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Flector Patch (diclofenac topical) Disease Interactions

There are 5 disease interactions with Flector Patch (diclofenac topical):

Major

Nsaids (Includes Flector Patch) ↔ Asthma

Severe Potential Hazard, High plausibility

Applies to: Asthma

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. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  2. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  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. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  6. 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
  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. 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):
  10. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  11. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  12. 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
  13. 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
  14. Haddow GR, Riley E, Isaacs R, McSharry R "Ketorolac, nasal polyposis, and bronchial asthma: a cause for concern." Anesth Analg 76 (1993): 420-2
  15. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  16. 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
  17. Shapiro N "Acute angioedema after ketorolac ingestion - report of case." J Oral Maxillofac Surg 52 (1994): 626-7
  18. Ayres JG, Fleming DM, Whittington RM "Asthma death due to ibuprofen." Lancet 05/09/87 (1987): 1082
  19. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  20. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  21. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  22. Szczeklik A, Stevenson DD "Aspirin-induced asthma: Advances in pathogenesis and management." J Allerg Clin Immunol 104 (1999): 5-13
  23. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  24. Schreuder G "Ketoprofen: possible idiosyncratic acute bronchospasm." Med J Aust 152 (1990): 332-3
  25. Nasser SMS, Lee TH "Aspirin-induced early and late asthmatic responses." Clin Exp Allergy 25 (1995): 1-3
  26. Chan TY "Severe asthma attacks precipitated by NSAIDs." Ann Pharmacother 29 (1995): 199
  27. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  28. Woessner KM, Simon RA, Stevenson DD "The safety of celecoxib in patients with aspirin-sensitive asthma." Arthritis Rheum 46 (2002): 2201-6
  29. Zikowski D, Hord AH, Haddox JD, Glascock J "Ketorolac-induced bronchospasm." Anesth Analg 76 (1993): 417-9
  30. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  31. Dahlen B, Szczeklik A, Murray HH "Celecoxib in patients with asthma and aspirin intolerance." N Engl J Med 344 (2000): 142
  32. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  33. Lee TH "Mechanism of bronchospasm in aspirin-sensitive asthma." Am Rev Respir Dis 148 (1993): 1442-3
  34. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  35. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  36. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  37. Salberg DJ, Simon MR "Severe asthma induced by naproxen: a case report and review of the literature." Ann Allergy 45 (1980): 372-5
  38. Lee TH "Mechanism of aspirin sensitivity." Am Rev Respir Dis 145 (1992): s34-6
View all 38 references
Moderate

Diclofenac Topical (Includes Flector Patch) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

No information is available from controlled clinical trials regarding the use of topical diclofenac in patients with advanced renal disease. Therefore, treatment with this drug is not recommended in patients with advanced renal disease. If therapy with topical diclofenac is initiated, close monitoring of the patient's renal function is advisable.

Moderate

Nsaids (Includes Flector Patch) ↔ Heart Failure

Moderate Potential Hazard, Moderate plausibility

Applies to: 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 (Includes Flector Patch) ↔ Hypertension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypertension

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 (Includes Flector Patch) ↔ Platelet Aggregation Inhibition

