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 Paracetamol 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 Ardeparin and Paracetamol 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 Ardeparin . Paracetamol should be discontinued several days prior to surgery.
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 Paracetamol concurrently, monitor blood pressure and weight. Also, follow the patient for decreased urine output and increased edema.
Busulphan
Adverse Effect: Reduced busulfan clearance Clinical Management: Until the clinical significance of this interaction is further defined, acetaminophen use should be minimized or eliminated less than 72 hours before the administration of busulfan.
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.
Carbamazepine
Adverse Effect: An increased risk of acetaminophen hepatotoxicity Clinical Management: At usual therapeutic oral doses of carbamazepine and acetaminophen, no special monitoring is required.
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.
Chloramphenicol
Adverse Effect: Chloramphenicol toxicity (vomiting, hypotension, hypothermia) Clinical Management: Monitor chloramphenicol concentrations and adjust dosage of chloramphenicol as necessary.
Chlorpropamide
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Paracetamol is coadministered with Chlorpropamide , patients should be monitored more closely for hypoglycemia. Doses of the Chlorpropamide may need to be reduced when Paracetamol 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 Paracetamol 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 Paracetamol is coadministered with Glibenclamide , patients should be monitored more closely for hypoglycemia. Dose of Glibenclamide may need to be reduced when Paracetamol is added to therapy.
Gliclazide
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Paracetamol is coadministered with Gliclazide, patients should be monitored more closely for hypoglycemia. Doses of Gliclazide may need to be reduced when Paracetamol is added to therapy.
Glimepiride
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Paracetamol is coadministered with Glimepiride , patients should be monitored more closely for hypoglycemia. Dose of Glimepiride may need to be reduced when Paracetamol is added to therapy.
Glipizide
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Paracetamol is coadministered with Glipizide , patients should be monitored more closely for hypoglycemia. Dose of Glipizide may need to be reduced when Paracetamol is added to therapy.
INH
Adverse Effect: An increased risk of hepatotoxicity Clinical Management: Acetaminophen use should be limited in patients taking isoniazid.
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.
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.
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 Paracetamol and Nimodipine 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.
Phenytoin
Adverse Effect: Decreased acetaminophen effectiveness and an increased risk of hepatotoxicity Clinical Management: Patients receiving phenytoin therapy should avoid large and/or chronic doses of acetaminophen. Monitor the patient for evidence of hepatotoxicity. 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 Paracetamol 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 Paracetamol is coadministered with Tolbutamide , patients should be monitored more closely for hypoglycemia. Doses of Tolbutamide may need to be reduced when Paracetamol is 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: Patients receiving warfarin or other coumarin anticoagulants should be cautioned to limit their intake of acetaminophen; a prudent rule of thumb would be to use no more than 2 grams of acetaminophen per day for no more than a few days. Patients needing to take larger doses of acetaminophen (or for longer periods) should have intensified monitoring of prothrombin times in order to assess any effect on anticoagulant response.
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.
Zidovudine
Adverse Effect: neutropenia; acetaminophen toxicity (hepatotoxicity)
Clinical Management: Avoid chronic/multiple-dose acetaminophen use in patients on zidovudine therapy. Alternatively, aspirin or ibuprofen should be considered in place of acetaminophen. However, if chronic acetaminophen and zidovudine are to be given concurrently, monitor not only white blood count but also liver function tests, particularly in malnourished patients. |