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Ibuprofen PM Disease Interactions

There are 21 disease interactions with Ibuprofen PM (diphenhydramine / ibuprofen).

Major

Anxiolytics/sedatives/hypnotics (applies to Ibuprofen PM) depression

Major Potential Hazard, Moderate plausibility.

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Buspar (buspirone)." Bristol-Myers Squibb (2002):
  2. "Product Information. Ambien (zolpidem)." sanofi-aventis (2001):
  3. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  4. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  5. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  6. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical (2001):
  8. "Product Information. Xyrem (sodium oxybate)." Orphan Medical (2002):
  9. "Product Information. Lunesta (eszopiclone)." Sepracor Inc (2004):
  10. "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America (2005):
  11. "Product Information. Silenor (doxepin)." Somaxon Pharmaceuticals (2010):
  12. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
  13. "Product Information. Hetlioz (tasimelteon)." Vanda Pharmaceuticals Inc (2014):
  14. "Product Information. Belsomra (suvorexant)." Merck & Company Inc (2014):
View all 14 references
Major

NSAIDs (applies to Ibuprofen PM) asthma

Major Potential Hazard, High plausibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. A subpopulation of patients with asthma may have aspirin-sensitive asthma which may include chronic rhinosinusitis complicated by nasal polyps, severe potentially fatal bronchospasm, and/or intolerance to aspirin and other NSAIDs. Since cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, therapy with any NSAID should be avoided in patients with this form of aspirin sensitivity. NSAIDs should be used with caution in patients with preexisting asthma (without known aspirin sensitivity), and these patients should be monitored for changes in the signs and symptoms of asthma.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 15 references
Major

NSAIDs (applies to Ibuprofen PM) 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. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Anaprox (naproxen)." Roche Laboratories (2006):
  7. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 14 references
Major

NSAIDs (applies to Ibuprofen PM) GI toxicity

Major Potential Hazard, High plausibility. Applicable conditions: Peptic Ulcer, Gastrointestinal Hemorrhage, Gastrointestinal Perforation, Duodenitis/Gastritis, History - Peptic Ulcer, Alcoholism, Colitis/Enteritis (Noninfectious), Colonic Ulceration, Smoking, Intestinal Anastomoses

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal. These serious adverse events can develop at any time, with or without warning symptoms. Only 1 in 5 patients who develop a serious upper GI side effect on NSAIDs is symptomatic. NSAIDs should be used with caution in patients with history of peptic ulcer disease and/or GI bleeding, as these patients had a greater than 10-fold increased risk for developing a GI bleed compared to patients without these risk factors. Caution is also advised if NSAIDs are prescribed to patients with other factors that increase risk of GI bleeding, such as: prolonged NSAID therapy; concomitant use of oral corticosteroids, antiplatelet agents (e.g., aspirin), anticoagulants, selective serotonin reuptake inhibitors; alcohol use; smoking; history of gastrointestinal surgery or anastomosis, older age; poor general health status; and advanced liver disease and/or coagulopathy. Particular vigilance is necessary when treating elderly or debilitated patients since most postmarketing reports of fatal GI events occurred in these patients.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Celebrex (celecoxib)." Searle (2001):
  16. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 16 references
Major

NSAIDs (applies to Ibuprofen PM) rash

Major Potential Hazard, High plausibility. Applicable conditions: Dermatitis - Drug-Induced

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious skin adverse reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis), which can be fatal. These serious events may occur without warning. Patients should be advised to discontinue the NSAID and seek medical attention promptly at the first sign of skin rash or any other sign of hypersensitivity. NSAIDs are contraindicated in patients with previous serious skin reactions to these drugs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
  16. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
View all 16 references
Major

NSAIDs (applies to Ibuprofen PM) renal toxicities

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

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) has resulted in renal papillary necrosis and other renal injury. Renal toxicity has been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion: in such patients, NSAIDs may cause a dose-dependent reduction in prostaglandin synthesis and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk for this reaction include the elderly, those with impaired renal function, dehydration, hypovolemia, heart failure, or liver dysfunction, and those taking diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; discontinuation of NSAID therapy will usually lead to recovery to the pretreatment state. No information is available regarding use NSAIDs in patients with advanced renal disease; the renal effects of NSAIDs may hasten the progression of renal dysfunction in patients with preexisting renal disease. Volume status should be corrected in dehydrated or hypovolemic patients prior to initiating treatment. Renal function should be monitored during therapy in patients with renal or liver dysfunction, heart failure, dehydration, or hypovolemia. NSAIDs should be avoided in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function; if an NSAID is used in such patients, they should be monitored for signs of worsening renal function.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Celebrex (celecoxib)." Searle (2001):
  16. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 16 references
Major

