Paracetamol Diflunisal

Diflunisal Overdose (15 g) of diflunisal leads to poisoning, which could be fatal.51 Treatment can be given by gastric lavage and supportive care. Interactions of diflunisal with indomethacin, paracetamol, antacids, benzodiazepines, and probenecid have been reported.5 Concomitant use with indomethacin should be avoided, as this could cause fatal GI complications. 

In contrast to alcohols, phenols form stable sulfate esters (reaction 2). The reaction is usually of high affinity (i.e., rapid), but the limited availability of PAPS restricts the amounts of conjugate being produced. Typical drugs undergoing limited sulfation include paracetamol (8) (Fig. 13.10) and diflunisal (20) (Fig. 13.19). 

Paracetamol levels are increased by diflunisal. Aspirin, diclofenac, nabumetone and sulindac pharmacokinetics do not appear to be affected by paracetamol. There is no pharmacokinetic interaction between ibuprofen and paracetamol. Propacetamol, and possibly paracetamol, increase the antiplatelet effects of diclofenac, although the evidence is limited and the clinical relevance of this is uncertain. 

Diflunisal. Diflunisal significantly raised serum paraeetamol levels by 50% but the total bioavailability was unehanged in healthy subjects. Diflunisal levels were not affected. This interaetion has not been shown to be clinically important. Nevertheless, the manufaeturer of diflunisal ree-ommends that the combination should be used with eaution, beeause ofthe association of high levels of paracetamol with hepatotoxieity. ... 

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