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Luai Al Bakour
El Temamy Pharmacy
Akoni Hijyen Teknolojileri Sanayi ve Dış Ticaret LTD. ŞTİ
Britton Chance Center for Biomedical Photonics
Arabian Trade Center - ATC
Medical Facility (32206):
Legality International. (Pvt.) Ltd.
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Colic; dyskinesia; menstrual disorders
Allergic rhinitis, sinusitis, urticaria or asthma sensitive to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Hypersensitivity to ibuprofen.
Alcohol: the use of alcohol after ingestion of ibuprofen may increase the risk of upper gastrointestinal bleeding additive effect on the gastric mucosal damage. Avoid drinking alcohol within 12 hours after the administration of ibuprofen and enteric-coated formulations used. "Alendronate: the use of alendronate may increase gastrointestinal adverse effects of ibuprofen. Monitor their appearance. "Aminoglycosides: Concomitant use may increase the nephrotoxic effects of aminoglycosides and that NSAIDs can reduce renal excretion thereof. It is suggested that renal function monitoring during coadministration. "Oral anticoagulants: oral anticoagulant use may cause increased risk of bleeding from protein binding displacement of anticoagulants. Avoid the association and if used the same monitor INR, signs and symptoms of GI bleeding and adjust the dose of anticoagulant. -Aspirin: the use of ibuprofen with aspirin may decrease the effectiveness of the latter for platelet aggregation due to competition for binding site cyclooxygenase 1 (COX1). It is recommended in patients receiving antiplatelet aspirin and ibuprofen, used occasionally, swallow the aspirin two hours after taking ibuprofen. In patients using ibuprofen chronically and should receive antiplatelet therapy, rotate acetaminophen or ibuprofen a selective inhibitor of COX2. Alpha-blockers -1 Adrenoceptor: the administration of an NSAID along with an alpha blocker -1 Can result in a reduction of the antihypertensive effect with increased blood pressure values for interfering with the production of vasodilator prostaglandins and natriuretic renal vasodilator. Monitor blood pressure and adjust the dose of alpha blockers -1. Beta-adrenergic blockers: the administration of an NSAID along with a beta blocker may produce an antihypertensive effect decreased with increased blood pressure values for interfering with production of vasodilator prostaglandins renal vasodilator and natriuretic. Monitor blood pressure and adjust the dose of beta blocker. "Calcium channel blockers: the administration of an NSAID with a calcium channel blocker may produce an antihypertensive effect decreased with increasing blood pressure values. In addition, there has been an increased risk of gastrointestinal bleeding with verapamil and diltiazem. Monitor blood pressure, and in patients treated with verapamil and diltiazem control the appearance of signs or symptoms of gastrointestinal bleeding. "Cyclosporin: use of an NSAID with cyclosporine may increase concentrations of the latter as well as increasing the risk of renal toxicity. Measuring cyclosporin in blood and monitor kidney function and adjust the dose. "Clopidogrel: Concurrent administration with clopidogrel may increase the risk of gastrointestinal bleeding due to the antiplatelet effect of the latter. Check for signs or symptoms of gastrointestinal bleeding. -Cholestyramine: Concomitant administration of these drugs reduces the absorption of NSAIDs, which points to the separate administration of two or more hours to reduce the risk of this interaction. -Digoxin: NSAIDs can increase blood digoxin concentration. Monitor signs of toxicity for the same. Potassium-sparing diuretics: Use in conjunction with a NSAID can result in decreased antihypertensive effect and increase the risk of renal toxicity and hyperkalemia by decreasing prostaglandin synthesis of renal vasodilator and that NSAIDs may produce a state of hyperaldosteronism hiporeninémico. Monitor blood pressure values, potassium and renal function. -Diuretics: use of loop diuretics or thiazides concurrently with a NSAID may decrease the diuretic and antihypertensive effect of them, possibly by decreasing the production of renal vasodilatory prostaglandins. Monitor blood pressure and peripheral edema. "Eptifibatide: the use of an NSAID with eptifibatide simultaneously increases the risk of bleeding by additive effects on platelets. Avoid this association, using it only when the benefits of it outweigh the increased risk of bleeding. Using them jointly monitor signs and symptoms of bleeding. -Phenytoin is possible that concomitant use increases occur in plasma levels of phenytoin with increased risk of toxicity. The likely mechanism would be in reduced metabolism at the level of cytochrome P450. Although the information is not conclusive, given the low therapeutic index of phenytoin is recommended to monitor plasma levels and adjust dose. -Ginkgo: use increases the risk of bleeding from the antiplatelet effect of ginkgo. Monitor signs of bleeding. Low-molecular-weight heparin (LMWH): the use of low molecular weight heparins in conjunction with an NSAID increases the risk of bleeding from the effect on platelets of the latter, in particular increases the risk of gastrointestinal bleeding or spinal or epidural hematomas in patients who receive anesthesia