Treximet (naproxen / sumatriptan) Disease Interactions

There are 14 disease interactions with Treximet (naproxen / sumatriptan):

5-Ht1 Agonists (Includes Treximet) ↔ Cad Risk Factors

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus, History (Familial) - Ischemic Heart Disease, Hyperlipidemia, Menopausal Disorders, Obesity, Smoking

The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease. As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur. Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

References

  1. Mueller L, Gallagher RM, Ciervo CA "Vasospasm-induced myocardial infarction with sumatriptan." Headache 36 (1996): 329-31
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references

5-Ht1 Agonists (Includes Treximet) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Cardiovascular Disease, Cerebral Vascular Disorder, History - Cerebrovascular Disease

The use of 5-hydroxytryptamine1 receptor (5-HT1) agonists is contraindicated in patients with a current or past history of ischemic cardiac, cerebrovascular, and/or peripheral vascular diseases. In addition, these agents should not be used in patients with significant underlying cardiovascular diseases or uncontrolled hypertension. 5-HT1 agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. Cerebrovascular events have included cerebral hemorrhage, subarachnoid hemorrhage, and stroke, some resulting in fatalities. However, the relationship to 5-HT1 agonists is uncertain and, in a number of cases, the cerebrovascular events may have been primary where symptoms were mistaken to be migraine.

References

  1. Ottervanger JP, Paalman HJ, Boxma GL, Stricker BH "Transmural myocardial infarction with sumatriptan." Lancet 341 (1993): 861-2
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references

Nsaids (Includes Treximet) ↔ Asthma

Severe Potential Hazard, High plausibility

Applies to: Asthma

Approximately 10% of patients with asthma may have aspirin-sensitive asthma, characterized by nasal polyposis, pansinusitis, eosinophilia, and precipitation of asthma and rhinitis attacks after ingestion of aspirin. The use of aspirin in these patients has been associated with severe bronchospasm and fatal anaphylactoid reactions. Since cross-sensitivity has been noted between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), therapy with any NSAID should be avoided in asthmatic patients with a history of aspirin or other NSAID sensitivity, and administered cautiously in all patients with preexisting asthma. Prior to initiating therapy with NSAIDs, patients should be questioned about previous allergic-type reactions to these agents. Salicylate salts, salsalate, salicylamide, and acetaminophen may be appropriate alternatives in patients with a history of NSAID-induced bronchospasm, since cross-sensitivity to these agents appears to be low. However, cross-sensitivity has been demonstrated occasionally with high dosages of these agents (e.g., acetaminophen >= 1000 mg), thus it may be appropriate to initiate therapy with low dosages and increase gradually. There is some evidence suggesting that COX-2 inhibitors may be safely used in patients with aspirin-sensitive asthma, although the labeling for these products contraindicate such use. If necessary, aspirin desensitization may also be attempted in some patients under medical surveillance.

References

  1. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  3. Stevenson DD, Hougham AJ, Schrank PJ, Goldlust MB, Wilson RR "Salsalate cross-sensitivity in aspirin-sensitive patients with asthma." J Allergy Clin Immunol 86 (1990): 749-58
View all 38 references

Nsaids (Includes Treximet) ↔ Fluid Retention

Severe Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Hypertension, Fluid Retention

Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

References

  1. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med 158 (1998): 1108-12
  2. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. Lewis RV, Toner JM, Jackson PR, Ramsay LE "Effects of indomethacin and sulindac on blood pressure of hypertensive patients." Br Med J 292 (1986): 934-5
View all 29 references

Nsaids (Includes Treximet) ↔ Gi Toxicity

Severe Potential Hazard, High plausibility

Applies to: Peptic Ulcer, Gastrointestinal Hemorrhage, Gastrointestinal Perforation, Duodenitis/Gastritis, History - Peptic Ulcer, Alcoholism, Colitis/Enteritis (Noninfectious), Colonic Ulceration, Smoking

