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Xylon 10 (hydrocodone / ibuprofen) Disease Interactions

There are 29 disease interactions with Xylon 10 (hydrocodone / ibuprofen):

Major

Narcotic Analgesics (Includes Xylon 10) ↔ Impaired Gi Motility

Severe Potential Hazard, Moderate plausibility

Applies to: Inflammatory Bowel Disease, Constipation, Gastrointestinal Obstruction, Intestinal Anastomoses

Narcotic (opioid) analgesic agents increase smooth muscle tone in the gastrointestinal tract and decrease peristalsis, which can lead to elevated intraluminal pressure, spasm, and constipation following prolonged use. In patients with severe or acute inflammatory bowel disease, the decrease in colonic motility may induce toxic megacolon. Therapy with opioids should be administered cautiously in patients with gastrointestinal obstruction, constipation, inflammatory bowel disease, or recent gastrointestinal tract surgery. Gastrointestinal effects appear to be the most pronounced with morphine.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  3. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  4. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  5. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  8. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  10. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  13. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  14. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  15. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  16. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  17. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  18. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  19. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  21. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  22. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  23. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  25. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  26. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
View all 26 references
Major

Narcotic Analgesics (Includes Xylon 10) ↔ Infectious Diarrhea

Severe Potential Hazard, Moderate plausibility

Applies to: Infectious Diarrhea/Enterocolitis/Gastroenteritis

Narcotic (opioid) analgesic agents may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella, Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. These agents decrease gastrointestinal motility, which may delay the excretion of infective gastroenteric organisms and/or their toxins. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. Therapy with opioids should be avoided or administered cautiously in patients with infectious diarrhea, particularly that due to pseudomembranous enterocolitis or enterotoxin-producing bacteria or if accompanied by high fever, pus, or blood in the stool.

References

  1. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  2. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  6. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  15. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  16. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  19. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  20. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  21. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  22. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  23. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  25. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  26. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
View all 26 references
Major