NSAIDs (applies to Ibuprofen PM) thrombosis

Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Ischemic Heart Disease

Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to 3 years duration have supported this increased risk. It is unclear from available data if the risk for cardiovascular thrombotic events is similar for all NSAIDs. 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 gastrointestinal events is increased. Physicians and patients should remain alert for the development of adverse cardiovascular events throughout the entire duration of therapy, even without prior cardiovascular symptoms. Patients should be advised to promptly seek medical attention if they experience symptoms of cardiovascular thrombotic events (including chest pain, shortness of breath, weakness, or slurring of speech).

NSAIDs are contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Two large clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10 to 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke.

The use of NSAIDs should be avoided in patients with a recent myocardial infarction unless the benefits are expected to outweigh the risk of recurrent cardiovascular thrombotic events. If an NSAID is used in patients with a recent myocardial infarction, they should be monitored for signs of cardiac ischemia.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  5. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Celebrex (celecoxib)." Searle (2001):
  7. "Product Information. Ponstel (mefenamic acid)." Pfizer U.S. Pharmaceuticals Group (2006):
  8. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
View all 8 references
Moderate

Antihistamines (applies to Ibuprofen PM) anticholinergic effects

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Obstruction, Urinary Retention, Glaucoma/Intraocular Hypertension

Antihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  6. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  13. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  14. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  15. Watemberg NM, Roth KS, Alehan FK, Epstein CE "Central anticholinergic syndrome on therapeutic doses of cyproheptadine." Pediatrics 103 (1999): 158-60
  16. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  18. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  19. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
  20. Talbert RL, Yee GC, DiPiro JT, Matzke GR, Posey LM, Wells BG "Pharmacotherapy: A Pathophysiologic Approach" Stamford, CT: Appleton & Lange (1999):
View all 20 references
Moderate

Antihistamines (applies to Ibuprofen PM) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

It has been suggested that the anticholinergic effect of antihistamines may reduce the volume and cause thickening of bronchial secretions, resulting in obstruction of respiratory tract. Some manufacturers and clinicians recommend that therapy with antihistamines be administered cautiously in patients with asthma or chronic obstructive pulmonary disease.

References

  1. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  3. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  4. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  5. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  6. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  7. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  9. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  10. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  11. "Product Information. Semprex-D (acrivastine-pseudoephedrine)." Endo Laboratories LLC (2001):
  12. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  14. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
  16. "Product Information. Tacaryl (methdilazine)." Westwood Squibb Pharmaceutical Corporation (2001):
  17. "Product Information. Temaril (trimeprazine)." Allergan Inc (2001):
View all 17 references
Moderate

Antihistamines (applies to Ibuprofen PM) cardiovascular

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease, Hyperthyroidism, Hypotension

Antihistamines may infrequently cause cardiovascular adverse effects related to their anticholinergic and local anesthetic (quinidine-like) activities. Tachycardia, palpitation, ECG changes, arrhythmias, hypotension, and hypertension have been reported. Although these effects are uncommon and usually limited to overdosage situations, the manufacturers and some clinicians recommend that therapy with antihistamines be administered cautiously in patients with cardiovascular disease, hypertension, and/or hyperthyroidism.

References

  1. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  5. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  6. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  7. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  8. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  9. Smith SJ "Cardiovascular toxicity of antihistamines." Otolaryngol Head Neck Surg 111 Suppl (1994): 348-54
  10. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  11. Woosley RL "Cardiac actions of antihistamines." Annu Rev Pharmacol Toxicol 36 (1996): 233-52
  12. "Product Information. Drixoral (dextromethorphan)." Schering-Plough (2001):
  13. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
  14. "Product Information. Vistaril (hydroxyzine)." Pfizer U.S. Pharmaceuticals (2001):
  15. "Product Information. Dramamine (dimenhydrinate)." Pharmacia and Upjohn (2001):
View all 15 references
Moderate