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal mucosal damage, the risk of which appears to be related to both dosage and duration of therapy. Serious GI toxicity such as bleeding, ulceration and perforation can develop at any time, with or without warning symptoms, and occurs in approximately 1% of patients treated for 3 to 6 months and 2% to 4% of patients treated for one year. These trends continue with longer duration of use, although short-term therapy is not without risk. While agents that selectively inhibit cyclooxygenase-2 (i.e., COX-2 inhibitors) are generally thought to be associated with a reduced risk of GI toxicity compared to conventional NSAIDs, they have not been proven risk-free. In addition, there is evidence that COX-2 inhibitors may delay healing of gastric ulcers, and likely to the same extent as traditional NSAIDs. Thus, therapy with all NSAIDs, including COX-2 inhibitors, should be prescribed cautiously in patients with a history of peptic ulcer disease and/or gastrointestinal bleeding. Patients with such a history who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. Caution is also advised if NSAIDs are prescribed to patients with other risk factors such as oral corticosteroid or anticoagulant use, alcohol use, smoking, older age, and poor general health status. Particular vigilance is necessary when treating elderly (i.e., age 60 years or more) and/or debilitated patients, since they are often more susceptible to the GI toxicity of these drugs and seem to tolerate ulceration and bleeding less well than younger, healthier individuals. Whenever possible, especially if prolonged use is anticipated, treatment with non-ulcerogenic agents should be attempted first. If NSAIDS are used, patients should be treated with the lowest effective dosage for the shortest duration possible, and prophylactic therapy with a cytoprotective agent (e.g., misoprostol), histamine H2-receptor antagonist, or a proton pump inhibitor should be administered as necessary. Patients should be counseled to avoid or minimize consumption of alcohol during NSAID therapy. Three or more alcoholic drinks per day during NSAID use may increase the risk of gastrointestinal ulceration and bleeding. Patients should also be advised to promptly seek medical attention if they experience symptoms that could indicate serious GI tract ulceration or bleeding such as epigastric pain, dyspepsia, melena, and hematemesis.

References

  1. Levy M, Miller DR, Kaufman DW, Siskind V, Schwingl P, Rosenberg L, Strom B, Shapiro S "Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other nonnarcotic analgesics." Arch Intern Med 148 (1988): 281-5
  2. Scott B "Bleeding massive gastric ulcer on diflunisal (Dolobid) ." Br Med J 1 (1979): 489
  3. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
View all 99 references

Nsaids (Includes Treximet) ↔ Rash

Severe Potential Hazard, High plausibility

Applies to: Dermatitis - Drug-Induced

Severe, potentially fatal dermatologic reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and other exfoliative dermatitis have been associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These events may occur without warning. Patients should be advised to discontinue the NSAID and seek medical attention promptly at the first sign of rash, blisters, fever, itching, or any other sign of hypersensitivity.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  3. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
View all 16 references

Nsaids (Includes Treximet) ↔ Renal Toxicities

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction, Dehydration, Hyponatremia, Liver Disease, Congestive Heart Failure

Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with renal toxicities, including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. In patients with pre-renal conditions whose renal perfusion may be dependent on the function of prostaglandins, NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Patients at greatest risk for this reaction include geriatric patients and those with impaired renal function, heart failure, liver dysfunction, or substantial volume and/or sodium depletion (e.g., due to diuretics). Therapy with NSAIDs should be administered cautiously in such patients, and hypovolemia and hyponatremia should be corrected prior to initiating treatment. Clinical monitoring of renal function is recommended during therapy, particularly in the presence of manifestations associated with mild azotemia (e.g., malaise, fatigue, loss of appetite). If renal function declines or renal failure occurs, prompt discontinuation of NSAID therapy will usually lead to recovery to the pretreatment state. NSAIDs are generally not recommended for patients with advanced renal disease due to the lack of information from controlled clinical studies regarding their use in such patients.

