Drug Interactions between aspirin/citric acid/sodium bicarbonate and desirudin

MONITOR CLOSELY: Coadministration of thrombin inhibitors with drugs that affect platelet function may potentiate the risk of bleeding due to additive or synergistic effects on hemostasis.

GENERALLY AVOID: In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during thrombin inhibitor therapy may be increased by the concomitant use of other drugs that affect coagulation, including nonsteroidal anti-inflammatory drugs (NSAIDs) and platelet inhibitors. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: Close clinical and laboratory observation for bleeding complications is recommended if thrombin inhibitors are used with drugs that interfere with platelet function, including long-term or chronic NSAIDs. In patients undergoing neuraxial intervention, coadministration of these agents should be approached with extreme caution and only after thorough assessment of risks and benefits. Besides bleeding complications, these patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. Urgent diagnosis and treatment (e.g., spinal cord decompression) are required if signs or symptoms of spinal hematoma develop. To reduce the potential risk of bleeding, placement or removal of an epidural catheter or lumbar puncture should ideally be performed when the anticoagulant effect of the thrombin inhibitor is low. An optimal interval has not been established, but should take into consideration the pharmacokinetic profile of the thrombin inhibitor.

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MONITOR: Agents that cause urinary alkalinization can reduce serum salicylate concentrations in patients receiving anti-inflammatory dosages of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to increased urinary pH, resulting in increased renal salicylate clearance especially above urine pH of 7. This interaction is sometimes exploited in the treatment of salicylate toxicity.

MANAGEMENT: Patients treated chronically with urinary alkalinizers and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

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