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Baclofen / flurbiprofen / lidocaine topical Disease Interactions

There are 23 disease interactions with baclofen / flurbiprofen / lidocaine topical:

Major

Antiarrhythmics (applies to baclofen/flurbiprofen/lidocaine topical) cardiovascular dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Hypotension

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  2. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  4. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
  5. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  8. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
  9. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  10. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
  11. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
  12. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
  13. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  15. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  16. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  17. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
View all 17 references
Major

Antiarrhythmics (applies to baclofen/flurbiprofen/lidocaine topical) proarrhythmic effects

Major Potential Hazard, High plausibility. Applicable conditions: Arrhythmias

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
  2. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  3. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  4. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
  5. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. Lo KS, Gantz KB, Stetson PL, et al "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
  7. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
  8. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
  10. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
  11. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
  12. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
  13. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
  14. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
  15. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
  16. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
  17. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
  18. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
  19. Damle R, Levine J, Matos J, et al "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
  20. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  21. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
  22. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
  23. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  24. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
  25. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
  26. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  27. Au PK, Bhandari AK, Bream R, et al "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
  28. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  29. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
  30. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
  31. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
  32. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
  33. Bauman JL, Bauernfeind RA, Hoff JV, et al "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
  34. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
  35. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
  36. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
  37. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
  38. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
  39. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
  40. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
  41. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
  42. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  43. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.
  44. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
  45. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
  46. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
  47. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  48. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
  49. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
  50. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
  51. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
  52. Hii JT, Wyse DG, Gillis AM, et al "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
  53. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
  54. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  55. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
  56. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
  57. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  58. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  59. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
  60. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
  61. Strasberg B, Sclarovsky S, Erdberg A, et al "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
  62. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
View all 62 references
Major

Baclofen (applies to baclofen/flurbiprofen/lidocaine topical) renal dysfunction

Major Potential Hazard, High plausibility.

Baclofen is primarily eliminated by the kidney. Patients with impaired renal function may be at greater risk for adverse effects from baclofen due to decreased drug clearance. Therapy with baclofen should be administered cautiously in such patients. Dosage adjustments may be necessary.

References

  1. Himmelsbach FA, Kohler E, Zanker B "Toxic effect of baclofen in chronic haemodialysis and renal transplantation." Dtsch Med Wochenschr 117 (1992): 733-7
  2. "Product Information. Lioresal (baclofen)." Medtronic Inc, Minneapolis, MN.
  3. Krahn A, Penner SB "Use of baclofen for intractable hiccups in uremia." Am J Med 96 (1994): 391
Major

Lidocaine (applies to baclofen/flurbiprofen/lidocaine topical) hepatic dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Liver Disease

Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.

References

  1. Thomson AH, Elliott HL, Kelman AW, et al "The pharmacokinetics and pharmacodynamics of lignocaine and MEGX in healthy subjects." J Pharmacokinet Biopharm 15 (1987): 101-15
  2. Huang YS, Lee SD, Deng JF, Wu JC, Lu RH, Lin YF, Wang YJ, Lo KJ "Measuring lidocaine metabolite - monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis." J Hepatol 19 (1993): 140-7
  3. Barry M, Keeling PW, Weir D, Feely J "Severity of cirrhosis and the relationship of a1-acid glycoprotein concentration to plasma protein binding of lidocaine." Clin Pharmacol Ther 47 (1990): 366-70
  4. Huet PM, Villeneuve JP "Determinants of drug disposition in patients with cirrhosis." Hepatology 3 (1983): 913-8
  5. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  6. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  7. Villeneuve JP, Thibeault MJ, Ampelas M, et al "Drug disposition in patients with HBsAg-positive chronic liver disease." Dig Dis Sci 32 (1987): 710-4
  8. Williams RL, Blaschke TF, Meffin PJ, et al "Influence of viral hepatitis on the disposition of two compounds with high hepatic clearance: lidocaine and indocyanine green." Clin Pharmacol Ther 20 (1976): 290-9
  9. Huet P-M, LeLorier J "Effects of smoking and chronic hepatitis B on lidocaine and indocyanine green kinetics." Clin Pharmacol Ther 28 (1980): 208-15
  10. Bauer LA, Brown T, Gibaldi M, et al "Influence of long-term infusions on lidocaine kinetics." Clin Pharmacol Ther 31 (1982): 433-7
  11. Forrest JA, Finlayson ND, Adjepon-Yamoah KK, Prescott LF "Antipyrine, paracetamol, and lignocaine elimination in chronic liver disease." Br Med J 1 (1977): 1384-7
  12. Colli A, Buccino G, Cocciolo M, et al "Disposition of a flow-limited drug (lidocaine) and a metabolic capacity-limited drug (theophylline) in liver cirrhosis." Clin Pharmacol Ther 44 (1988): 642-9
  13. Shiffman ML, Luketic VA, Sanyal AJ, Duckworth PF, Purdum PP, Contos MJ, Mills AS, Edinboro LE, Poklis A "Hepatic lidocaine metabolism and liver histology in patients with chronic hepatitis and cirrhosis." Hepatology 19 (1994): 933-40
View all 13 references
Major

Lidocaine (applies to baclofen/flurbiprofen/lidocaine topical) renal dysfunction

Major Potential Hazard, High plausibility.

Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.