References

  1. Cefali EA, Poyner WJ, Sica D, Cox S "Pharmacokinetic comparison of flurbiprofen in end-stage renal disease subjects and subjects with normal renal function." J Clin Pharmacol 31 (1991): 808-14
  2. Beun GD, Leunissen KM, Van Breda Vriesman PJ, Van Hooff JP, Grave W "Isolated minimal change nephropathy associated with diclofenac." Br Med J (Clin Res Ed) 295 (1987): 182-3
  3. Eriksson L-O, Sturfelt G, Thysell H, Wollheim FA "Effects of sulindac and naproxen on prostaglandin excretion in patients with impaired renal function and rheumatoid arthritis." Am J Med 89 (1990): 313-21
View all 152 references

Nsaids (Includes Treximet) ↔ Thrombosis

Severe Potential Hazard, High plausibility

Applies to: Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Ischemic Heart Disease

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with an increased risk of cardiovascular thrombotic events such as myocardial infarction and stroke, which can be fatal. The risk may increase with duration of use. Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to three years duration have supported this association. Although not all NSAIDs have been studied, investigators believe it may be a class effect, and that the risk may be similar for all NSAIDs, both COX-2 selective and nonselective. Therapy with NSAIDs should be administered cautiously in patients with a history of cardiovascular or cerebrovascular disease. Patients should be treated with the lowest effective dosage for the shortest duration necessary. Appropriate antiplatelet therapy should be administered to patients requiring cardioprotection. However, there is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious cardiovascular thrombotic events associated with NSAID use, while the risk of serious GI events is increased. Patients should be advised to promptly seek medical attention if they experience symptoms that could indicate a cardiovascular thrombotic event such as chest pain, shortness of breath, weakness, and slurring of speech.
<br />
<br />NSAIDs are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. Two large clinical trials of a COX-2 inhibitor for the treatment of pain in the first 10 to 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke.

References

  1. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  2. Fitzgerald GA, Patrono C "The coxibs, selective inhibitors of cyclooxsygenase-2." N Engl J Med 345 (2001): 433-42
  3. Marcus AJ, Broekman MJ, Pinsky DJ "COX inhibitors and thromboregulation." N Engl J Med 347 (2002): 1025-6
View all 6 references

Sumatriptan (Includes Treximet) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

The manufacturer considers the use of sumatriptan to be contraindicated in patients with severe hepatic impairment. Sumatriptan is primarily metabolized by the liver. Following subcutaneous administration, the pharmacokinetics of sumatriptan were not significantly altered in patients with hepatic impairment compared to healthy controls. Following oral administration, however, the bioavailability was substantially increased compared to controls, presumably because the liver plays an important role in the presystemic clearance of orally administered sumatriptan. The maximum single oral dose should generally not exceed 50 mg in patients with impaired hepatic function. Data are not available for the nasal formulation.

References

  1. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Dixon CM, Saynor DA, Andrew PD, Oxford J, Bradbury A, Tarbit MH "Disposition of sumatriptan in laboratory animals and humans." Drug Metab Dispos 21 (1993): 761-9
  3. Fowler PA, Lacey LF, Thomas M, Keene ON, Tanner RJ, Baber NS "The clinical pharmacology, pharmacokinetics and metabolism of sumatriptan." Eur Neurol 31 (1991): 291-4
View all 4 references

Naproxen (Includes Treximet) ↔ Sodium

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Hypertension, Fluid Retention, Hypernatremia

Anaprox and Anaprox DS (brands of naproxen sodium) contain 25 mg and 50 mg of sodium per tablet (approximately 1 mEq/250 mg naproxen), respectively, and Naprosyn suspension contains 39 mg per teaspoonful (approximately 1.5 mEq/125 mg naproxen). The sodium content should be considered when these products are used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

References

  1. "Product Information. Anaprox (naproxen)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.

Nsaids (Includes Treximet) ↔ Anemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Anemia, Bleeding

Dose-dependent decreases in serum hemoglobin and hematocrit have been observed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Anemia has been reported occasionally. The mechanism may involve NSAID-induced fluid retention or gastrointestinal blood loss, or an incompletely described effect on erythropoiesis. The decreases in hemoglobin concentration tend to be slight with average doses but may exceed 1 g/dL when large doses are given, such as those used to treat osteoarthritis or rheumatoid arthritis. Although these effects are generally not clinically important in otherwise healthy individuals, they may be relevant in patients with preexisting anemia or substantial blood loss. Therapy with NSAIDs should be administered cautiously in patients with or predisposed to anemia. Clinical monitoring of hematopoietic function may be appropriate, particularly during chronic therapy.