Narcotic Analgesics (Includes Xylon 10) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  3. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  4. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  6. Yue QY, Hasselstrom J, Svensson JO, Sawe J "Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparisons between extensive and poor hydroxylators of debrisoquine." Br J Clin Pharmacol 31 (1991): 635-42
  7. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  8. McClain DA, Hug CC, Jr "Intravenous fentanyl kinetics." Clin Pharmacol Ther 28 (1980): 106-14
  9. Yun CH, Wood M, Wood AJ, Guengerich FP "Identification of the pharmacogenetic determinants of alfentanil metabolism: cytochrome P-450 3A4: an explanation of the variable elimination clearance." Anesthesiology 77 (1992): 467-74
  10. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  11. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P "Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis." Br J Anaesth 54 (1982): 1267-70
  13. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  14. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  15. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  16. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  18. Cone EJ, Darwin WD, Gorodetzky CW, Tan T "Comparative metabolism of hydrocodone in man, rat, guinea pig, rabbit, and dog." Drug Metab Dispos 6 (1978): 488-93
  19. Dershwitz M, Hoke JF, Rosow CE, Michalowski P, Connors PM, Muir KT, Dienstag JL "Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease." Anesthesiology 84 (1996): 812-20
  20. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  21. Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT "Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery." Anesthesiology 79 (1993): 893-903
  22. Osborne R, Joel S, Trew D, Slevin M "Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucoronide." Clin Pharmacol Ther 47 (1990): 12-9
  23. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, Shaw DL, Peng AW, Jamerson BD "Initial clinical experience with remifentanil, a new opioid metabolized by esterases." Anesth Analg 81 (1995): 619-23
  24. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  25. Otton SV, Schadel M, Cheung SW, Kaplan HL, Busto UE, Sellers EM "CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone." Clin Pharmacol Ther 54 (1993): 463-72
  26. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  27. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  28. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  29. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  30. Beckett AH, Taylor JF, Casy AF, Hassan MM "The biotransformation of methadone in man: synthesis and identification of a major metabolite." J Pharm Pharmacol 20 (1968): 754-62
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  32. Hasselstrom J, Sawe J "Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations." Clin Pharmacokinet 24 (1993): 344-54
  33. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  34. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  35. Hasselstrom J, Eriksson S, Persson A, Rane A, Svensson JO, Sawe J "The metabolism and bioavailability of morphine in patients with severe liver cirrhosis." Br J Clin Pharmacol 29 (1990): 289-97
  36. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  37. McHorse TS, Klotz U, Wilkinson G, Schenker S "Impaired elimination of meperidine in patients with liver disease." Trans Assoc Am Physicians 87 (1974): 281-7
  38. Neal EA, Meffin PJ, Gregory PB, Blaschke TF "Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis." Gastroenterology 77 (1979): 96-102
  39. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  40. Mazoit J-X, Sandouk P, Zetlaoui P, Scherrmann J-M "Pharmacokinetics of unchanged morphine in normal and cirrhotic subjects." Anesth Analg 66 (1987): 293-8
  41. Goromaru T, Matsuura H, Yoshimura N, Miyawaki T, Sameshima T, Miyao J, Furuta T, Baba S "Identification and quantitative determination of fentanyl metabolites in patients by gas chromatography--mass spectrometry." Anesthesiology 61 (1984): 73-7
  42. Giacomini KM, Giacomini JC, Gibson TP, Levy G "Propoxyphene and norpropoxyphene plasma concentrations after oral propoxyphene in cirrhotic patients with and without surgically constructed portacaval shunt." Clin Pharmacol Ther 28 (1980): 417-24
  43. Pond SM, Tong T, Benowitz NL, et al "Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects." Clin Pharmacol Ther 30 (1981): 183-8
  44. Novick DM, Kreek MJ, Arns PA, et al "Effect of severe alcoholic liver disease on the disposition of methadone in maintenance patients." Alcohol Clin Exp Res 9 (1985): 349
  45. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  46. Cone EJ, Darwin WD, Gorodetzky CW "Comparative metabolism of codeine in man, rat, dog, guinea-pig and rabbit: identification of four new metabolites." J Pharm Pharmacol 31 (1979): 314-7
  47. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  48. Chen ZR, Somogy AA, Reynolds G, Bochner F "Disposition and metabolism of codeine after single and chronic doses in one poor and seven extensive metabolisers." Br J Clin Pharmacol 31 (1991): 381-90
  49. Beckett AH, Vaughan DP, Essien EE "N-Oxidation--an important route in the metabolism of methadone in man." J Pharm Pharmacol 24 (1972): 244
  50. Hagen N, Thirlwell MP, Dhaliwal HS, Babul N, Harsanyi Z, Darke AC "Steady-state pharmacokinetics of hydromorphone and hydromorphone-3-glucuronide in cancer patients after immediate and controlled-release hydromorphone." J Clin Pharmacol 35 (1995): 37-44
  51. Kreek MJ, Fanizza AM, et al "Methadone disposition in patients with chronic liver disease." Clin Pharmacol Ther 30 (1981): 353-62
  52. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  53. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  54. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  55. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  56. Bower S, Sear JW, Roy RC, Carter RF "Effects of different hepatic pathologies on disposition of alfentanil in anaesthetized patients." Br J Anaesth 68 (1992): 462-5
  57. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  58. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
View all 58 references
Major

Narcotic Analgesics (Includes Xylon 10) ↔ Prematurity

Severe Potential Hazard, High plausibility

Applies to: Prematurity/Underweight in Infancy

The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Multum Information Services, Inc. Expert Review Panel"
Major

