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Drug Interactions between Advil PM and vancomycin

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

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Interactions between your drugs

Moderate

ibuprofen vancomycin

Applies to: Advil PM (diphenhydramine / ibuprofen) and vancomycin

MONITOR: When administered concomitantly, vancomycin and ketorolac may have additive nephrotoxic effects. Ketorolac, like other nonsteroidal anti-inflammatory drugs (NSAIDs), inhibits vasodilatory renal prostaglandin synthesis. Renal dysfunction associated with ketorolac has been reported to be dose-related and reversible following treatment discontinuation. In addition, chronic use of NSAIDs may also be associated with renal toxicities, including renal failure. The mechanism of vancomycin-induced nephrotoxicity is unknown; however, the risk may be increased in patients with preexisting risk factors for nephrotoxicity, high vancomycin blood levels, or prolonged treatment. Data for this interaction are limited to a case report of acute transient renal failure and gastrointestinal bleeding requiring transfusion following uncomplicated surgery and treatment with ketorolac and IV vancomycin in a previously healthy middle-aged man. Data are not available for other NSAIDs.

MANAGEMENT: Caution is recommended in patients receiving ketorolac or other NSAIDs in combination with IV vancomycin, particularly in patients with preexisting risk factors for nephrotoxicity. Renal function and vancomycin therapeutic drug monitoring is recommended according to local policies and protocols. The dose and duration of concomitant NSAID therapy should also be minimized where possible.

References

  1. (2002) "Product Information. Toradol (ketorolac)." Roche Laboratories
  2. (2001) "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. Hazlewood KA, Brouse SD, Pitcher WD, Hall RG (2010) "Vancomycin-associated nephrotoxicity: grave concern or death by character assassination?" Am J Med, 123, 182.e1-7
  6. Murray RP, Watson RC (1993) "Acute renal failure and gastrointestinal bleed associated with postoperative toradol and vancomycin." Orthopedics, 16, p. 1361-3
View all 6 references

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Drug and food interactions

Moderate

ibuprofen food

Applies to: Advil PM (diphenhydramine / ibuprofen)

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

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Moderate

diphenhydrAMINE food

Applies to: Advil PM (diphenhydramine / ibuprofen)

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M (1973) "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol, 6, p. 107-12

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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.

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