through these pathways. In these patients, monitor for signs of gastrointestinal bleeding and NSAIDs discontinued several days before the surgical procedure. If no anti-inflammatory analgesia using paracetamol or opioids. -Heparinoids: the use of heparinoids with an NSAID increases the risk of bleeding by the effect on platelets in humans, in particular increases the risk of spinal or epidural hematomas in patients who receive anesthesia through these pathways. In these patients discontinued NSAIDs several days before surgery. If no anti-inflammatory analgesia using paracetamol or opioids. -Hydralazine-may decrease the antihypertensive effect of hydralazine by inhibiting production of vasodilator prostaglandins. Monitor the effectiveness of hydralazine and blood pressure. -Herbs (anise, blueberry, garlic, ginseng, licorice): Concomitant use of these herbs, and ibuprofen increases the risk of bleeding (anticoagulants contain herbs or inhibit the production and / or platelet function). Is suggested to avoid concomitant use. "Ibandronate: use with NSAIDs may increase gastric irritation additive effects on the mucosa. With caution and monitor signs and symptoms of GI bleeding. "Inhibitors of angiotensin converting enzyme (ACE): The administration of an NSAID along with an ACE inhibitor can result in decreased antihypertensive effect with increased blood pressure values for interfering with the production of vasodilator prostaglandins and natriuretic renal vasodilator. They can also increase plasma potassium concentrations. Monitor blood pressure and heart function, as well as the values of calemia and renal function especially in patients with renal disease or predisposing factors for it. "Selective inhibitors of serotonin reuptake inhibitors (SSRIs): use of SSRIs with NSAIDs leads to an increased risk of gastrointestinal bleeding. In the particular case of ketorolac in combination with fluoxetine have been recorded episodes of hallucinations, so this association should be avoided. If you use other NSAIDs along with an SSRI should monitor signs and symptoms of GI bleeding. "Ketorolac: the simultaneous use of ketorolac with other NSAIDs significantly increases the risk of gastrointestinal adverse effects (ulcers, gastrointestinal bleeding, perforation) for cumulative effect. They should not be coadministered. , "Levofloxacin: the use of an NSAID and levofloxacin may increase the risk of seizures in patients with a history of epilepsy or seizures by inhibiting the action of gamma-aminobutyric acid (GABA) at the central level. Use alternative therapy in patients at risk. Lithium: lithium use may increase lithium levels by decreasing its renal clearance. Litemia monitor and adjust the dose. -Methyldopa: an NSAID administration with methyldopa may result in decreased antihypertensive effect with increased blood pressure values for interfering with the production of vasodilator prostaglandins and natriuretic renal vasodilator. Blood pressure monitor and adjust the dose of methyldopa. "Methotrexate: use increases the risk of methotrexate toxicity due to increased plasma levels secondary to a decrease in renal clearance by tubular secretion compentencia acids. It is recommended not to administer NSAIDs within 10 days of the use of high doses of methotrexate (chemotherapy), otherwise, as well as use of low-dose (immunosuppressive) use with caution and monitor the adverse effects of methotrexate. "Ofloxacin: the use of an NSAID and ofloxacin may increase risk of seizures in patients with a history of epilepsy or seizures by inhibiting the actions of gamma-aminobutyric acid (GABA) at central. Use alternative therapy in patients at risk. "Pemetrexed: concomitant use of these drugs increases the toxicity of pemetrexed (myelosuppression, nephrotoxicity, gastrointestinal toxicity) and that NSAIDs interfere with renal excretion. Is suggested to avoid the concomitant use of these drugs, if not, monitor the patient clinically. -Sulfonylureas: the use of sulfonylureas with an NSAID may increase the risk of hypoglycemia possibly due to inhibition of metabolism and protein binding competition. This effect is seen more often with first-generation sulfonylureas (clorpropramida, tolbutamide, glibenclamide). Monitor blood glucose and for signs and symptoms of hypoglycemia, dose adjustment. -Tacrine: NSAID use may enhance the hepatotoxic effect of tacrine. Avoid the association, otherwise, monitor liver function during combination therapy. "Tacrolimus: an NSAID use simultaneously with tacrolimus may lead to kidney failure probably by inhibiting the production of renal vasodilatory prostaglandins. Avoid this association or failing to monitor kidney function. -Valerian: the joint use increases the risk of hepatotoxicity. Avoid co-administration, if not, monitor liver function. "Vancomycin: In neonates, NSAIDs decrease the excretion of vancomycin, which points to monitor vancomycin serum levels to adjust dose.
Renal failure. History of gastrointestinal bleeding, perforation or gastrointestinal ulceration. Hypertension or edematous tables. Liver failure. Hemorrhagic diathesis. Alcoholism (power hepatic and gastrointestinal toxicity).
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Samir Moussa M.D.
Dr . Dirar Abboud
Dr. Faisal Dibsi
Dr. Talal Sabouni
Dr. Tahsin Martini
Dr. Hani Najjar
Dr. Samer Al-Jneidy
Yaser Habrawi , F.R.C.S.Ed