References

  1. Collinsworth KA, Strong JM, Atkinson AJ Jr, et al "Pharmacokinetics and metabolism of lidocaine in patients with renal failure." Clin Pharmacol Ther 18 (1975): 59-64
  2. Jacobi J, McGory RW, McCoy H, Matzke GR "Hemodialysis clearance of total and unbound lidocaine." Clin Pharm 2 (1983): 54-7
  3. Thomson PD, Rowland M, Melmon KL "The influence of heart failure, liver disease, and renal failure on the disposition of lidocaine in man." Am Heart J 82 (1971): 417-21
  4. Eriksson E, Granberg P-O, Ortengren B "Study of renal excretion of prilocaine and lidocaine." Acta Chem Scand 358 (1966): 55-69
  5. Grossman S, Davis D, Kitchell B, Shand D, Routledge P "Diazepam and lidocaine plasma protein binding in renal disease." Clin Pharmacol Ther 31 (1982): 350-7
  6. Vaziri ND, Saiki JK, Hughes W "Clearance of lidocaine by hemodialysis." South Med J 72 (1979): 1567-8
  7. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  8. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
View all 8 references
Major

Lidocaine (applies to baclofen/flurbiprofen/lidocaine topical) seizures

Major Potential Hazard, High plausibility.

Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.

References

  1. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8
  2. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12
  3. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483
  4. Pelter MA, Vollmer TA, Blum RL "Seizure-like reaction associated with subcutaneous lidocaine injection ." Clin Pharm 8 (1989): 767-8
  5. Sundaram MB "Seizures after intraurethral instillation of lidocaine." Can Med Assoc J 137 (1987): 219-20
  6. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  7. Ryan CA, Robertson M, Coe JY "Seizures due to lidocaine toxicity in a child during cardiac catheterization." Pediatr Cardiol 14 (1993): 116-8
View all 7 references
Major

Lidocaine (applies to baclofen/flurbiprofen/lidocaine topical) sinus/AV node dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block

The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.

References

  1. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73
  2. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7
  3. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  4. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5
View all 4 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) asthma

Major Potential Hazard, High plausibility.

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. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  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
  4. Stevenson DD, Simon RA "Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma." J Allerg Clin Immunol 108 (2001): 47-51
  5. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  7. Lewis RV "Severe asthma after naproxen." Lancet 05/30/87 (1987): 1270
  8. Settipane RA, Stevenson DD "Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma." J Allergy Clin Immunol 84 (1989): 26-33
  9. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  10. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  11. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  12. Ayres JG, Fleming DM, Whittington RM "Asthma death due to ibuprofen." Lancet 05/09/87 (1987): 1082
  13. Szczeklik A, Stevenson DD "Aspirin-induced asthma: Advances in pathogenesis and management." J Allerg Clin Immunol 104 (1999): 5-13
  14. Shapiro N "Acute angioedema after ketorolac ingestion - report of case." J Oral Maxillofac Surg 52 (1994): 626-7
  15. Nasser SMS, Lee TH "Aspirin-induced early and late asthmatic responses." Clin Exp Allergy 25 (1995): 1-3
  16. Chan TY "Severe asthma attacks precipitated by NSAIDs." Ann Pharmacother 29 (1995): 199
  17. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  18. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  19. Lee TH "Mechanism of bronchospasm in aspirin-sensitive asthma." Am Rev Respir Dis 148 (1993): 1442-3
  20. Schreuder G "Ketoprofen: possible idiosyncratic acute bronchospasm." Med J Aust 152 (1990): 332-3
  21. Zikowski D, Hord AH, Haddox JD, Glascock J "Ketorolac-induced bronchospasm." Anesth Analg 76 (1993): 417-9
  22. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  23. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  24. Woessner KM, Simon RA, Stevenson DD "The safety of celecoxib in patients with aspirin-sensitive asthma." Arthritis Rheum 46 (2002): 2201-6
  25. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  26. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  27. Lee TH "Mechanism of aspirin sensitivity." Am Rev Respir Dis 145 (1992): s34-6
  28. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  29. Salberg DJ, Simon MR "Severe asthma induced by naproxen: a case report and review of the literature." Ann Allergy 45 (1980): 372-5
  30. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  31. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  32. Carmona MJ, Blanca M, Garcia A, Fernandez S, Burgos F, Miranda A, Vega JM, Garcia J "Intolerance to piroxicam in patients with adverse reactions to nonsteroidal antiinflammatory drugs." J Allergy Clin Immunol 90 (1992): 873-9
  33. Israel E, Fischer AR, Rosenberg MA, Lilly CM, Callery JC, Shapiro J, Cohn J, Rubin P, Drazen JM "The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin." Am Rev Respir Dis 148 (1993): 1447-51
  34. Haddow GR, Riley E, Isaacs R, McSharry R "Ketorolac, nasal polyposis, and bronchial asthma: a cause for concern." Anesth Analg 76 (1993): 420-2
  35. Cohen RD, Bateman ED, Potgieter PD "Near-fatal bronchospasm in an asthmatic patient following ingestion of flurbiprofen. A case report." S Afr Med J 61 (1982): 803
  36. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  37. Dahlen B, Szczeklik A, Murray HH "Celecoxib in patients with asthma and aspirin intolerance." N Engl J Med 344 (2000): 142
  38. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
View all 38 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) fluid retention

Major Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure, Hypertension

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. Agnholt J, Andreasen F "The effect of ibuprofen therapy on water and electrolyte balance." Acta Med Scand 212 (1982): 65-9
  4. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  6. 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
  7. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
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  9. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  10. "Product Information. Anaprox (naproxen)." Roche Laboratories, Nutley, NJ.
  11. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
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  13. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  14. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  15. Gurwitz JH, Everitt DE, Monane M, et al "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci 51 (1996): m74-9
  16. Willkens RF "Worldwide clinical safety experience with diclofenac." Semin Arthritis Rheum 2 Suppl 1 (1985): 105-10
  17. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  18. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  19. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  20. Easton PA, Koval A "Hypertensive reaction with sulindac." Can Med Assoc J 122 (1980): 1273-4
  21. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  22. Petersson I, Nilsson G, Hansson B-G, Hedner T "Water intoxication associated with non-steroidal anti-inflammatory drug therapy." Acta Med Scand 221 (1987): 221-3
  23. Buckley MM, Brogden RN "Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential." Drugs 39 (1990): 86-109
  24. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  25. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  26. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  27. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  28. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  29. Heynen G "Toleration and safety of piroxicam." Eur J Rheumatol Inflamm 8 (1987): 86-93
View all 29 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) GI toxicity

