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Drug Interactions between Angiomax and esomeprazole / naproxen

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

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Interactions between your drugs

Moderate

naproxen bivalirudin

Applies to: esomeprazole / naproxen and Angiomax (bivalirudin)

MONITOR: The safety and efficacy of bivalirudin have not been established when used in conjunction with platelet inhibitors other than aspirin. Theoretically, the concomitant administration of bivalirudin (plus aspirin) and platelet inhibitors may increase the risk of bleeding complications due to additive or synergistic effects on the clotting cascade. However, limited data from drug interaction studies do not suggest pharmacodynamic interactions with the platelet inhibitors, ticlopidine and abciximab.

MANAGEMENT: Until further data are available, the coadministration of bivalirudin and antiplatelet agents, and possibly other agents with antiplatelet activity such as nonsteroidal anti-inflammatory drugs (NSAIDs), should probably be undertaken with caution. Close clinical and laboratory observation for bleeding complications is recommended.

References

  1. "Product Information. Angiomax (bivalirudin)." The Medicines Company PROD (2001):

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Moderate

naproxen esomeprazole

Applies to: esomeprazole / naproxen and esomeprazole / naproxen

GENERALLY AVOID: Theoretically, proton pump inhibitors may decrease the gastrointestinal absorption of enteric-coated naproxen, which requires an acidic environment for dissolution. The proposed mechanism is an increase in gastric pH (i.e. decreased gastric acidity) induced by proton pump inhibitors. In patients treated with proton pump inhibitors, the possibility of a reduced or subtherapeutic response to enteric-coated naproxen should be considered.

MANAGEMENT: Concomitant use of these drugs is generally not recommended.

References

  1. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc PROD (2002):

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Drug and food interactions

Moderate

esomeprazole food

Applies to: esomeprazole / naproxen

ADJUST DOSING INTERVAL: Food may interfere with the absorption of esomeprazole. The manufacturer reports that the area under the concentration-time curve for esomeprazole following a single 40 mg dose was 33% to 53% lower when administered after food intake as opposed to during fasting conditions.

MANAGEMENT: Esomeprazole should be taken at least one hour before meals. When administered to patients receiving continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of esomeprazole is given.

References

  1. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67

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Moderate

naproxen food

Applies to: esomeprazole / naproxen

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

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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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