Narcotic Analgesics (Includes Xylon 10) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Although narcotic (opioid) analgesic agents are generally metabolized by the liver, renal impairment can alter the elimination of these agents and their metabolites (some of which are pharmacologically active), resulting in drug accumulation and increased risk of toxicity. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with significantly impaired renal function. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. Hanna MH, D'Costa F, Peat SJ, Fung C, Venkat N, Zilkha TR, Davies S "Morphine-6-glucuronide disposition in renal impairment." Br J Anaesth 70 (1993): 511-4
  2. Wolff J, Bigler D, Christensen CB, et al "Influence of renal function on the elimination of morphine and morphine glucoronides." Eur J Clin Pharmacol 34 (1988): 353-7
  3. Aitkenhead AR, Vater M, Achola K, Cooper CM, Smith G "Pharmacokinetics of single-dose i.v. morphine in normal volunteers and patients with end-stage renal failure." Br J Anaesth 56 (1984): 813-9
  4. Charuvastra VC, Ouren J "Renal failure and treatment of a methadone maintenance patient." Med J Aust 09/24/77 (1977): 433-4
  5. Chan K, Jennings F, Orme ML "Pharmacokinetics of low-dose intravenous pethidine in patients with renal dysfunction." J Clin Pharmacol 27 (1987): 516-22
  6. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  7. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  8. Bechtel WD, Sinterhauf K "Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog." Arzneimittelforschung 28 (1978): 308-11
  9. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. Guy DR, Awni WM, Findlay JW, et al "Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease." Clin Pharmacol Ther 43 (1988): 63-71
  12. Kreek MJ, Schecter AJ, Gutjahr CL, et al "Methadone use in patients with chronic renal failure." Drug Alcohol Depend 5 (1980): 197-205
  13. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  15. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  16. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6
  17. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  19. Barnes JN, Williams AJ, Tomson MJ, et al "Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs." Br Med J (Clin Res Ed) 290 (1985): 740-2
  20. Drayer DE "Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure." Clin Pharmacokinet 1 (1976): 426-43
  21. Findlay JW, Butz RF, Welch RM "Codeine kinetics as determined by radioimmunoassay." Clin Pharmacol Ther 22 (1977): 439-46
  22. Drayer DE "Active drug metabolites and renal failure." Am J Med 62 (1977): 486-9
  23. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  24. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  25. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  26. Giacomini KM, Gibson TP, Levy G "Plasma protein binding of d-propoxyphene in normal subjects and anephric patients." J Clin Pharmacol 18 (1978): 106-9
  27. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  28. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  29. Gram LF, Schou J, Way WL, et al "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  30. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  31. Gibson TP, Giacomini KM, Briggs WA, Whitman W, Levy G "Propoxyphene and norpropoxyphene plasma concentrations in the anephric patient." Clin Pharmacol Ther 27 (1980): 665-70
  32. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  33. Verbeeck RK, Branch RA, Wilkinson GR "Drug metabolites in renal failure: pharmacokinetic and clinical implications." Clin Pharmacokinet 6 (1981): 329-45
  34. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  35. Inturrisi CE "Disposition of narcotics in patients with renal disease." Am J Med 62 (1977): 528-9
  36. Sawe J, Odar-Cederlof I "Kinetics of morphine in patients with renal failure." Eur J Clin Pharmacol 32 (1987): 377-82
  37. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  38. Baselt RC, Casarett LJ "Urinary excretion of methadone in man." Clin Pharmacol Ther 13 (1972): 64-70
  39. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  40. Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P "Morphine pharmacokinetics in renal failure." Anesthesiology 66 (1987): 327-31
  41. Parab PV, Ritschel WA, Coyle DE, et al "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  42. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  43. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  44. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  45. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  46. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  47. Wolfert AI, Sica DA "Narcotic usage in renal failure." Int J Artif Organs 11 (1988): 411-5
  48. Dhonneur G, Gilton A, Sandouk P, Scherrmann JM, Duvaldestin P "Plasma and cerebrospinal fluid concentrations of morphine and morphine glucuronides after oral morphine - the influence of renal failure." Anesthesiology 81 (1994): 87-93
  49. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  50. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  51. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  52. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  53. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  54. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  55. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  56. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
View all 56 references
Major

Nsaids (Includes Xylon 10) ↔ 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. 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
  2. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  4. 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
  5. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. 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):
  7. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  9. Lewis RV "Severe asthma after naproxen." Lancet 05/30/87 (1987): 1270
  10. 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
  11. 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
  12. Haddow GR, Riley E, Isaacs R, McSharry R "Ketorolac, nasal polyposis, and bronchial asthma: a cause for concern." Anesth Analg 76 (1993): 420-2
  13. Settipane RA, Stevenson DD "Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma." J Allergy Clin Immunol 84 (1989): 26-33
  14. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  15. 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
  16. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  17. Schreuder G "Ketoprofen: possible idiosyncratic acute bronchospasm." Med J Aust 152 (1990): 332-3
  18. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  19. Dahlen B, Szczeklik A, Murray HH "Celecoxib in patients with asthma and aspirin intolerance." N Engl J Med 344 (2000): 142
  20. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  21. Ayres JG, Fleming DM, Whittington RM "Asthma death due to ibuprofen." Lancet 05/09/87 (1987): 1082
  22. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  23. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  24. Shapiro N "Acute angioedema after ketorolac ingestion - report of case." J Oral Maxillofac Surg 52 (1994): 626-7
  25. Lee TH "Mechanism of aspirin sensitivity." Am Rev Respir Dis 145 (1992): s34-6
  26. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  27. Szczeklik A, Stevenson DD "Aspirin-induced asthma: Advances in pathogenesis and management." J Allerg Clin Immunol 104 (1999): 5-13
  28. Salberg DJ, Simon MR "Severe asthma induced by naproxen: a case report and review of the literature." Ann Allergy 45 (1980): 372-5
  29. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  30. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  31. Nasser SMS, Lee TH "Aspirin-induced early and late asthmatic responses." Clin Exp Allergy 25 (1995): 1-3
  32. Chan TY "Severe asthma attacks precipitated by NSAIDs." Ann Pharmacother 29 (1995): 199
  33. Zikowski D, Hord AH, Haddox JD, Glascock J "Ketorolac-induced bronchospasm." Anesth Analg 76 (1993): 417-9
  34. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  35. Lee TH "Mechanism of bronchospasm in aspirin-sensitive asthma." Am Rev Respir Dis 148 (1993): 1442-3
  36. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  37. Woessner KM, Simon RA, Stevenson DD "The safety of celecoxib in patients with aspirin-sensitive asthma." Arthritis Rheum 46 (2002): 2201-6
  38. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 38 references
Major

