NSAIDs interactions

Diclofenac is a non-steroidal anti-inflammatory drug. NSAIDs interact with both angiotensin-converting enzyme inhibitors, such as enalapril, and beta-adrenoceptor blockers, such as atenolol, resulting in antagonism to the hypotensive reaction, leading to a hypertensive reaction. NSAIDs interact with... 

Kinetic studies of COX inhibition reveal that many NSAIDs interact with COX through a multistep mechanism in which a rapid, reversible step is followed by one or more slow steps that may be poorly reversible (Eq. 2) (9, 10) ... 

Discuss the types, uses, general drug actions, common adverse reactions, contraindications, precautions, and interactions of the NSAIDs. 

The hypotensive effects of most antihypertensive dru are increased when administered with diuretics and other antihypertensives. Many dnigp can interact with the antihypertensive drugs and decrease their effectiveness (eg, antidepressants, monoamine oxidase inhibitors, antihistamines, and sympathomimetic bronchodilators). When the ACE inhibitors are administered with the NSAIDs, their antihypertensive effect may be decreased. Absorption of the ACE inhibitors may be decreased when administered with the antacids. Administration of potassium-sparing diuretics or potassium supplements concurrently with the ACE inhibitors may cause hyperkalemia. When the angiotensin II receptor agonists are administered with... 

Non-selective NSAIDs [those that inhibit both cyclooxygenase-1 and -2 (COX-1 and COX-2)] cause gastric mucosal damage by two primary mechanisms (1) a direct toxic interaction and (2) systemic pharmacologic actions. 

Evaluate for adverse effects and drug interactions. For patients on topical therapy, evaluate for local adverse effects. For patients on acetaminophen or NSAIDs, inquire about alcohol use. 

Herbette, L. G. Vecchiarelli, M. Tmmlitz, G., NSAID Mechanism of Action Membrane Interactions in the Role of Intracellular Pharmacokinetics, Vane, Botting, Botting, pp. 85-102 (1995). 

Animal studies indicate that the pathogenesis of NSAID small intestinal toxicity involves multiple interactions dependent on enterohepatic circulation, epithelial permeability, neutrophil infiltration and bacterial infection [233]. Several investigations [234-238] have suggested that bacterial flora may play a role in the pathogenesis of NSAID bowel injury and Robert and Asano [239] did show more than 25 years ago that germ-free rats are resis-... 

The most potentially serious drug interactions include the concomitant use of NSAIDs with lithium, warfarin, oral hypoglycemics, high-dose methotrexate, antihypertensives, angiotensin-converting enzyme inhibitors, fi-blockers, and diuretics. 

The interaction between NSAID and diuretics is not taken into consideration... 

Drug interactions Diuretics" NSAIDs (e.g., ibuprofen)" Lamotrigine Clozapine" Contraceptives HIV protease inhibitors" ... 

Drugs that may interact include digoxin, potassium preparations, ACE inhibitors, and NSAIDs. 

Unexpectedly severe (sometimes fatal) bone marrow suppression, aplastic anemia, and Gl toxicity have occurred with coadministration of methotrexate (usually in high dosage) along with some NSAIDs (see Precautions. Drug Interactions). 

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