Antihistamines (applies to Ibuprofen PM) renal/liver disease

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

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

References

  1. Glazko AJ, Dill WA, Young RM, Smith TC, Ogilvie RI "Metabolic disposition of diphenhydramine." Clin Pharmacol Ther 16 (1974): 1066-76
  2. Paton DM, Webster DR "Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines)." Clin Pharmacokinet 10 (1985): 477-97
  3. Rumore MM "Clinical pharmacokinetics of chlorpheniramine." Drug Intell Clin Pharm 18 (1984): 701-7
  4. Huang SM, Athanikar NK, Sridhar K, Huang YC, Chiou WL "Pharmacokinetics of chlorpheniramine after intravenous and oral administration in normal adults." Eur J Clin Pharmacol 22 (1982): 359-65
  5. Simons KJ, Simons FE, Luciuk GH, Frith EM "Urinary excretion of chlorpheniramine and its metabolites in children." J Pharm Sci 73 (1984): 595-9
  6. Meredith CG, Christian CD Jr, Johnson RF, Madhavan SV, Schenker S "Diphenhydramine disposition in chronic liver disease." Clin Pharmacol Ther 35 (1984): 474-9
  7. Blyden GT, Greenblatt DJ, Scavone JM, Shader RI "Pharmacokinetics of diphenhydramine and a demethylated metabolite following intravenous and oral administration." J Clin Pharmacol 26 (1986): 529-33
  8. Albert KS, Hallmark MR, Sakmar E, Weidler DJ, Wagner JG "Pharmacokinetics of diphenhydramine in man." J Pharmacokinet Biopharm 3 (1975): 159-70
  9. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  10. Bruce RB, Turnbull LB, Newman JH, Pitts JE "Metabolism of brompheniramine." J Med Chem 11 (1968): 1031-4
  11. Porter CC, Arison BH, Gruber VF, Titus DC, Vandenheuvel WJ "Human metabolism of cyproheptadine." Drug Metab Dispos 3 (1975): 189-97
  12. Hintze KL, Wold JS, Fischer LJ "Disposition of cyproheptadine in rats, mice, and humans and identification of a stable epoxide metabolite." Drug Metab Dispos 3 (1975): 1-9
  13. Maddox DE, Reed CE "Clinical pharmacodynamics of antihistamines." Ann Allergy 59 (1987): 43-8
  14. Simons FE, Simons KJ, Frith EM "The pharmacokinetics and antihistaminic of the H1 receptor antagonist hydroxyzine." J Allergy Clin Immunol 73 (1984): 69-75
  15. Simons FE, Watson WT, Chen XY, Minuk GY, Simons KJ "The pharmacokinetics and pharmacodynamics of hydroxyzine in patients with primary biliary cirrhosis." J Clin Pharmacol 29 (1989): 809-15
View all 15 references
Moderate

Anxiolytics/sedatives/hypnotics (applies to Ibuprofen PM) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Urinary Retention

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

References

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
Moderate

Anxiolytics/sedatives/hypnotics (applies to Ibuprofen PM) liver disease

Moderate Potential Hazard, Moderate plausibility.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

References

  1. "Product Information. Buspar (buspirone)." Bristol-Myers Squibb (2002):
  2. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  3. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  4. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  5. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Precedex (dexmedetomidine)." Abbott Pharmaceutical (2001):
  7. "Product Information. Xyrem (sodium oxybate)." Orphan Medical (2002):
  8. "Product Information. Lunesta (eszopiclone)." Sepracor Inc (2004):
  9. "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America (2005):
  10. "Product Information. Silenor (doxepin)." Somaxon Pharmaceuticals (2010):
  11. "Product Information. Intermezzo (zolpidem)." Purdue Pharma LP (2011):
  12. "Product Information. Hetlioz (tasimelteon)." Vanda Pharmaceuticals Inc (2014):
  13. "Product Information. Belsomra (suvorexant)." Merck & Company Inc (2014):
View all 13 references
Moderate

Anxiolytics/sedatives/hypnotics (applies to Ibuprofen PM) resp depression

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Asthma

Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.