Nsaids (Includes Xylon 10) ↔ Fluid Retention

Severe Potential Hazard, Moderate plausibility

Applies to: Fluid Retention, 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. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. 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
  3. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
  4. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  5. "Product Information. Anaprox (naproxen)." Roche Laboratories, Nutley, NJ.
  6. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  7. Agnholt J, Andreasen F "The effect of ibuprofen therapy on water and electrolyte balance." Acta Med Scand 212 (1982): 65-9
  8. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. 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
  10. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  12. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  13. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  14. 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
  15. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  16. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  17. Heynen G "Toleration and safety of piroxicam." Eur J Rheumatol Inflamm 8 (1987): 86-93
  18. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  19. Van Den Ouweland FA, Gribnau FW, Meyboom RH "Congestive heart failure due to nonsteroidal anti-inflammatory drugs in the elderly." Age Ageing 17 (1988): 8-16
  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. Willkens RF "Worldwide clinical safety experience with diclofenac." Semin Arthritis Rheum 2 Suppl 1 (1985): 105-10
  28. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  29. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
View all 29 references
Major

Nsaids (Includes Xylon 10) ↔ Gi Toxicity

Severe Potential Hazard, High plausibility

Applies to: Peptic Ulcer, Gastrointestinal Hemorrhage, 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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  37. Bergmann JF, Chassany O, Geneve J, Abiteboul M, Caulin C, Segrestaa JM "Endoscopic evaluation of the effect of ketoprofen, ibuprofen and aspirin on the gastroduodenal mucosa." Eur J Clin Pharmacol 42 (1992): 685-8
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  39. Abraham NS, Hartman C, Castillo D, Richardson P, Smalley W "Effectiveness of National Provider Prescription of PPI Gastroprotection Among Elderly NSAID Users." Am J Gastroenterol 103 (2008): 323-32
  40. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
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  42. Greb WH, von Schrader HW, Cerlek S, Dominis M, Hauptmann E, Zenic N "Endoscopic studies of nabumetone in patients with rheumatoid arthritis. A comparative endoscopic and histologic evaluation." Am J Med 83 (1987): 19-24
  43. Stewart JT, Pennington CR, Pringle R "Anti-inflammatory drugs and bowel perforations and haemorrhage." Br Med J 290 (1985): 787-8
  44. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  45. Sacanella E, Munoz F, Cardellach F, Estruch R, Miro O, Urbanomarquez A "Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs." Postgrad Med J 72 (1996): 57-8
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  47. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  48. Fok KH, George PJ, Vicary FR "Peptic ulcers induced by piroxicam." Br Med J (Clin Res Ed) 290 (1985): 117
  49. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  50. Peskar BM, Maricic N, Gretzera B, Schuligoi R, Schmassmann A "Role of cyclooxygenase-2 in gastric mucosal defense." Life Sci 69 (2001): 2993-3003
  51. Willkens RF "Worldwide clinical safety experience with diclofenac." Semin Arthritis Rheum 2 Suppl 1 (1985): 105-10
  52. Ecker GA, Karsh J "Naproxen induced ulcerative esophagitis." J Rheumatol 19 (1992): 646-7
  53. Fitzgerald GA, Patrono C "The coxibs, selective inhibitors of cyclooxsygenase-2." N Engl J Med 345 (2001): 433-42
  54. Feldman M, McMahon AT "Do cyclooxygenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflammatory drugs, with less gastrointestinal toxicity?." Ann Intern Med 132 (2000): 134-43
  55. Maliekal J, Elboim CM "Gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in the elderly." Ann Pharmacother 29 (1995): 698-701
  56. Khoury MI "Ulcerative proctitis in juvenile systemic lupus erythematosus after ibuprofen treatment." J Rheumatol 16 (1989): 217-8
  57. Mason AM "Bleeding massive gastric ulcer on diflunisal (Dolobid) ." Br Med J 1 (1979): 888
  58. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  59. Voss GD, Schweitzer P "GI bleeding associated with nabumetone." Am J Hosp Pharm 51 (1994): 2506-8