Major Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Hemorrhage, Peptic Ulcer, 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

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  58. Witham R "Voltaren (diclofenac sodium)-induced ileocolitis ." Am J Gastroenterol 86 (1991): 246-7
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  60. Quigley EMM, Donovan JP, Livingston WC "Ketorolac-related giant gastric ulcers." Am J Gastroenterol 89 (1994): 631-2
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  63. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  64. Ecker GA, Karsh J "Naproxen induced ulcerative esophagitis." J Rheumatol 19 (1992): 646-7
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  67. Peterson WL, Cryer B "COX-1-sparing NSAIDs - Is the enthusiasm justified?." JAMA 282 (1999): 1961-3
  68. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  69. Mason AM "Bleeding massive gastric ulcer on diflunisal (Dolobid) ." Br Med J 1 (1979): 888
  70. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  71. Langman MJ, Jensen DM, Watson DJ, et al. "Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs." JAMA 282 (1999): 1929-33
  72. Estes LL, Fuhs DW, Heaton AH, Butwinick CS "Gastric ulcer perforation associated with the use of injectable ketorolac." Ann Pharmacother 27 (1993): 42-3
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  95. Peskar BM, Maricic N, Gretzera B, Schuligoi R, Schmassmann A "Role of cyclooxygenase-2 in gastric mucosal defense." Life Sci 69 (2001): 2993-3003
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  97. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
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  99. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
View all 99 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) rash

Major Potential Hazard, High plausibility. Applicable conditions: 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. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  4. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  6. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  7. Friedman B, Orlet HK, Still JM, Law E "Toxic epidermal necrolysis due to administration of celecoxib (Celebrex)." South Med J 95 (2002): 1213-4
  8. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  9. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  12. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  13. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  14. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  16. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
View all 16 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) renal toxicities

Major Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction, Dehydration, Liver Disease, Congestive Heart Failure, Hyponatremia

