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Drug Interactions between Accuretic and aspirin

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

aspirin hydroCHLOROthiazide

Applies to: aspirin and Accuretic (hydrochlorothiazide / quinapril)

MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics may adversely affect renal function due to NSAID inhibition of the renal synthesis of prostaglandins that help maintain renal perfusion in dehydrated states. The risk may be increased in patients on dietary sodium restriction. At the same time, hypotensive effect of the diuretics may be reduced because inhibition of prostaglandins can lead to unopposed pressor activity and, consequently, elevation in blood pressure. Natriuretic and diuretic effects may also be reduced, as NSAIDs have been reported to cause sodium and water retention, which may account for the increased risk of congestive heart failure associated with the combination. One study showed an increase in the incidence density of congestive heart failure (in patients over 55 years of age) from 9.3 per 1,000 person-years in patients on diuretics to 23.3 per 1,000 person-years in patients on both diuretic and NSAID therapy. NSAIDs may also increase the risk of hyperkalemia associated with potassium-sparing diuretics.

MANAGEMENT: In patients receiving both diuretic and NSAID therapy, management consists of avoiding dehydration and carefully monitoring the patient's renal function and blood pressure. If renal insufficiency or hyperkalemia develops, both drugs should be discontinued until the condition is corrected.

References (33)
  1. Allan SG, Knox J, Kerr F (1981) "Interaction between diuretics and indomethacin." Br Med J, 283, p. 1611
  2. McCarthy JT, Torres VE, Romero JC, et al. (1982) "Acute intrinsic renal failure induced by indomethacin." Mayo Clin Proc, 57, p. 289-96
  3. Favre L, Glasson P, Vallotton MB (1982) "Reversible acute renal failure from combined triamterene and indomethacin." Ann Intern Med, 96, p. 317-20
  4. Poe TE, Scott RB, Keith JF Jr (1983) "Interaction of indomethacin with furosemide." J Fam Pract, 16, p. 610-6
  5. Ahmad S (1984) "Indomethacin-bumetanide interaction: an alert." Am J Cardiol, 54, p. 246-7
  6. Dixey JJ, Noormohamed FH, Lant AF, Brewerton DA (1987) "The effects of naproxen and sulindac on renal function and their interaction with hydrochlorothiazide and piretanide in man." Br J Clin Pharmacol, 23, p. 55-63
  7. Brater DC, Fox WR, Chennavasin P (1981) "Interaction studies with bumetanide and furosemide: effects of probenecid and of indomethacin on response to bumetanide in man." J Clin Pharmacol, 21, p. 647-53
  8. Smith DE, Brater DC, Lin ET, Benet LZ (1979) "Attenuation of furosemide's diuretic effect by indomethacin: pharmacokinetic evaluation." J Pharmacokinet Biopharm, 7, p. 265-74
  9. Mor R, Pitlik S, Rosenfeld JB (1983) "Indomethacin- and Moduretic--induced hyperkalemia." Isr J Med Sci, 19, p. 535-7
  10. Kaufman J, Hamburger R, Matheson J, Flamenbaum W (1981) "Bumetanide-induced diuresis and natriuresis: effect of prostaglandin synthetase inhibition." J Clin Pharmacol, 21, p. 663-7
  11. Favre L, Glasson P, Riondel A, Vallotton MB (1983) "Interaction of diuretics and non-steroidal anti-inflammatory drugs in man." Clin Sci, 64, p. 407-15
  12. Pedrinelli R, Magagna A, Arzilli F, et al. (1980) "Influence of indomethacin on the natriuretic and renin-stimulating effect of bumetanide in essential hypertension." Clin Pharmacol Ther, 28, p. 722-31
  13. Weinberg MS, Quigg RJ, Salant DJ, Bernard DB (1985) "Anuric renal failure precipitated by indomethacin and triamterene." Nephron, 40, p. 216-8
  14. Furst DE (1988) "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl, 17, p. 58-62
  15. Gehr T, Sica DA, Steigler BW, Marshall C (1990) "Interaction of triamterene-hydrochlorothiazide (T-H) and ibuprofen (I)." Clin Pharmacol Ther, 47, p. 200
  16. (2002) "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co., Inc
  17. Watkins J, Abbot EC, Hensby CN, Webster J, Dollery CT (1980) "Attenuation of hypotensive effect of propranolol and thiazide diuretics by indomethacin." Br Med J, 281, p. 702-5
  18. Salerno F, Lorenzano E, Maggi A, Badalamenti S, Minuz P, Degan M, Chinea B, Scotti A (1993) "Effects of imidazole-salicylate on renal function and the diuretic action of furosemide in cirrhotic patients with ascites." J Hepatol, 19, p. 279-84
  19. Ripley EB, Gehr TW, Wallace H, Wade J, Kish C, Sica DA (1994) "The effect of nonsteroidal agents (NSAIDs) on the pharmacokinetics and pharmacodynamics of metolazone." Int J Clin Pharmacol Ther, 32, p. 12-8
  20. Desaulles E, Schwartz J (1979) "A comparative study of the action of frusemide and methyclothiazide on renin release by rat kidney slices and the interaction with indomethacin." Br J Pharmacol, 65, p. 193-6
  21. Muller FO, Schall R, Devaal AC, Groenewoud G, Hundt HKL, Middle MV (1995) "Influence of meloxicam on furosemide pharmacokinetics and pharmacodynamics in healthy volunteers." Eur J Clin Pharmacol, 48, p. 247-51
  22. Gurwitz JH, Everitt DE, Monane M, et al. (1996) "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci, 51, m74-9
  23. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A (1998) "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med, 158, p. 1108-12
  24. Bartoli E, Arras S, Faedda R, Soggia G, Satta A, Olmeo NA (1980) "Blunting of furosemide diuresis by aspirin in man." J Clin Pharmacol, 20, p. 452-8
  25. Tobert MB, Ostaszewski T, Reger B, Meisinger MA, Cook TJ (1980) "Diflunisal-furosemide interaction." Clin Pharmacol Ther, 27, p. 289-90
  26. Planas R, Arroyo V, Rimola A, Perez-Ayuso RM, Rodes J (1983) "Acetylsalicylic acid suppresses the renal hemodynamic effect and reduces the diuretic action of furosemide in cirrhosis with ascites." Gastroenterology, 84, p. 247-52
  27. Wilson TW, McCauley FA, Wells HD (1986) "Effects of low-dose aspirin on responsses to furosemide." J Clin Pharmacol, 26, p. 100-5
  28. Valette H, Apoil E (1979) "Interaction between salicylate and two loop diuretics." Br J Clin Pharmacol, 8, p. 592-4
  29. Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
  30. Bennett WM (1997) "Drug interactions and consequences of sodium restriction." Am J Clin Nutr, 65, S678-81
  31. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
  32. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  33. Perazella MA (2000) "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med, 109, p. 307-14