  60. Wolfe MM, Lichtenstein DR, Singh G "Gastrointestinal toxicity of nonsteroiddal antiinflammatory drugs." N Engl J Med 340 (1999): 1888-99
  61. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  62. Estes LL, Fuhs DW, Heaton AH, Butwinick CS "Gastric ulcer perforation associated with the use of injectable ketorolac." Ann Pharmacother 27 (1993): 42-3
  63. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  64. 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
  65. Roth SH "Naproxen: antirheumatic efficacy and safety in patients with pre-existing gastrointestinal disease." Semin Arthritis Rheum 17 (1988): 36-9
  66. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  67. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  68. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  69. Schnitzer TJ, Truitt K, Fleischmann R, Dalgin P, Block J, Zeng Q, Bolognese J, Seidenberg B, Ehrich EW "The safety profile, tolerability, and effective dose range of rofecoxib in the treatment of rheumatoid arthritis." Clin Ther 21 (1999): 1688-702
  70. 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
  71. Buchman AL, Schwartz MR "Colonic ulceration associated with the systemic use of nonsteroidal antiinflammatory medication." J Clin Gastroenterol 22 (1996): 224-6
  72. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  73. Wolfe PA, Polhamus CD, Kubik C, Robinson AB, Clement DJ "Giant duodenal ulcers associated with the postoperative use of ketorolac: report of three cases." Am J Gastroenterol 89 (1994): 1110-1
  74. Lanza FL, Codispoti JR, Nelson EB "An endoscopic comparison of gastroduodenal injury with over-the-counter doses of ketoprofen and acetaminophen." Am J Gastroenterol 93 (1998): 1051-4
  75. Clements D, Williams GT, Rhodes J "Colitis associated with ibuprofen." Br Med J 301 (1990): 987
  76. Geczy M, Peltier L, Wolbach R "Naproxen tolerability in the elderly: a summary report." J Rheumatol 14 (1987): 348-54
  77. Laine L, Harper S, Simon T, Bath R, Johanson J, Schwartz H, Stern S, Quan H, Bolognese J "A randomized trial comparing the effect of rofecoxib, a cyclooxygenase 2-specific inhibitor, with that of ibuprofen on the gastroduodenal mucosa of patients with osteoarthritis." Gastroenterology 117 (1999): 776-83
  78. Wilcox CM, Shalek KA, Cotsonis G "Striking prevalence of over-the-counter nonsteroidal anti- inflammatory drug use in patients with upper gastrointestinal hemorrhage." Arch Intern Med 154 (1994): 42-6
  79. Kwo PY, Tremaine WJ "Nonsteroidal anti-inflammatory drug-induced enteropathy: case discussion and review of the literature." Mayo Clin Proc 70 (1995): 55-61
  80. Wiedrick JE, Friesen EG, Garton AM, Otten NH "Upper gastrointestinal bleeding associated with oral ketorolac therapy." Ann Pharmacother 28 (1994): 1109
  81. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  82. 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
  83. Strom BL, Berlin JA, Kinman JL "Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study." JAMA 275 (1996): 376-82
  84. Heynen G "Toleration and safety of piroxicam." Eur J Rheumatol Inflamm 8 (1987): 86-93
  85. Goldenberg MM "Celecoxib, a selective cyclooxygenase-2 inhibitor for the treatment of rheumatoid arthritis and osteoarthritis." Clin Ther 21 (1999): 1497-513
  86. Siegel MA, Balciunas BA "Medication can induce severe ulcerations." J Am Dent Assoc 122 (1991): 75-7
  87. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  88. Witham R "Voltaren (diclofenac sodium)-induced ileocolitis ." Am J Gastroenterol 86 (1991): 246-7
  89. Linder JD, Klaus E, Monkemuller KE, Davis JV, Wilcox CM "Cyclooxygenase-2 inhibitor celecoxib: a possible cause of gastropathy and hypoprothrombinemia." South Med J 93 (2000): 930-2
  90. Quigley EMM, Donovan JP, Livingston WC "Ketorolac-related giant gastric ulcers." Am J Gastroenterol 89 (1994): 631-2
  91. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  92. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  93. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  94. Peterson WL, Cryer B "COX-1-sparing NSAIDs - Is the enthusiasm justified?." JAMA 282 (1999): 1961-3
  95. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  96. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  97. Langman MJ, Jensen DM, Watson DJ, et al. "Adverse upper gastrointestinal effects of rofecoxib compared with NSAIDs." JAMA 282 (1999): 1929-33
  98. Talbot R, Rees H "Perforated duodenal ulcer on diflunisal (Dolobid) ." Br Med J 2 (1978): 1229
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View all 99 references
Major