Moderate Potential Hazard, Moderate plausibility

Applies to: Coagulation Defect, Thrombocytopenia, 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. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  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. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
  4. 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
  5. Thwaites BK, Nigus DB, Bouska GW, Mongan PD, Ayala EF, Merrill GA "Intravenous ketorolac tromethamine worsens platelet function during knee arthroscopy under spinal anesthesia." Anesth Analg 82 (1996): 1176-81
  6. Robb PJ, Rollin AM, Saunders DA "Diclofenac and post-tonsillectomy haemorrhage." Clin Otolaryngol 20 (1995): 483
  7. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  8. Park GD, Spector R, Headstream T, Goldberg M "Serious adverse reactions associated with sulindac." Arch Intern Med 142 (1982): 1292-4
  9. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  10. 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
  11. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  12. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  13. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  14. Katz ME, Wang P "Fenoprofen-associated thrombocytopenia." Ann Intern Med 92 (1980): 262
  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. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  17. Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
  18. Camba L, Joyner MV "Acute thrombocytopenia following ingestion of indomethacin." Acta Haematol 71 (1984): 350-2
  19. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  20. Baber N, Halliday LDC, van den Heuval, et al "Indomethacin in rheumatoid arthritis: clinical effects, pharmacokinetics, and platelet studies in responders and non-responders." Ann Rheum Dis 38 (1979): 128-37
  21. 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
  22. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  23. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  24. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  25. Bobrove AM "Diflunisal-associated thrombocytopenia in a patient with rheumatoid arthritis ." Arthritis Rheum 31 (1988): 148-9
  26. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  27. O'Brien WM "Long-term efficacy and safety of tolmetin sodium in treatment of geriatric patients with rheumatoid arthritis and osteoarthritis: a retrospective study." J Clin Pharmacol 23 (1983): 309-23
  28. Rosenbaum JT, O'Connor M "Thrombocytopenia associated with sulindac." Arthritis Rheum 24 (1981): 753-4
  29. Karachalios GN, Parigorakis JG "Thrombocytopenia and sulindac." Ann Intern Med 104 (1986): 128
  30. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  31. Bjornstad H, Vik O "Thrombocytopenic purpura associated with piroxicam." Br J Clin Pract 40 (1986): 42
  32. Stambaugh JE Jr, Gordon RL, Geller R "Leukopenia and thrombocytopenia secondary to clinoril therapy." Lancet 2 (1980): 594
  33. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  34. Hirsh J, Dalen JE, Fuster V, Harker LB, Patrono C, Roth G "Aspirin and other platelet-active drugs: the relationship among dose, effectiveness, and side effects." Chest 108 Suppl (1995): s247-57
  35. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. Longenecker GL, Swift IA, Bowen RJ, et al "Kinetics of ibuprofen effect on platelet and endothelial prostanoid release." Clin Pharmacol Ther 37 (1985): 343-8
  37. Epstein M, Vickars L, Stein H "Diclofenac induced immune thrombocytopenia." J Rheumatol 17 (1990): 1403-4
  38. Bondeson J, Berglund S "Diclofenac-induced thrombocytopenic purpura with renal and hepatic involvement." J Intern Med 230 (1991): 543-7
  39. Price AJ, Obeid D "Spontaneous non-gastrointestinal bleeding associated with diclofenac ." Lancet 2 (1989): 1520
  40. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  41. Robinson PM, Ahmed I "Diclofenac and post-tonsillectomy haemorrhage." Clin Otolaryngol 19 (1994): 344-5
  42. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  43. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  44. Gandini R, Cunietti E, Pappalepore V, et al "Effects of intravenous high doses of ketoprofen on blood clotting, bleeding time and platelet aggregation in man." J Int Med Res 11 (1983): 243
  45. Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
  46. Kim HL, Kovacs MJ "Diclofenac-associated thrombocytopenia and neutropenia." Ann Pharmacother 29 (1995): 713-5
  47. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  48. Khazan U, Toth M, Mutgi A "Diclofenac sodium and bruising ." Ann Intern Med 112 (1990): 472-3
  49. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  50. Schafer AI "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol 35 (1995): 209-19
  51. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
  52. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  53. Tomson G, Lunell N-O, Oliw E, Rane A "Relation of naproxen kinetics to effect on platelet prostaglandin release in men and dysmenorrheic women." Clin Pharmacol Ther 29 (1981): 168-73
  54. Shojania AM, Rusen SD "Thrombocytopenia secondary to sulindac therapy." Can Med Assoc J 125 (1981): 1313
  55. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  56. Poldre PA "Naproxen thrombocytopenia." Am J Hematol 31 (1989): 74
View all 56 references

Flector Patch (diclofenac topical) drug Interactions

There are 156 drug interactions with Flector Patch (diclofenac topical)

Flector Patch (diclofenac topical) alcohol/food Interactions

There is 1 alcohol/food interaction with Flector Patch (diclofenac topical)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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