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 |