Nsaids (Includes Xylon 10) ↔ Rash

Severe Potential Hazard, High plausibility

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

Nsaids (Includes Xylon 10) ↔ Renal Toxicities

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction, Dehydration, Congestive Heart Failure, Hyponatremia, Liver Disease

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.

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Major

Nsaids (Includes Xylon 10) ↔ Thrombosis

Severe Potential Hazard, High plausibility

Applies to: 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. Marcus AJ, Broekman MJ, Pinsky DJ "COX inhibitors and thromboregulation." N Engl J Med 347 (2002): 1025-6
  3. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  4. Mukherjee D, Nissen SE, Topol EJ "Risk of cardiovascular events associated with selective COX-2 inhibitors." JAMA 286 (2001): 954-9
  5. 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
  6. 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
View all 6 references
Major

Opiate Agonists (Includes Xylon 10) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication

The use of opiate agonists is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of opiate agonists may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with opiate agonists should be administered cautiously in patients who might be prone to acute alcohol intake.

References

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  4. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  7. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  8. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  9. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  10. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  14. "Multum Information Services, Inc. Expert Review Panel"
  15. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 15 references
Major

Opiate Agonists (Includes Xylon 10) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: Drug Abuse/Dependence, Alcoholism

Opiate agonists have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use. Abrupt cessation, reduction in dosage, or administration of an opiate antagonist such as naloxone may precipitate withdrawal symptoms. In patients who have developed tolerance to an opiate agonist, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with opiate agonists. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of opiate therapy should be undertaken gradually using a dosage-tapering schedule.

References

  1. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  2. Fishbain DA, Goldberg M, Rosomoff RS, Rosomoff H "Atypical withdrawal syndrome (organic delusional syndrome) secondary to oxycodone detoxification ." J Clin Psychopharmacol 8 (1988): 441-2
  3. Morrison AB "Toxicity and abuse of hydrocodone bitartrate." Can Med Assoc J 120 (1979): 1338
  4. Strode SW "Propoxyphene dependence and withdrawal." Am Fam Physician 32 (1985): 105-8
  5. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  6. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  8. Azorlosa JL, Stitzer ML, Greenwald MK "Opioid physical dependence development - effects of single versus repeated morphine pretreatments and of subjects opioid exposure history." Psychopharmacology (Berl) 114 (1994): 71-80
  9. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  10. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  11. Salguero CH, Villarreal JE, Hug CC Jr, Domino EF "Propoxyphene dependence." JAMA 210 (1969): 135-6
  12. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  13. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  14. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  15. Whittington RM "Dextropropoxyphene addiction." Lancet 2 (1979): 743-4
  16. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  17. Hedenmalm K "A case of severe withdrawal syndrome due to dextropropoxyphene." Ann Intern Med 123 (1995): 473
  18. Collins GB, Kiefer KS "Propoxyphene dependence: an update." Postgrad Med 70 (1981): 57-61
  19. Miser AW, Chayt KJ, Sandlund JT, Cohen PS, Dothage JA, Miser JS "Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates." Am J Dis Child 140 (1986): 603-4
  20. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  21. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  22. Wall R, Linford SM, Akhter MI "Addiction to Distalgesic (dextropropoxyphene)." Br Med J 280 (1980): 1213-4
  23. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  24. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  25. Claghorn JL, Schoolar JC "Propoxyphene hydrochloride, a drug of abuse." JAMA 196 (1966): 1089-91
  26. Ng B, Alvear M "Dextropropoxyphene addiction--a drug of primary abuse." Am J Drug Alcohol Abuse 19 (1993): 153-8
View all 26 references
Major