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Moderate

aspirin quinapril

Applies to: aspirin and Accuretic (hydrochlorothiazide / quinapril)

MONITOR: Some investigators suggest that coadministration with aspirin may attenuate the vasodilator and hypotensive effects of ACE inhibitors. In addition, some have found that the benefits of ACE inhibitors on morbidity and mortality in post-acute myocardial infarction, coronary heart disease, and particularly congestive heart failure may be compromised or even nullified by aspirin. The proposed mechanism is aspirin inhibition of cyclooxygenase, resulting in suppression of prostaglandin synthesis and prostaglandin-mediated hemodynamic effects of ACE inhibitors. However, evidence of a negative interaction is largely contradictory, and interpretation of relevant data has often been complicated by multiple confounding elements as well as the retrospective or post hoc nature of most studies. Available data seem to indicate that low-dose aspirin (less than 236 mg/day, and especially less than 100 mg/day) is unlikely, or at least significantly less likely, to interfere with ACE inhibitor effects, although susceptibility to the interaction may be subject to some degree of interpatient variability.

MANAGEMENT: Based on current data, it is difficult to determine the likelihood of a negative interaction between aspirin and ACE inhibitors and its clinical relevance during long-term therapy, particularly in congestive heart failure. Current recommendations generally do not preclude combination use in patients with cardiovascular diseases or risk factors that might otherwise benefit from the drugs independently. However, patients receiving long-term therapy with the combination should undergo regular blood pressure and other appropriate clinical monitoring such as renal function assessments. The lowest therapeutic dosage of aspirin should be used.