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

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  92. Kagan A, Nissim F, Green L, Bar-Khayim Y "Scleroderma renal crisis without hypertension." J Rheumatol 16 (1989): 707-8
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  101. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
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  103. Kimberly RP, Plotz PH "Aspirin-induced depression of renal function." N Engl J Med 296 (1977): 418-24
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  105. Morgenstern SJ, Bruns FJ, Fraley DS, et al "Ibuprofen-associated lipoid nephrosis without interstitial nephritis." Am J Kidney Dis 14 (1989): 50-2
  106. Feldman HI, Kinman JL, Berlin JA, et al. "Parenteral ketorolac: the risk for acute renal failure." Ann Intern Med 126 (1997): 193-9
  107. Loeffler M, Hanson G, Philp T "Piroxicam-induced renal failure following relief of chronic retention." Br J Urol 63 (1989): 438-9
  108. Mitnick PD, Greenberg A, DeOreo PB, Weiner BM, Coffman TM, Walker BR, Agus ZS, Goldfarb S "Effects of two nonsteroidal anti-inflammatory drugs, indomethacin and oxaprozin, on the kidney." Clin Pharmacol Ther 28 (1980): 680-9
  109. Brater DC, Anderson SA, Brown-Cartwright D, Toto RD, Chen A, Jacob GB "Effect of etodolac in patients with moderate renal impairment compared with normal subjects." Clin Pharmacol Ther 38 (1985): 674-9
  110. Sarma PS "Fatal acute renal failure after piroxicam." Clin Nephrol 31 (1989): 54
  111. Sennesael J, Van den Houte K, Verbeelen D "Reversible membranous glomerulonephritis associated with ketoprofen." Clin Nephrol 26 (1986): 213-5
  112. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  113. Anttila M, Haataja M, Kasanen A "Pharmacokinetics of naproxen in subjects with normal and impaired renal function." Eur J Clin Pharmacol 18 (1980): 263-8
  114. Katz SM, Capaldo R, Everts EA, DiGregorio JG "Tolmetin: association with reversible renal failure and acute interstitial nephritis." JAMA 246 (1981): 243-5
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  116. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  117. Bergamo RR, Cominelli F, Kopple JD, Zipser RD "Comparative acute effects of aspirin, diflunisal, ibuprofen and indomethacin on renal function in healthy men." Am J Nephrol 9 (1989): 460-3
  118. Turner GA, Walker RJ, Bailey RR, et al "Sulindac-induced acute interstitial nephritis." N Z Med J 97 (1984): 239-40
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  120. Jick H, Derby LE, Garcia Rodriguez LA, Jick SS, Dean AD "Nonsteroidal antiinflammatory drugs and certain rare, serious adverse events: a cohort study." Pharmacotherapy 13 (1993): 212-7
  121. Perneger TV, Whelton PK, Klag MJ "Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs." N Engl J Med 331 (1994): 1675-9
  122. Brater DC "Evaluation of etodolac in subjects with renal impairment." Eur J Rheumatol Inflamm 10 (1990): 44-55
  123. Verbeeck RK, Richardson CJ, Blocka KL "Clinical pharmacokinetics of piroxicam." J Rheumatol 13 (1986): 789-96
  124. Radford RG, Holley KE, Grande JP, Larson TS, Wagoner RD, Donadio JV, Mccarthy JT "Reversible membranous nephropathy associated with the use of nonsteroidal anti-inflammatory drugs." JAMA 276 (1996): 466-9
  125. Stafanger G, Larsen HW, Hansen H, Sorensen K "Pharmacokinetics of ketoprofen in patients with chronic renal failure." Scand J Rheumatol 10 (1981): 189-92
  126. Klassen DK, Stout RL, Spilman PS, Whelton A "Sulindac kinetics and effects on renal function and prostaglandin excretion in renal insufficiency." J Clin Pharmacol 29 (1989): 1037-42
  127. Eriksson LO, Beermann B, Kallner M "Renal function and tubular transport effects of sulindac and naproxen in chronic heart failure." Clin Pharmacol Ther 42 (1987): 646-54
  128. Wong F, Massie D, Hsu P, Dudley F "Indomethacin-induced renal dysfunction in patients with well- compensated cirrhosis." Gastroenterology 104 (1993): 869-76
  129. Artinano M, Etheridge WB, Stroehlein KB, Barcenas CG "Progression of minimal-change glomerulopathy to focal glomerulosclerosis in a patient with fenoprofen nephropathy." Am J Nephrol 6 (1986): 353-7
  130. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  131. Poitirt TI "Reversible renal failure associated with ibuprofen: case report and review of the literature." Drug Intell Clin Pharm 18 (1984): 27-32
  132. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  133. Brater DC, Brown-Cartwright D, Anderson SA, Uaamnuichai M "Effect of high-dose etodolac on renal function." Clin Pharmacol Ther 42 (1987): 283-9
  134. Munn E, Lynn KL, Bailey RR "Renal papillary necrosis following regular consumption of non-steroidal anti-inflammatory drugs." N Z Med J 95 (1982): 213-4
  135. Haragsim L, Dalal R, Bagga H, Bastani B "Ketorolac-induced acute renal failure and hyperkalemia: report of three cases." Am J Kidney Dis 24 (1994): 578-80
  136. Rudy AC, Figueroa NL, Hall SD, Brater DC "The pharmacokinetics of piroxicam in elderly persons with and without renal impairment." Br J Clin Pharmacol 37 (1994): 1-5
  137. Ling BN, Bourke E, Campbell WG, Delaney VB "Naproxen-induced nephropathy in systemic lupus erythematosus." Nephron 54 (1990): 249-55
  138. Blackshear JL, Davidman M, Stillman MT "Identification of risk for renal insufficiency from nonsteroidal anti-inflammatory drugs." Arch Intern Med 143 (1983): 1130-4
  139. Whelton A "Renal effects of over-the-counter analgesics." J Clin Pharmacol 35 (1995): 454-63
  140. Aitken HA, Burns JW, McArdle CS, Kenny GNC "Effects of ketorolac trometamol on renal function." Br J Anaesth 68 (1992): 481-5
  141. de Crespigny PJ, Becker GJ, Ihle BU, et al "Renal failure and nephrotic syndrome associated with sulindac." Clin Nephrol 30 (1988): 52-5
  142. Curt GA, Kaldany A, Whitley LG, et al "Reversible rapidly progressive renal failure with nephrotic syndrome due to fenoprofen calcium." Ann Intern Med 92 (1980): 72-3
  143. Vitting KE, Nichols NJ, Seligson GR "Naproxen and acute renal failure in a runner." Ann Intern Med 105 (1986): 144
  144. van Biljon G "Reversible renal failure associated with ibuprofen in a child. A case report." S Afr Med J 76 (1989): 34-5
  145. Fong J, Gora ML "Reversible renal insufficiency following ketorolac therapy." Ann Pharmacother 27 (1993): 510-2
  146. Buller GK, Perazella MA "Acute renal failure and ketorolac." Ann Intern Med 127 (1997): 493
  147. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  148. Quigley MR, Richfield M, Krumlovsky FA, et al "Concurrent naproxen and penicillamine-induced renal disease in rheumatoid arthritis." Arthritis Rheum 25 (1982): 1016-9
  149. Blackwell E, Loughlin K, Dumler F, Smythe M "Nabumetone-associated interstitial nephritis." Pharmacotherapy 15 (1995): 669-72
  150. Pearce CJ, Gonzalez FM, Wallin JD "Renal failure and hyperkalemia associated with ketorolac tromethamine." Arch Intern Med 153 (1993): 1000-2
  151. Perazella MA, Buller GK "Can ibuprofen cause acute renal failure in a normal individual? A case of acute overdose." Am J Kidney Dis 18 (1991): 600-2
  152. Pascoe MD, Gordon GD, Temple-Camp CR "Tolmetin-induced acute renal failure." S Afr Med J 70 (1986): 232-3
View all 152 references
Major

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) thrombosis

Major Potential Hazard, High plausibility. Applicable conditions: 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.

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. Fitzgerald GA, Patrono C "The coxibs, selective inhibitors of cyclooxsygenase-2." N Engl J Med 345 (2001): 433-42
  2. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  3. Bombardier C, Laine L, Reicin A, et al. "Comparison of upper gastrointestinal toxicity of refecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group." N Engl J Med 343 (2000): 1520-8
  4. Mukherjee D, Nissen SE, Topol EJ "Risk of cardiovascular events associated with selective COX-2 inhibitors." JAMA 286 (2001): 954-9
  5. Silverstein FE, Faich G, Goldstein JL, et al. "Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthtitis and rheumatoid arthritis. The CLASS Study: a randomized controlled trial." JAMA 284 (2000): 1247-55
  6. Marcus AJ, Broekman MJ, Pinsky DJ "COX inhibitors and thromboregulation." N Engl J Med 347 (2002): 1025-6
View all 6 references
Moderate

Antiarrhythmics (applies to baclofen/flurbiprofen/lidocaine topical) electrolyte imbalance

Moderate Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Hyperkalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  2. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  3. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  4. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  6. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  7. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  8. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  9. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  13. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 13 references
Moderate

Baclofen (applies to baclofen/flurbiprofen/lidocaine topical) autonomic dysreflexia

Moderate Potential Hazard, Moderate plausibility.