Opiate Agonists (Includes Xylon 10) ↔ Hypotension

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Hypotension, Shock

Opiate agonists can induce vasodilation and significant hypotension, particularly when given in high dosages and/or by rapid intravenous administration. Shock and cardiac arrest have occurred. At therapeutic analgesic dosages, ambulatory patients are more likely to experience dizziness and hypotension than patients who are confined to bed. However, orthostatic hypotension may occur in supine patients upon rising. Therapy with opiate agonists should be administered cautiously and initiated at reduced dosages in patients with circulatory shock, hypovolemia, or a predisposition to hypotension. When given by intramuscular or subcutaneous administration, clinicians should also be aware that impaired perfusion in these patients may prevent complete absorption of the drug. With repeated injections, an excessive amount may be absorbed suddenly if normal circulation is reestablished.

References

  1. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  3. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  4. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  6. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  7. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  8. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  11. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  12. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  13. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  14. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  18. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  19. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  20. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4
  21. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  22. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
View all 23 references
Major

Opiate Agonists (Includes Xylon 10) ↔ Intracranial Pressure

Severe Potential Hazard, Moderate plausibility

Applies to: Brain/Intracranial Tumor, Head Injury, Cerebral Vascular Disorder

The hypoventilation associated with administration of opiate agonists, particularly by the intravenous route, can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Unless mechanical ventilation is provided, extreme caution is advised when opiate agonists are given to patients with head injury, intracranial lesions, or a preexisting elevated CSF pressure. Also, clinicians treating such patients should be aware that opiate agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

References

  1. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  7. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  8. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  9. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  10. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  11. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  12. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  14. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  16. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  17. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  18. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  19. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  20. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
View all 20 references
Major

Opiate Agonists (Includes Xylon 10) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Asphyxia, Brain/Intracranial Tumor, Cerebral Vascular Disorder, Head Injury, Pulmonary Impairment, Respiratory Arrest

Opiate agonists may produce significant central nervous system and respiratory depression of varying duration, particularly when given in high dosages and/or by rapid intravenous administration. Apnea may result from decreased respiratory drive as well as increased airway resistance, and rigidity of respiratory muscles may occur during rapid IV administration or when these agents are used in the induction of anesthesia. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS depression; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral or neuraxial routes are used. Naloxone may be administered to reverse clinically significant respiratory depression, which may be prolonged depending on the opioid agent, cumulative dose, and route of administration.

References

  1. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8
  2. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  3. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  4. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. Amin HM, Sopchak AM, Esposito BF, Henson LG, Batenhorst RL, Fox AW, Camporesi EM "Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil." J Pharmacol Exp Ther 274 (1995): 34-9
  7. Hudson RJ "Apnoea and unconsciousness after apparent recovery from alfentanil- supplemented anaesthesia." Can J Anaesth 37 (1990): 255-7
  8. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH "Profound respiratory depression after extradural fentanyl." Br J Anaesth 64 (1990): 243-5
  11. Morley AD "Profound respiratory depression with morphine patient-controlled analgesia in an elderly patient." Anaesth Intensive Care 24 (1996): 287
  12. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  13. Harper MH, Hickey RF, Cromwell TH, Linwood S "The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man." J Pharmacol Exp Ther 199 (1976): 464-8
  14. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  15. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  16. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  17. Comstock MK, Carter JG, Moyers JR, Stevens WC "Rigidity and hypercarbia associated with high dose fentanyl induction of anesthesia." Anesth Analg 60 (1981): 362-3
  18. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  19. Sandler AN, Baxter AD, Katz J, Samson B, Friedlander M, Norman P, Koren G, Roger S, Hull K, Klein J "A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects." Anesthesiology 81 (1994): 1169-80
  20. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  21. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  22. Palmer CM "Early respiratory depression following intrathecal fentanyl-morphine combination." Anesthesiology 74 (1991): 1153-5
  23. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  24. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  25. Rigg JR, Ilsley AH, Vedig AE "Relationship of ventilatory depression to steady-state blood pethidine concentrations." Br J Anaesth 53 (1981): 613-9
  26. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  27. Eisenach JC "Respiratory depression following intrathecal opioids." Anesthesiology 75 (1991): 712
  28. Jackson FW "Fentanyl and the wooden chest." Gastroenterology 106 (1994): 820-1
  29. Elloway R, Sherman S, Maas L, et al "Meperidine-induced bronchospasm." Gastrointest Endosc 38 (1992): 93
  30. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  31. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  32. Etches RC "Respiratory depression associated with patient-controlled analgesia - a review of eight cases." Can J Anaesth 41 (1994): 125-32
  33. Varrassi G, Celleno D, Capogna G, et al. "Ventilatory effects of subarachnoid fentanyl in the elderly." Anaesthesia 47 (1992): 558-62
  34. Samuels SI, Rabinov W "Difficulty reversing drug-induced coma in a patient with sleep apnea." Anesth Analg 65 (1986): 1222-4
  35. Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE "The respiratory depressant effect of morphine - a comparative study in three ethnic groups." Anaesthesia 49 (1994): 197-201
  36. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  37. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  38. Sackner MA "Effects of hydrocodone bitartrate on breathing pattern of patients with chronic obstructive pulmonary disease and restrictive lung disease." Mt Sinai J Med 51 (1984): 222-6
  39. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  40. Ogawa K, Iranami H, Yoshiyama T, Maeda H, Hatano Y "Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy." Can J Anaesth 40 (1993): 968-70
  41. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  42. Bigler D, Eriksen J, Christensen CB "Prolonged respiratory depression caused by slow release morphine." Lancet 06/30/84 (1984): 1477
  43. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  44. Noble DW, Morrison LM, Brockway MS, Mcclure JH "Respiratory depression after extradural fentanyl." Br J Anaesth 72 (1994): 251
View all 44 references
Moderate