References

  1. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. Lheureux P, Debailleul G, De Witte O, Askenasi R "Zolpidem intoxication mimicking narcotic overdose: response to flumazenil." Hum Exp Toxicol 9 (1990): 105-7
  3. Murciano D, Aubier M, Palacios S, Parients R "Comparison of zolpidem (Z), triazolam (T), and flunitrazepam (F) effects on arterial blood gases and control of breathing in patients with severe chronic obstructive pulmonary disease (COPD)." Chest 97 Suppl (1990): s51-2
  4. "Product Information. Ambien (zolpidem)." sanofi-aventis (2001):
  5. Biban P, Baraldi E, Pettennazzo A, Filippone M, Zacchello F "Adverse effect of chloral hydrate in two young children with obstructive sleep apnea." Pediatrics 92 (1993): 461-3
  6. Greenberg SB, Faerber EN "Respiratory insufficiency following chloral hydrate sedation in two children with Leigh disease (subacute necrotizing encephalomyelopathy)." Pediatr Radiol 20 (1990): 287-8
  7. "Product Information. Placidyl (ethchlorvynol)." Abbott Pharmaceutical (2001):
  8. "Product Information. Aquachloral Supprettes (chloral hydrate)." Medisca Inc (2001):
  9. "Product Information. Equanil (meprobamate)." Wallace Laboratories (2001):
  10. "Product Information. Sonata (zaleplon)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Unisom (doxylamine)." Pfizer U.S. Pharmaceuticals Group (2013):
View all 11 references
Moderate

Ibuprofen (applies to Ibuprofen PM) PKU

Moderate Potential Hazard, High plausibility. Applicable conditions: Phenylketonuria

Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Motrin (brand of ibuprofen) chewable 50 mg and 100 mg tablets provide the equivalent of 3 mg and 6 mg of phenylalanine each, respectively. The aspartame/phenylalanine content should be considered when these and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

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

NSAIDs (applies to Ibuprofen PM) anemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bleeding

Anemia has been reported in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). This may be due to fluid retention, occult/gross blood loss, or an incompletely described effect on erythropoiesis. Hemoglobin or hematocrit should be monitored in patients with any signs/symptoms of anemia or blood loss, especially during long-term therapy. NSAIDs may increase risk of bleeding events; comorbid conditions (e.g., coagulation disorders; concomitant use of warfarin/other anticoagulants, antiplatelet agents, serotonin/serotonin norepinephrine reuptake inhibitors) may increase this risk, and patients with these conditions should be monitored for signs of bleeding. 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. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 17 references
Moderate

NSAIDs (applies to Ibuprofen PM) heart failure

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

Fluid retention and edema have been observed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs), including some topical formulations. These drugs should be avoided in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. If an NSAID is used in patients with severe heart failure, they should be monitored for signs of worsening heart failure.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):
View all 12 references
Moderate

NSAIDs (applies to Ibuprofen PM) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Borderline elevations of 1 or more liver tests may occur in up to 15% of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These laboratory abnormalities may progress, remain unchanged, or regress with continuing therapy. Elevations of ALT or AST (at least 3 times the upper limit of normal) have been reported in about 1% of patients in clinical trials. In addition, rare (sometimes fatal) cases of severe hepatotoxicity, including liver necrosis, hepatic failure, jaundice, and 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. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
View all 17 references
Moderate

NSAIDs (applies to Ibuprofen PM) hyperkalemia

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

Increases in serum potassium concentration (including hyperkalemia) have been reported with use of nonsteroidal anti-inflammatory drugs (NSAIDs), even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. Caution is advised in patients with hyperkalemia.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  2. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  3. "Product Information. Celebrex (celecoxib)." Searle (2001):
Moderate

NSAIDs (applies to Ibuprofen PM) hypertension

Moderate Potential Hazard, Moderate plausibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including topicals, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. NSAIDs should be used with caution in patients with hypertension. Blood pressure should be monitored closely during the initiation of NSAID therapy and throughout the course of therapy.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):
View all 12 references
Moderate

NSAIDs (applies to Ibuprofen PM) 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. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Company Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Company Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Company Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
  16. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):
View all 16 references

Ibuprofen PM drug interactions

There are 710 drug interactions with Ibuprofen PM (diphenhydramine / ibuprofen).

Ibuprofen PM alcohol/food interactions

There are 3 alcohol/food interactions with Ibuprofen PM (diphenhydramine / ibuprofen).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.