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

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