References

  1. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  2. Salom IL, Jacob G, Jallad N, Perdomo CA, Mullane JF, Weidler D "Gastrointestinal microbleeding associated with the use of etodolac, ibuprofen, indomethacin, and naproxen in normal males." J Clin Pharmacol 24 (1984): 240-6
  3. Kornberg A, Rachmilewitz EA "Aplastic anemia after prolonged ingestion of indomethacin." Acta Haematol 67 (1982): 136-8
View all 49 references

Nsaids (Includes Treximet) ↔ Hepatotoxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Borderline elevations of serum transaminases, LDH, and alkaline phosphatase have been reported in up to 15% of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These abnormalities may progress, remain unchanged, or regress with continuing therapy. Notable liver enzyme elevations exceeding 3 times the upper limit of normal have been reported in approximately 1% of patients in clinical trials. In addition, rare cases of severe hepatotoxicity, including liver necrosis, hepatic failure, jaundice and fatal fulminant hepatitis, have been reported. Therapy with NSAIDs should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver function is recommended during prolonged therapy. NSAIDs are also highly protein-bound and some are extensively metabolized by the liver. Metabolic activity and/or plasma protein binding may be altered in patients with hepatic impairment. A dosage reduction may be required in some cases.

References

  1. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Dhand AK, LaBrecque DR, Metzger J "Sulindac (clinoril) hepatitis." Gastroenterology 80 (1981): 585-6
  3. Mroszczak EJ, Lee FW, Combs D, Sarnquist FH, Huang BL, Wu AT, Tokes LG, Maddox ML, Cho DK "Ketorolac tromethamine absorption, distribution, metabolism, excretion, and pharmacokinetics in animals and humans." Drug Metab Dispos 15 (1987): 618-26
View all 92 references

Nsaids (Includes Treximet) ↔ Platelet Aggregation Inhibition

Moderate Potential Hazard, Moderate plausibility

Applies to: Thrombocytopathy, Thrombocytopenia, Coagulation Defect, Bleeding, Vitamin K Deficiency

Nonsteroidal anti-inflammatory drugs (NSAIDs) reversibly inhibit platelet adhesion and aggregation and may prolong bleeding time in some patients. With the exception of aspirin, the platelet effects seen with most NSAIDs at usual recommended dosages are generally slight and of relatively short duration but may be more pronounced in patients with underlying hemostatic abnormalities. Thrombocytopenia has also been reported rarely during NSAID use. Therapy with NSAIDs should be administered cautiously in patients with significant active bleeding or a hemorrhagic diathesis, including hemostatic and/or coagulation defects associated with hemophilia, vitamin K deficiency, hypoprothrombinemia, thrombocytopenia, thrombocytopathy, or severe hepatic impairment. NSAIDs that selectively inhibit cyclooxygenase-2 (i.e., COX-2 inhibitors) do not appear to affect platelet function or bleeding time at indicated dosages and may be preferable if risk of bleeding is a concern.

References

  1. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  2. Leese PT, Hubbard RC, Karim A, Isakson PC, Yu SS, Geis GS "Effects of celecoxib, a novel cyclooxygenase-2 inhibitor, on platelet function in healthy adults: A randomized, controlled trial." J Clin Pharmacol 40 (2000): 124-32
  3. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
View all 56 references

Sumatriptan (Includes Treximet) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: Seizures

Seizures have rarely been reported following the administration of sumatriptan. Therapy with sumatriptan should be administered cautiously in patients with epilepsy or a history of seizures.

References

  1. "Product Information. Imitrex (sumatriptan)." Glaxo Wellcome, Research Triangle Park, NC.

You should also know about...

Treximet (naproxen / sumatriptan) drug Interactions

There are 464 drug interactions with Treximet (naproxen / sumatriptan)

Treximet (naproxen / sumatriptan) alcohol/food Interactions

There are 5 alcohol/food interactions with Treximet (naproxen / sumatriptan)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

Hide
(web1)