Acenocoumarol
Adverse Effect: an increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including fenoprofen. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation
Amiloride
Adverse Effect: reduced diuretic effectiveness, hyperkalemia, or possible nephrotoxicity Clinical Management: When administering Piroxicam and Amiloride concurrently, monitor the patient for decreased effectiveness of the diuretic and hyperkalemia. Monitor blood pressure, weight changes, urine output, potassium levels, and creatinine levels.
Amlodipine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Ardeparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Aspirin
Adverse Effect: Gastrointestinal hemorrhage Clinical Management: When aspirin and piroxicam are administered concomitantly, patients should be observed for signs of gastrointestinal bleeding such as coffee ground emesis and black, tarry stools.
Atenolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Benazepril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Betaxolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Bisoprolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Bumetanide
Adverse Effect: decreased diuretic and antihypertensive efficacy Clinical Management: When administering Bumetanide and Piroxicam concurrently, monitor blood pressure and weight. Also, follow the patient for decreased urine output and increased edema.
Captopril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Carvedilol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Celiprolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Chlorpropamide
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When Piroxicam is coadministered with Chlorpropamide , patients should be monitored more closely for hypoglycemia. Dose of Chlorpropamide may need to be reduced when Piroxicam is added to therapy.
Chlorthalidone
Adverse Effect: Decreased diuretic and antihypertensive efficacy Clinical Management: When administering thiazide diuretics and nonsteroidal antiinflammatory agents (NSAIDs) concurrently, monitor blood pressure and weight. Also, follow the patient for decreases in urine output and increased edema.
Clopamide
Adverse Effect: Decreased diuretic and antihypertensive efficacy Clinical Management: When administering thiazide diuretics and nonsteroidal antiinflammatory agents (NSAIDs) concurrently, monitor blood pressure and weight. Also, follow the patient for decreases in urine output and increased edema.
Dalteparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Diltiazem
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Enalapril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Enoxaparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Esmolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Felodipine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Flunarizine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Frusemide
Adverse Effect: decreased diuretic and antihypertensive efficacy Clinical Management: When administering Frusemide and Piroxicam concurrently, monitor blood pressure and weight. Also, follow the patient for decreased urine output and increased edema.
Glibenclamide
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Piroxicam is coadministered with Glibenclamide , patients should be monitored more closely for hypoglycemia. Dose of Glibenclamide may need to be reduced when Piroxicam is added to therapy.
Gliclazide
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Glimepiride
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Glipizide
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Indapamide
Adverse Effect: Decreased diuretic and antihypertensive efficacy Clinical Management: When administering thiazide diuretics and nonsteroidal antiinflammatory agents (NSAIDs) concurrently, monitor blood pressure and weight. Also, follow the patient for decreases in urine output and increased edema.
Ketorolac
Adverse Effect: enhanced gastrointestinal adverse effects (peptic ulcers, gastrointestinal bleeding and/or perforation) Clinical Management: Concomitant use of ketorolac and other nonsteroidal antiinflammatory agents is contraindicated.
LMWH sod.salt
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Labetalol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Lacidipine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Levobunolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Lisinopril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Lithium
Adverse Effect: Lithium toxicity (weakness, tremor, excessive thirst, confusion) Clinical Management: If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for any symptoms of toxicity. A decrease in the lithium dose may be required.
Methotrexate
Adverse Effect: methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations) Clinical Management: In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Metoprolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Nadroparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Nifedipine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Nimodipine
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Nitrendipine
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Ofloxacin
Adverse Effect: an increased risk of seizures Clinical Management: Ofloxacin should be used cautiously in patients receiving other medications which may lower the seizure threshold, including nonsteroidal antiinflammatory drugs (NSAIDs). Alternative therapy should be considered, especially in patients who are predisposed to seizure activity.
Oxprenolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Perindopril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Phenindione
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of Piroxicam , including piroxicam. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the phenindione dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Pindolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Propranolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Ramipril
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Reviparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Sotalol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Spironolactone
Adverse Effect: reduced diuretic effectiveness, hyperkalemia, or possible nephrotoxicity Clinical Management: When administering Piroxicam and Spironolactone concurrently, monitor the patient for decreased effectiveness of the diuretic and hyperkalemia. Monitor blood pressure, weight changes, urine output, potassium levels, and creatinine levels.
Timolol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Tinzaparin
Adverse Effect: an increased risk of bleeding and an increased risk of hematoma when neuraxial anesthesia is employed Clinical Management: Patients receiving a low molecular weight heparin and a nonsteroidal antiinflammatory agent (NSAID) concurrently should be monitored closely for bleeding, which may be serious. Gastrointestinal bleeding is a particular concern with this combination, as is the development of a spinal or epidural hematoma in patients who receive epidural/spinal anesthesia or spinal puncture prior to low molecular weight heparin therapy. NSAID therapy should be discontinued several days prior to surgery.
Tolbutamide
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Verapamil
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving oral anticoagulation, the prothrombin time (PT) or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with nonsteroidal antiinflammatory drugs (NSAIDs), including piroxicam. Coagulation parameters should also be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. Clinicians and patients should be aware of the increased potential for bleeding, especially from the gastrointestinal tract, during concomitant therapy.
Xipamide
Adverse Effect: Decreased diuretic and antihypertensive efficacy Clinical Management: When administering thiazide diuretics and nonsteroidal antiinflammatory agents (NSAIDs) concurrently, monitor blood pressure and weight. Also, follow the patient for decreases in urine output and increased edema |