiency. NSAIDs may reduce the natriuretic effect of diuretics in some patients. NSAIDs have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. [30489] [48492] Tositumomab: (Major) The tositumomab therapeutic regimen frequently causes severe and prolonged thrombocytopenia. The potential benefits of medications that interfere with platelet function and/or anticoagulation should be weighed against the potential increased risk of bleeding and hemorrhage. An additive risk of bleeding may be seen in patients receiving concomitant NSAIDs. In addition, large doses of salicylates (>= 3-4 g/day) can cause hypoprothrombinemia, an additional risk factor for bleeding. [5170] [7918] Trandolapril: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Trandolapril; Verapamil: (Moderate) In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors. NSAIDs may attenuate the antihypertensive effects of ACE inhibitors by inhibiting the synthesis of vasodilatory prostaglandins. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, the coadministration of ACE inhibitors may result in a further deterioration of renal function, including acute renal failure. These effects are usually reversible. Therefore, blood pressure and renal function should be monitored closely when an NSAID is administered to a patient taking an ACE inhibitor. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. The potential clinical effects of selective or preferential COX-2 inhibitors are not known. Mean arterial blood pressure increased 3 mmHg in patients receiving ACE inhibitor (benazepril 10 to 40 mg daily for 4 weeks) with rofecoxib 25 mg once daily compared to the ACE inhibitor regimen alone. [24233] [29155] [35075] Trazodone: (Moderate) Platelet aggregation may be impaired by trazodone due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Patients should be instructed to monitor for signs and symptoms of bleeding while taking trazodone concurrently with medications that impair platelet function and to promptly report any bleeding events to the practitioner. [38831] Treprostinil: (Moderate) NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways. [4087] Tretinoin, ATRA: (Moderate) The concomitant use of systemic tretinoin, ATRA and ibuprofen should be done cautiously due to the potential for increased intracranial pressure and an increased risk of pseudotumor cerebri (benign intracranial hypertension). Early signs and symptoms of pseudotumor cerebri include papilledema, headache, nausea, vomiting, and visual disturbances. [28568] [30251] [30252] Triamcinolone: (Moderate) Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged concomitant administration should be avoided. Concomitant use of corticosteroids appears to increase the risk of adverse GI events due to NSAIDs. Corticosteroids can have profound effects on sodium-potassium balance; NSAIDs also can affect sodium and fluid balance. Monitor serum potassium concentrations; potassium supplementation may be necessary. In addition, NSAIDs may mask fever, pain, swelling and other signs and symptoms of an infection; use NSAIDs with caution in patients receiving immunosuppressant dosages of corticosteroids. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. [24574] [29890] [63923] Triamterene: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Urea: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the natriuretic effect of diuretics in some patients. NSAIDS have been associated with an inhibition of prostaglandin synthesis, which may result in reduced renal blood flow leading to renal insufficiency and increases in blood pressure that are often accompanied by peripheral edema and weight gain. Patients taking diuretics and NSAIDS concurrently are at higher risk of developing renal insufficiency. If an NSAID and a diuretic are used concurrently, carefully monitor the patient for signs and symptoms of decreased renal function and diuretic efficacy. [30489] [48492] Urokinase: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, prolong bleeding time; these pharmacodynamic effects may be increased when administered to patients receiving thrombolytic agents. Patients receiving these drugs concurrently should be monitored closely for bleeding. [28469] [30569] Valacyclovir: (Moderate) Monitor patients for signs of worsening renal function during coadministration of valacyclovir and nonsteroidal antiinflammatory drugs. Coadministration may increase the risk for drug-induced nephrotoxicity. [29970] [56268] Valganciclovir: (Minor) Concurrent use of nephrotoxic agents, such as NSAIDs, with valganciclovir should be done cautiously to avoid additive nephrotoxicity. [5193] Valsartan: (Moderate) Nonsteroidal antiinflammatory drugs (NSAIDs) (including selective COX-2 inhibitors) may alter the response to Angiotensin II receptor blockers due to inhibition of vasodilatory prostaglandins. Among NSAIDs, indomethacin, naproxen, and piroxicam may have the greatest pressor effect, while the effects of sulindac and nabumetone may be significantly less. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function who are being treated with NSAIDs, coadministration of angiotensin II receptor antagonists may result in further deterioration of renal function, including acute renal failure. These effects are usually reversible. [24233] [27388] [27991] [28608] [29130] [60860] Vancomycin: (Minor) It is possible that additive nephrotoxicity may occur in patients who receive NSAIDs concurrently with other nephrotoxic agents, including vancomycin. [28370] [28468] [30110] [30268] Vasodilators: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [24233] [26486] [27388] [30489] Vemurafenib: (Major) Concomitant use of vemurafenib and ibuprofen may result in increased ibuprofen concentrations. Vemurafenib is a CYP2C9 inhibitor and ibuprofen is a CYP2C9 substrate. Patients should be monitored for toxicity. [34454] [45335] Venlafaxine: (Moderate) Platelet aggregation may be impaired by venlafaxine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Monitor patients for signs and symptoms of bleeding when coadministering venlafaxine with NSAIDs. [28275] Verteporfin: (Moderate) Use caution if coadministration of verteporfin with nonsteroidal anti-inflammatory drugs is necessary due to the risk of decreased verteporfin efficacy. Oxaprozin may additionally worsen photosensitivity. Verteporfin is a light-activated drug. Once activated, local damage to neovascular endothelium results in a release of procoagulant and vasoactive factors resulting in platelet aggregation, fibrin clot formation, and vasoconstriction. Concomitant use of drugs that decrease platelet aggregation like nonsteroidal anti-inflammatory drugs could decrease the efficacy of verteporfin therapy. [30003] Vilazodone: (Moderate) Platelet aggregation may be impaired by vilazodone due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Patients should be instructed to monitor for signs and symptoms of bleeding while taking vilazodone concurrently with NSAIDs and to promptly report any bleeding events to the practitioner. [43177] Voclosporin: (Moderate) Concomitant use of voclosporin and nonsteroidal anti-inflammatory drugs (NSAIDs) may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required. [66336] [66357] Vorapaxar: (Moderate) NSAIDs can cause GI bleeding, inhibit platelet aggregation, and prolong bleeding time. If NSAIDs are administered with platelet inhibitors, these pharmacodynamic effects may be increased. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen [28435] [29816] [36055] Voriconazole: (Moderate) Voriconazole is a substrate and inhibitor of cytochrome P450 isoenzyme 2C9, which is the isoenzyme responsible for the metabolism of ibuprofen. Thus, increased plasma concentrations of ibuprofen is possible. The clinical significance of this potential interaction is unknown. If voriconazole is administered concurrently with ibuprofen, monitor for NSAID-related side-effects, such as fluid retention or GI irritation, and adjust the dose of the NSAID, if needed. [34447] [4882] Vorinostat: (Major) An increased risk of bleeding may occur when NSAIDs are used with agents that cause clinically significant thrombocytopenia, such as myelosuppressive antineoplastic agents. Monitor closely for bleeding. [32789] Vortioxetine: (Moderate) Platelet aggregation may be impaired by vortioxetine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving nonsteroidal antiinflammatory drugs (NSAIDs). Bleeding events related to drugs that inhibit serotonin reuptake have ranged from ecchymosis to life-threatening hemorrhages. Patients should be instructed to monitor for signs and symptoms of bleeding while taking vortioxetine concurrently with medications which impair platelet function and to promptly report any bleeding events to the practitioner. [56041] Warfarin: (Moderate) Monitor patients for signs or symptoms of bleeding during concurrent use of warfarin and nonsteroidal antiinflammatory drugs (NSAIDs).To minimize the potential for GI bleeding, use the lowest effective NSAID dose for the shortest possible duration. If signs or symptoms of bleeding occur, promptly evaluate and treat. Systemic hematological effects may also occur with the use of topical NSAIDs. NSAIDs inhibit platelet aggregation and may prolong bleeding time in some patients. [28549] [33554] [56268] [61088] [63923] Zafirlukast: (Minor) Zafirlukast inhibits the CYP2C9 isoenzymes and should be used cautiously should be used cautiously in patients stabilized on drugs metabolized by CYP2C9, such as ibuprofen. [4718] [4948]
Revision Date: 07/07/2021, 02:29:00 AM

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Monitoring Parameters

  • blood pressure
  • CBC
  • LFTs
  • serum creatinine/BUN

US Drug Names

  • Advil
  • Advil Children's
  • Advil Children's Fever
  • Advil Infants'
  • Advil Junior Strength
  • Advil Migraine
  • Caldolor
  • Children's Ibuprofen
  • ElixSure IB
  • EnovaRX
  • Genpril
  • Ibren
  • IBU
  • Midol
  • Midol Cramps and Body Aches
  • Motrin
  • Motrin Children's
  • Motrin IB
  • Motrin Infants'
  • Motrin Junior Strength
  • Motrin Migraine Pain
  • PediaCare Children's Pain Reliever/Fever Reducer IB
  • PediaCare Infants' Pain Reliever/Fever Reducer IB
  • Samson-8
;