References (23)
  1. Moore TJ, Crantz FR, Hollenberg NK (1981) "Contribution of prostaglandins to the antihypertensive action of captopril in essential hypertension." Hypertension, 3, p. 168-73
  2. Silberbauer K, Stanek B, Templ H (1982) "Acute hypotensive effect of captopril in man modified by prostaglandin synthesis inhibition." Br J Clin Pharmacol, 14, s87-93
  3. Pfeffer MA, Braunwald E, Moye LA, et al. (1992) "Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement Trial." N Engl J Med, 327, p. 669-77
  4. Hall D, Zeitler H, Rudolph W (1992) "Counteraction of the vasodilator effects of enalapril by aspirin in severe heart failure." J Am Coll Cardiol, 20, p. 1549-55
  5. Acute Infarction Ramipril Efficacy (AIRE) Study Investigators (1993) "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure." Lancet, 342, p. 821-8
  6. Polonia J, Boaventura I, Gama G, Camoes I, Bernardo F, Andrade P, Nunes JP, Brandao F, Cerqueiragomes M (1995) "Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients." J Hypertens, 13, p. 925-31
  7. Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole DS, Auclert L, Pauly NC, et al. (1995) "A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group." N Engl J Med, 333, p. 1670-6
  8. Nguyen KN, Aursnes I, Kjekshus J (1997) "Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the cooperative new scandinavian enalapril survival study II (CONSENSUS II)." Am J Cardiol, 79, p. 115-9
  9. Oosterga M, Anthonio RL, deKam PJ, Kingma JH, Crijns HJGM, vanGilst WH (1998) "Effects of aspirin on angiotensin-converting enzyme inhibition and left ventricular dilation one year after acute myocardial infarction." Am J Cardiol, 81, p. 1178-81
  10. Spaulding C, Charbonnier B, CohenSolal A, Juilliere Y, Kromer EP, Benhamda K, Cador R, Weber S (1998) "Acute hemodynamic interaction of aspirin and ticlopidine with enalapril: Results of a double-blind, randomized comparative trial." Circulation, 98, p. 757-65
  11. Song KH, Fedyk R, Hoover R (1999) "Interaction of ACE inhibitors and aspirin in patients with congestive heart failure." Ann Pharmacother, 33, p. 375-7
  12. Leor J, ReicherReiss H, Goldbourt U, Boyko V, Gottlieb S, Battler A, Behar S (1999) "Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors - A cohort study of 11,575 patients with coronary artery disease." J Am Coll Cardiol, 33, p. 1920-5
  13. The Heart Outcomes Prevention Evaluation Study Investigators (2000) "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients." N Engl J Med, 342, p. 145-53
  14. Massie BM, Teerlink JR (2000) "Interaction between aspirin and angiotensin-converting enzyme inhibitors: Real or imagined." Am J Med, 109, p. 431-3
  15. Meune C, Mahe I, Mourad JJ, Simoneau G, Knellwolf AL, Bergmann JF, Caulin C (2000) "Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review." Eur J Clin Pharmacol, 56, p. 609-20
  16. Mahe I, Meune C, Diemer M, Caulin C, Bergmann JF (2001) "Interaction between aspirin and ACE inhibitors in patients with heart failure." Drug Saf, 24, p. 167-82
  17. Zanchetti A, Hansson L, Leonetti G, et al. (2002) "Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy." J Hypertens, 20, p. 1015-1022
  18. Ahmed A (2002) "Interaction between aspirin and angiotensin-converting enzyme inhibitors: should they be used together in older adults with heart failure?" J Am Geriatr Soc, 50, p. 1293-6
  19. Lapane KL, Hume AL, Barbour MM, Lipsitz LA (2002) "Does aspirin attenuate the effect of angiotensin-converting enzyme inhibitors on health outcomes of very old patients with heart failure?" J Am Geriatr Soc, 50, p. 1198-204
  20. Nawarskas JJ, Spinler SA (2000) "Update on the interaction between aspirin and angiotensin-converting enzyme inhibitors." Pharmacotherapy, 20, p. 698-710
  21. Nawarskas JJ, Spinler SA (1998) "Does aspirin interfere with the therapeutic efficacy of angiotensin-converting enzymen inhibitors in hypertension or congestive heart failure?" Pharmacotherapy, 18, p. 1041-52
  22. Teo K, Yusuf S, Pfeffer M, et al. (2002) "Effects of long-term treatment with angiotensin-converting-enzyme inhibitors in the presence or absence of aspirin: a systematic review." Lancet, 360, p. 1037
  23. Guazzi M, Brambilla R, Reina G, Tumminello G, Guazzi MD (2003) "Aspirin-angiotensin-converting enzyme inhibitor coadministration and mortality in patients with heart failure: a dose-related adverse effect of aspirin." Arch Intern Med, 163, p. 1574-9

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Moderate

hydroCHLOROthiazide quinapril

Applies to: Accuretic (hydrochlorothiazide / quinapril) and Accuretic (hydrochlorothiazide / quinapril)

MONITOR: Although they are frequently combined in clinical practice, diuretics and angiotensin converting enzyme (ACE) inhibitors may have additive effects. Coadministration makes hypotension and hypovolemia more likely than does either drug alone. Some ACE inhibitors may attenuate the increase in the urinary excretion of sodium caused by some loop diuretics. Some patients on diuretics, especially those on dialysis or a dietary salt restriction, may experience acute hypotension with lightheadedness and dizziness after receiving the first dose of the ACE inhibitor. In addition, ACE inhibitors may cause renal insufficiency or acute renal failure in patients with sodium depletion or renal artery stenosis.

MANAGEMENT: Monitoring of blood pressure, diuresis, electrolytes, and renal function is recommended during coadministration. The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor, or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor. Alternatively, the patient may remain under medical supervision for at least two hours after the first dose of the ACE inhibitor, or until blood pressure has stabilized.

