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Table 1 Potential drug interactions with OTC analgesics[5,42,43]

From: OTC analgesics and drug interactions: clinical implications

Drug combinations Effect Management options/considerations
Aspirin and NSAIDs or multiple NSAIDs Increased risk of serious GI complications. Risk increases with increased dose and number of agents Avoid concurrent use of more than one NSAID, if possible. Consider adding gastroprotective agents
Anticoagulants and NSAIDs Increased risk of bleeding (especially GI) and increased oral warfarin activity Avoid concurrent use of NSAID; monitor prothrombin time and occult blood in urine and stool
Corticosteroids and NSAIDs Increased GI side effects, including ulceration and hemorrhage Avoid concurrent use of NSAID and consider adding a gastroprotective agent
SSRIs and NSAIDs Increased risk of GI bleeding Avoid concurrent use of NSAID
Aspirin and ibuprofen or naproxen Reduced antiplatelet effects of aspirin Not seen with other NSAIDs or acetaminophen
Antihypertensive agents and NSAIDs Use of NSAIDs may increase blood pressure Monitor blood pressure and cardiac function
Antidiabetic agents (eg, sulfonylureas) and aspirin Increased hypoglycemic effect Avoid concurrent use and monitor blood glucose concentration
Lithium and NSAIDs Increased steady-state lithium concentration and lithium toxicity Monitor lithium concentrations. Interactions are less likely with aspirin than with naproxen or ibuprofen
Methotrexate and NSAIDs Reduced renal clearance. Increased plasma methotrexate concentration Avoid NSAIDs with high-dose methotrexate
  1. GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug; OTC = over the counter; SSRI = selective serotonin reuptake inhibitor.