Therapy with intrathecal baclofen should be administered cautiously in patients with a history of autonomic dysreflexia, since the presence of nociceptive stimuli or abrupt withdrawal of the medication may trigger an episode of dysreflexia.

References

  1. "Product Information. Lioresal Intrathecal (baclofen)." Medtronic Inc, Minneapolis, MN.
Moderate

Baclofen (applies to baclofen/flurbiprofen/lidocaine topical) psychoses

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis, History - Psychiatric Disorder

Baclofen may precipitate or exacerbate psychotic symptoms, both during therapy and following abrupt withdrawal of the drug. Therapy with baclofen should be administered cautiously in patients with a history of psychiatric disorders.

References

  1. Sommer BR, Petrides G "A case of baclofen-induced psychotic depression." J Clin Psychiatry 53 (1992): 211-2
  2. Penn RD "Intrathecal baclofen for spasticity of spinal origin: seven years of experience." J Neurosurg 77 (1992): 236-40
  3. Siegfried RN, Jacobson L, Chabal C "Development of an acute withdrawal syndrome following the cessation of intrathecal baclofen in a patient with spasticity." Anesthesiology 77 (1992): 1048-50
  4. Stewart JT "A case of mania associated with high-dose baclofen therapy." J Clin Psychopharmacol 12 (1992): 215-7
  5. Garabedian-Ruffalo SM, Ruffalo RL "Adverse effects secondary to baclofen withdrawal." Drug Intell Clin Pharm 19 (1985): 304-6
  6. Yassa RY, Iskandar HL "Baclofen-induced psychosis: two cases and a review." J Clin Psychiatry 49 (1988): 318-20
  7. "Product Information. Lioresal (baclofen)." Medtronic Inc, Minneapolis, MN.
  8. Sandyk R, Gillman MA "Baclofen-induced memory impairment." Clin Neuropharmacol 8 (1985): 294-5
  9. Rivas DA, Chancellor MB, Hill K, Freedman MK "Neurological manifestations of baclofen withdrawal." J Urol 150 (1993): 1903-5
  10. Arnold ES, Rudd SM, Kirshner H "Manic psychosis following rapid withdrawal from baclofen." Am J Psychiatry 137 (1980): 1466-7
  11. Kirubakaran V, Mayfield D, Rengachary S "Dyskinesia and psychosis in a patient following baclofen withdrawal." Am J Psychiatry 141 (1984): 692-3
  12. Terrence CF, Fromm GH "Complications of baclofen withdrawal." Arch Neurol 38 (1981): 588-9
  13. Lees AJ, Clarke CR, Harrison MJ "Hallucinations after sudden withdrawal of baclofen." Lancet 2 (1977): 44-5
  14. Wolf ME, Almy G, Toll M, Mosnaim AD "Mania associated with the use of baclofen." Biol Psychiatry 17 (1982): 757-9
  15. Jamous A, Kennedy P, Psychol C, Grey N "Psychological and emotional effects of the use of oral baclofen - a preliminary study." Paraplegia 32 (1994): 349-53
View all 15 references
Moderate

Baclofen (applies to baclofen/flurbiprofen/lidocaine topical) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Deterioration in seizure control and electroencephalographic (EEG) changes have been reported occasionally in epileptic patients treated with baclofen. Therapy with baclofen should be administered cautiously in patients with a history of seizures. Clinical status and EEG should be monitored at regular intervals during treatment. Except in cases of overdose or severe adverse reactions, cessation of baclofen therapy, whenever necessary, should occur gradually with incrementally reduced dosages. Abrupt withdrawal has been associated with central nervous system effects including seizures, hallucinations, and psychosis.