References (23)
  1. Reader C, Peyregne EA, Suarez LD (1983) "Amrinone therapy in congestive cardiomyopathy." Am Heart J, 105, p. 1045
  2. Fujimura A, Shimokawa Y, Ebihara A (1990) "Influence of captopril on urinary excretion of furosemide in hypertensive subjects." J Clin Pharmacol, 30, p. 538-42
  3. Funck-Brentano C, Chatellier G, Alexandre JM (1986) "Reversible renal failure after combined treatment with enalapril and furosemide in a patient with congestive heart failure." Br Heart J, 55, p. 596-8
  4. Weisser K, Schloos J, Jakob S, et al. (1992) "The influence of hydrochlorothiazide on the pharmacokinetics of enalapril in elderly patients." Eur J Clin Pharmacol, 43, p. 173-7
  5. Motwani JG, Fenwick MK, Morton JJ, Struthers AD (1992) "Furosemide-induced natriuresis is augmented by ultra-low-dose captopril but not by standard doses of captopril in chronic heart failure." Circulation, 86, p. 439-45
  6. Burnakis TG, Mioduch HJ (1984) "Combined therapy with captopril and potassium supplementation: a potential for hyperkalemia." Arch Intern Med, 144, p. 2371-2
  7. Murphy BF, Whitworth JA, Kincaid-Smith P (1984) "Renal insufficiency with combinations of angiotensin converting enzyme inhibitors and diuretics." Br Med J, 288, p. 844-5
  8. Thind GS (1985) "Renal insufficiency during angiotensin-converting enzyme inhibitor therapy in hypertensive patients with no renal artery stenosis." J Clin Hypertens, 1, p. 337-43
  9. Radley AS, Fitzpatrick RW (1987) "An evaluation of the potential interaction between enalapril and amiloride." J Clin Pharm Ther, 12, p. 319-23
  10. Champ JD (1993) "Case report: azotemia secondary to enalapril and diuretic use and the diagnosis of renovascular hypertension." Am J Med Sci, 305, p. 25-7
  11. Hume AL, Murphy JL, Lauerman SE (1989) "Angiotensin-converting enzyme inhibitor-induced cough." Pharmacotherapy, 9, p. 88-90
  12. Lee HB, Blaufox MD (1992) "Renal functional response to captopril during diuretic therapy." J Nucl Med, 33, p. 739-43
  13. DeQuattro V (1991) "Comparison of benazepril and other antihypertensive agents alone and in combination with the diuretic hydrochlorothiazide." Clin Cardiol, 14, iv28-32;
  14. (2002) "Product Information. Vasotec (enalapril)." Merck & Co., Inc
  15. McLay JS, McMurray JJ, Bridges AB, Fraser CG, Struthers AD (1993) "Acute effects of captopril on the renal actions of furosemide in patients with chronic heart failure." Am Heart J, 126, p. 879-86
  16. Sudoh T, Fujimura A, Shiga T, et al. (1993) "Influence of lisinopril on urinary electrolytes excretion after furosemide in healthy subjects." J Clin Pharmacol, 33, p. 640-3
  17. Lederle RM (1985) "Captopril and hydrochlorothiazide in the fixed combination multicenter trial." J Cardiovasc Pharmacol, 7, S63-9
  18. (2001) "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc
  19. Good JM, Brady AJ, Noormohamed FH, Oakley CM, Cleland JG (1994) "Effect of intense angiotensin II suppression on the diuretic response to furosemide during chronic ACE inhibition." Circulation, 90, p. 220-4
  20. (2001) "Product Information. Capoten (captopril)." Bristol-Myers Squibb
  21. (2001) "Product Information. Lexxel (enalapril-felodipine)." Astra-Zeneca Pharmaceuticals
  22. "Product Information. Zestril (lisinopril)." Astra-Zeneca Pharmaceuticals
  23. Cerner Multum, Inc. "Australian Product Information."

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Drug and food interactions

Moderate

quinapril food

Applies to: Accuretic (hydrochlorothiazide / quinapril)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References (3)
  1. (2002) "Product Information. Vasotec (enalapril)." Merck & Co., Inc
  2. Good CB, McDermott L (1995) "Diet and serum potassium in patients on ACE inhibitors." JAMA, 274, p. 538
  3. Ray K, Dorman S, Watson R (1999) "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens, 13, p. 717-20

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Moderate

aspirin food

Applies to: aspirin

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References (1)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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Moderate

hydroCHLOROthiazide food

Applies to: Accuretic (hydrochlorothiazide / quinapril)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd

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Moderate

quinapril food

Applies to: Accuretic (hydrochlorothiazide / quinapril)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd

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Minor

aspirin food

Applies to: aspirin

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References (1)
  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.