NSAIDs coagulation

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Administration of zafirlukast and aspirin increases plasma levels of zafirlukast, When zafirlukast is administered with warfarin, there is an increased effect of the anti coagulant. Administration of zafirlukast and theophylline or erythromycin may result in a decreased level of zafirlukast. Administration of montelukast with other drugs has not revealed any adverse responses. Administration of montelukast with aspirin and NSAIDs is avoided in patients with known aspirin sensitivity. Administration of zileuton with propranolol increases the activity or the propranolol with theophylline increases serum theophylline levels and with warfarin may increase prothrombin time (PT). A prothrombin blood test should be done regularly in the event dosages of warfarin need to be decreased. 

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

Lower dose of warfarin (titrate to goal INR) Minimize NSAID use while on warfarin Increased dose of warfarin may be needed estrogens contraindicated in patient with coagulation disorder Monitor INR carefully during course of antibiotics reduce dose of warfarin if necessary... 

All NSAIDs are contraindicated in patients with active peptic ulceration and in those who have a history of hypersensitivity to any NSAID. They should be used with caution in older people (because of the risk of serious gastrointestinal side effects and drug-induced hepatitis), in allergic disorders including asthma, during pregnancy and in coagulation disorders. 

Tolerability, reduction of adverse events in recommended doses, acetaminophen does not irritate the lining of the stomach, affect blood coagulation as much as NSAIDs or affect the fimction of the kidneys. It is safe in pregnancy and does not affect the closure of the fetal ductus arteriosus as NSAIDs can. Unlike aspirin, acetaminophen is safe in children as it is not associated with a risk of Reye s syndrome in children with viral illnesses. Unlike opioids, acetaminophen does not cause euphoria, alter mood, or pose a risk of addiction, dependence, tolerance, and withdrawal. 

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