References

  1. Kirubakaran V, Mayfield D, Rengachary S "Dyskinesia and psychosis in a patient following baclofen withdrawal." Am J Psychiatry 141 (1984): 692-3
  2. "Product Information. Lioresal (baclofen)." Medtronic Inc, Minneapolis, MN.
  3. Terrence CF, Fromm GH "Complications of baclofen withdrawal." Arch Neurol 38 (1981): 588-9
  4. Penn RD "Intrathecal baclofen for spasticity of spinal origin: seven years of experience." J Neurosurg 77 (1992): 236-40
  5. Abarbanel J, Herishanu Y, Frisher S "Encephalopathy associated with baclofen." Ann Neurol 17 (1985): 617-8
  6. Lees AJ, Clarke CR, Harrison MJ "Hallucinations after sudden withdrawal of baclofen." Lancet 2 (1977): 44-5
  7. Kofler M, Arturo Leis A "Prolonged seizure activity after baclofen withdrawal." Neurology 42 (1992): 697-8
  8. Hormes JT, Benarroch EE, Rodriguez M, Klass DW "Periodic sharp waves in baclofen-induced encephalopathy." Arch Neurol 45 (1988): 814-5
  9. Siegfried RN, Jacobson L, Chabal C "Development of an acute withdrawal syndrome following the cessation of intrathecal baclofen in a patient with spasticity." Anesthesiology 77 (1992): 1048-50
  10. Barker I, Grant IS "Convulsions after abrupt withdrawal of baclofen." Lancet 2 (1982): 556-7
  11. Arnold ES, Rudd SM, Kirshner H "Manic psychosis following rapid withdrawal from baclofen." Am J Psychiatry 137 (1980): 1466-7
  12. Rush JM, Gibberd FB "Baclofen-induced epilepsy." J R Soc Med 83 (1990): 115-6
  13. Rivas DA, Chancellor MB, Hill K, Freedman MK "Neurological manifestations of baclofen withdrawal." J Urol 150 (1993): 1903-5
  14. Garabedian-Ruffalo SM, Ruffalo RL "Adverse effects secondary to baclofen withdrawal." Drug Intell Clin Pharm 19 (1985): 304-6
  15. Zak R, Solomon G, Petito F, Labar D "Baclofen-induced generalized nonconvulsive status epilepticus." Ann Neurol 36 (1994): 113-4
View all 15 references
Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) anemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  3. 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
  4. Squires JE, Mintz PD, Clark S "Tolmetin-induced hemolysis." Transfusion 25 (1985): 410-3
  5. Johnson FP Jr, Hamilton HE, Liesch MR "Immune hemolytic anemia associated with sulindac." Arch Intern Med 145 (1985): 1515-6
  6. Bennett L, Schlossman R, Rosenthal J, et al "Aplastic anemia and sulindac." Ann Intern Med 92 (1980): 874
  7. Kornberg A, Rachmilewitz EA "Aplastic anemia after prolonged ingestion of indomethacin." Acta Haematol 67 (1982): 136-8
  8. Arnold R, Heimpel H "Aplastic anaemia after naproxen?" Lancet 02/09/80 (1980): 321
  9. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  10. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  13. Angeles ML, Reid ME, Yacob UA, Cash KL, Fetten JV "Sulindac-induced immune hemolytic anemia." Transfusion 34 (1994): 255-8
  14. Randi ML, Tison T, Luzzatto G "Haemolytic uraemic syndrome during treatment with ketorolac trometamol." BMJ 306 (1993): 186
  15. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  16. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  17. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  18. Sanada M, Takai K "Aplastic anaemia associated with piroxicam." Br J Haematol 77 (1991): 256-7
  19. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  20. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  21. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  22. Lopez A, Linares M, Sanchez H, Blanquer A "Autoimmune hemolytic anemia induced by diclofenac." Ann Pharmacother 29 (1995): 787
  23. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  24. Lussier A, LeBel E "Radiochromium (chromium-51) evaluation of gastrointestinal blood loss associated with placebo, aspirin, and nabumetone." Am J Med 83 (1987): 15-8
  25. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  26. Reitz CL, Bottomley SS "Pure red cell aplasia associated with fenoprofen." Am J Med Sci 287 (1984): 62-3
  27. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  28. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  29. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  30. Schattner A, Shtalrid M, Levy R, Berrebi A "Fatal aplastic anemia due to indomethacin: lymphocyte transformation tests in vitro." Isr J Med Sci 17 (1981): 433-6
  31. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  32. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  33. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  34. Salama A, Gottsche B, Mueller-Eckhardt C "Autoantibodies and drug- or metabolite-dependent antibodies in patients with diclofenac-induced immune haemolysis." Br J Haematol 77 (1991): 546-9
  35. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  37. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  38. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  39. Eustace S, O'Neill T, McHale S, Molony J "Fatal aplastic anaemia following prolonged diclofenac use in an elderly patient." Ir J Med Sci 158 (1989): 217
  40. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  41. Ashraf M, Pearson RM, Winfield DA "Aplastic anaemia associated with fenoprofen." Br Med J 284 (1982): 1301-2
  42. Andrews R, Russell N "Aplastic anaemia associated with a non-steroidal anti-inflammatory drug: relapse after exposure to another such drug." Br Med J 301 (1990): 38
  43. Lee SH, Fawcett V, Preece JM "Aplastic anaemia associated with piroxicam." Lancet 1 (1982): 1186
  44. Miller JL "Marrow aplasia and sulindac." Ann Intern Med 92 (1980): 129
  45. Hughes JA, Sudell W "Hemolytic anemia associated with naproxen." Arthritis Rheum 26 (1983): 1054
  46. Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
  47. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  48. McNeil P, MacKenzie I, Manoharan A "Naproxen-associated aplastic anaemia." Med J Aust 145 (1986): 53-5
  49. van Dijk BA, Rico PB, Hoitsma A, Kunst VA "Immune hemolytic anemia associated with tolmetin and suprofen." Transfusion 29 (1989): 638-41
View all 49 references
Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) heart failure

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure

Fluid retention and edema have been observed in patients treated with NSAIDs, including some topical formulations. These drugs should be used with caution in patients with fluid retention or heart failure.

Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Davies NM "Clinical pharmacokinetics of flurbiprofen and its enantiomers." Clin Pharmacokinet 28 (1995): 100-14
  3. Knadler MP, Brater DC, Hall SD "Plasma protein binding of flurbiprofen: enantioselectivity and influence of pathophysiological status." J Pharmacol Exp Ther 249 (1989): 378-85
  4. Dhand AK, LaBrecque DR, Metzger J "Sulindac (clinoril) hepatitis." Gastroenterology 80 (1981): 585-6
  5. Lockwood GF, Albert KS, Szpunar GJ, Wagner JG "Pharmacokinetics of ibuprofen in man III: plasma protein binding." J Pharmacokinet Biopharm 11 (1983): 469-82
  6. Haddock RE, Jeffery DJ, Lloyd JA, Thawley AR "Metabolism of nabumetone (BRL 14777) by various species including man." Xenobiotica 14 (1984): 327-37
  7. Reeve PA, Moshiri M, Bell GD "Pulmonary oedema, jaundice and renal impairment with naproxen." Br J Rheumatol 26 (1987): 70-1
  8. Hyneck ML, Smith PC, Munafo A, et al "Disposition and irreversible plasma protein binding of tolmetin in humans." Clin Pharmacol Ther 44 (1988): 107-14
  9. Calvo MV, Dominguez-Gil A, Macias JG, Diez JL "Naproxen disposition in hepatic and biliary disorders." Int J Clin Pharmacol Ther Toxicol 18 (1980): 242-6
  10. Breen EG, McNicholl J, Cosgrove E, McCabe J, Stevens FM "Fatal hepatitis associated with diclofenac." Gut 27 (1986): 1390-3
  11. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  12. Banks AT, Zimmerman HJ, Ishak KG, Harter JG "Diclofenac-associated hepatotoxicity: analysis of 180 cases reported to the food and drug administration as adverse reactions." Hepatology 22 (1995): 820-7
  13. Homon CA, Fluck ER, Janssen FW, Ruelius HW "Protein binding and clearance of oxaprozin, a highly bound anti- inflammatory agent." Agents Actions 12 (1982): 211-5
  14. Hucker HB, Stauffer SC, White SD, et al "Physiologic disposition and metabolic fate of a new anti-inflammatory agent, cis-5-fluoro-2-methyl-1-[p-(methylsulfinyl)-benzylidenyl]-indene-3-acetic acid in the." Drug Metab Dispos 1 (1973): 721-36
  15. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  16. Lewellen OR, Templeton R "The pharmacokinetics of ketoprofen in man during and after repeated oral dosing (50mg q.i.d.) with orudis." Scand J Rheumatol 14 (1976): 53-62
  17. Helfgott SM, Sandberg-Cook J, Zakim D, Nestler J "Diclofenac-associated hepatotoxicity." JAMA 264 (1990): 2660-2
  18. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  19. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
  20. Gallanosa AG, Spyker DA "Sulindac hepatotoxicity: a case report and review." Clin Toxicol 23 (1985): 205-38
  21. Ramakrishna B, Viswanath N "Diclofenac-induced hepatitis - case report and literature review." Liver 14 (1994): 83-4
  22. Ferdinandi ES, Sehgal SN, Demerson CA, Dubuc J, Zilber J, Dvornik D, Cayen MN "Disposition and biotransformation of C-etodolac in man." Xenobiotica 16 (1986): 153-66
  23. Verbeeck RK, Richardson CJ, Blocka KL "Clinical pharmacokinetics of piroxicam." J Rheumatol 13 (1986): 789-96
  24. Whittaker SJ, Amar JN, Wanless IR, Heathcote J "Sulindac hepatotoxicity." Gut 23 (1982): 875-7
  25. Scully LJ, Clarke D, Barr RJ "Diclofenac induced hepatitis. 3 cases with features of autoimmune chronic active hepatitis." Dig Dis Sci 38 (1993): 744-51
  26. Stierlin H, Faigle JW "Biotransformation of diclofenac sodium (Voltaren) in animals and man. II. Quantitative determination of the unchanged drug and principal phenolic metabolites, in urine and bile." Xenobiotica 9 (1979): 611-21
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  31. Bhogaraju A, Nazeer S, AlBaghdadi Y, Rahman M, Wrestler F, Patel N "Diclofenac-associated hepatitis." South Med J 92 (1999): 711-3
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  33. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  34. Turner R "Hepatic and renal tolerability of long-term naproxen treatment in patients with rheumatoid arthritis." Semin Arthritis Rheum 17 (1988): 29-35
  35. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
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  38. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  39. Planas R, De Leon R, Quer JC, Barranco C, Bruguera M, Gassull MA "Fatal submassive necrosis of the liver associated with piroxicam." Am J Gastroenterol 85 (1990): 468-70
  40. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  41. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  42. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
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  45. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  46. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  47. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  48. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  49. Park GD, Spector R, Headstream T, Goldberg M "Serious adverse reactions associated with sulindac." Arch Intern Med 142 (1982): 1292-4
  50. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  51. Julh RP, Van Thiel DH, Dittert LW, et al "Ibuprofen and sulindac kinetics in alcoholic liver disease." Clin Pharmacol Ther 34 (1983): 104-9
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  53. Selley ML, Madsen BW, Thomas J "Protein binding of tolmetin." Clin Pharmacol Ther 24 (1978): 694-705
  54. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  55. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  56. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  57. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  58. Blouin R, Chaudhary I, Nishihara K, Cox S "The effects of liver and renal disease on stereoselective serum binding of flurbiprofen." Br J Clin Pharmacol 35 (1993): 62-4
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  60. Victorino RM, Baptista A, Silveira JC, de Moura MC "Jaundice associated with naproxen." Postgrad Med J 56 (1980): 368-70
  61. Hyneck ML "An overview of the clinical pharmacokinetics of nabumetone." J Rheumatol 19 (1992): 20-4
  62. Sallie RW, McKenzie T, Reed WD, Quinlan MF, Shilkin KB "Diclofenac hepatitis." Aust N Z J Med 21 (1991): 251-5
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  64. Cappell MS, Kozicky O, Competiello LS "Indomethacin-induced cholestasis." J Clin Gastroenterol 10 (1988): 445-7
  65. Richardson CJ, Blocka KL, Ross SG, Verbeeck RK "Piroxicam and 5'-hydroxypiroxicam kinetics following multiple dose administration of piroxicam." Eur J Clin Pharmacol 32 (1987): 89-91
  66. Daniele B, Pignata S, D'Agostino L, et al "Sulindac-induced severe hepatitis." Am J Gastroenterol 83 (1988): 1429-31
  67. Brocks DR, Jamali F "Etodolac clinical pharmacokinetics." Clin Pharmacokinet 26 (1994): 259-74
  68. Hvidberg E, Lausen HH, Jansen JA "Indomethacin: plasma concentrations and protein binding in man." Eur J Clin Pharmacol 4 (1972): 119-24
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  70. Lasseter K, Shamblen E, Murdoch A, Marino M, Minor M, Kraml MJ "Pharmacokinetics of etodolac in patients with hepatic cirrhosis." J Clin Pharmacol 28 (1988): 933
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  73. Selley ML, Glass J, Triggs EJ, Thomas J "Pharmacokinetic studies of tolmetin in man." Clin Pharmacol Ther 17 (1975): 599-605
  74. Giroux Y, Moreau M, Kass TG "Cholestatic jaundice caused by sulindac." Can J Surg 25 (1982): 334-5
  75. Klein SM, Khan MA "Hepatitis, toxic epidermal necrolysis and pancreatitis in association with sulindac therapy." J Rheumatol 10 (1983): 513-3
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  77. Hepps KS, Maliha GM, Estrada R, Goodgame RW "Severe cholestatic jaundice associated with piroxicam." Gastroenterology 101 (1991): 1737-40
  78. Rubin A, Warrick P, Wolen RL, et al "Physiological disposition of fenoprofen in man III: metabolism and protein binding of fenoprofen." J Pharmacol Exp Ther 183 (1972): 449-57
  79. Jick H, Derby LE, Rodriguez LA, et al "Liver disease associated with diclofenac, naproxen, and piroxicam." Pharmacotherapy 12 (1992): 207-12
  80. Purdum PP, Shelden SL, Boyd JW, Shiffman ML "Oxaprozin-induced fulminant hepatitis." Ann Pharmacother 28 (1994): 1159-61
  81. Lee SM, O'Brien CJ, Williams R, Whitaker S, Gould SR "Subacute hepatic necrosis induced by piroxicam." Br Med J (Clin Res Ed) 293 (1986): 540-1
  82. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  83. Caballeria E, Masso RM, Arago JV, Sanchis A "Piroxicam hepatotoxicity." Am J Gastroenterol 85 (1990): 898-9
  84. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  85. Helleberg L "Clinical pharmacokinetics of indomethacin." Clin Pharmacokinet 6 (1981): 245-58
  86. Wood LJ, Mundo F, Searle J, Powell LW "Sulindac hepatotoxicity: effects of acute and chronic exposure." Aust N Z J Med 15 (1985): 397-401
  87. Pages LJ, Martinez JJ, Garg DC, et al "Pharmacokinetics of ketorolac tromethamine in hepatically impaired vs young healthy subjects." J Clin Pharmacol 27 (1987): 724
  88. O'Brien WM, Bagby GF "Rare adverse reactions to nonsteroidal antiinflammatory drugs." J Rheumatol 12 (1985): 562-7
  89. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  90. Macdonald JI, Wallace SM, Mahachai V, Verbeeck RK "Both phenolic and acyl glucuronidation pathways of diflunisal are impaired in liver cirrhosis." Eur J Clin Pharmacol 42 (1992): 471-4
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  92. Maleev A, Vlahov V, Gruev I, Dierdorf D, Kostova N, Bacracheva N "Liver insufficiency as a factor modifying the pharmacokinetic characteristic of the preparation nabumetone." Int J Clin Pharmacol Ther Toxicol 24 (1986): 425-9
View all 92 references
Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) hyperkalemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Increase in serum potassium concentration, including hyperkalemia, have been reported with use of NSAIDs, even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic- hypoaldosteronism state.

Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) hypertension

Moderate Potential Hazard, Moderate plausibility.

NSAIDs including topicals can lead to the onset of new hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. Blood pressure should be monitored closely during NSAID therapy and throughout the course of therapy.

Moderate

NSAIDs (applies to baclofen/flurbiprofen/lidocaine topical) platelet aggregation inhibition

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thrombocytopathy, Coagulation Defect, Thrombocytopenia, 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. Berliner S, Sidi Y, Shaklai M, Pinkhas J "Appearance of thrombocytopenia and benign monoclonal gammopathy following intake of drugs." Acta Haematol 67 (1982): 71-2
  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. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  4. Park GD, Spector R, Headstream T, Goldberg M "Serious adverse reactions associated with sulindac." Arch Intern Med 142 (1982): 1292-4
  5. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
  6. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  7. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  8. Robb PJ, Rollin AM, Saunders DA "Diclofenac and post-tonsillectomy haemorrhage." Clin Otolaryngol 20 (1995): 483
  9. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  10. Katz ME, Wang P "Fenoprofen-associated thrombocytopenia." Ann Intern Med 92 (1980): 262
  11. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  12. Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
  13. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  14. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  15. Buchanan GR, Martin V, Levine PH, et al "The effects of "anti-platelet" drugs on bleeding time and platelet aggregation in normal human subjects." Am J Clin Pathol 68 (1977): 355-9
  16. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  17. Jick H, Derby LE, Garcia Rodriguez LA, Jick SS, Dean AD "Nonsteroidal antiinflammatory drugs and certain rare, serious adverse events: a cohort study." Pharmacotherapy 13 (1993): 212-7
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Baclofen / flurbiprofen / lidocaine topical drug interactions

There are 772 drug interactions with baclofen / flurbiprofen / lidocaine topical

Baclofen / flurbiprofen / lidocaine topical alcohol/food interactions

There are 3 alcohol/food interactions with baclofen / flurbiprofen / lidocaine topical

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.