Ibuprofen (Includes Xylon 10) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: 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, Kalamazoo, MI.
Moderate

Narcotic Analgesics (Includes Xylon 10) ↔ Adrenal Insufficiency

Moderate Potential Hazard, Moderate plausibility

Applies to: Adrenal Insufficiency

Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  2. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  3. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  7. 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):
  8. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  12. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  17. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  18. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  19. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  20. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  21. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  22. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  23. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  24. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  25. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  26. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
View all 26 references
Moderate

Narcotic Analgesics (Includes Xylon 10) ↔ Biliary Spasm

Moderate Potential Hazard, Moderate plausibility

Applies to: Biliary Obstruction, Gallbladder Disease

Narcotic (opioid) analgesic agents increase smooth muscle tone in the biliary tract, which can lead to spasm and elevated biliary tract pressure, especially in the sphincter of Oddi. Biliary effects appear to be the most pronounced with morphine, although they do not always occur with therapeutic doses. Therapy with opioids should be administered cautiously in patients with biliary or gallbladder disease.

References

  1. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  2. Hey VM, Ostick DG, Mazumder JK, Lord WD "Pethidine, metoclopramide and the gastro-oesophageal sphincter." Anaesthesia 36 (1981): 173-6
  3. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  7. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  9. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  11. Daikos GK, Kosmidis JC "Propoxyphene jaundice." JAMA 232 (1975): 835
  12. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  14. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  15. McCammon RL, Viegas OJ, Stoelting RK, Dryden GE "Naloxone reversal of choledochoduodenal sphincter spasm associated with narcotic administration." Anesthesiology 48 (1978): 437
  16. Zsigmond EK, Vieira ZEG, Duarte B, Renigers SA, Hirota K "Double-blind placebo-controlled ultrasonographic confirmation of constriction of the common bile duct by morphine." Int J Clin Pharmacol Ther Toxicol 31 (1993): 506-9
  17. Lang DW, Pilon RN "Naloxone reversal of morphine-induced biliary colic." Anesth Analg 59 (1980): 619-20
  18. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  19. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  20. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  23. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  24. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  25. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7
  26. Ford MJ, Kellett RJ, Busuttil A, Finlayson ND "Dextropropoxyphene and jaundice." Br Med J 2 (1977): 674
  27. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  28. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  29. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  30. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 30 references
Moderate

Narcotic Analgesics (Includes Xylon 10) ↔ Hypothyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism, Panhypopituitarism

Patients with hypothyroidism may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. These agents may also exacerbate the effects of hypothyroidism such as lethargy, impaired mentation, depression, and constipation. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with uncontrolled hypothyroidism or myxedema. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  2. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  5. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  6. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  7. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  8. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  9. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  10. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  13. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  14. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  16. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  17. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  18. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  19. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  21. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  23. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  24. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  25. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
View all 25 references
Moderate

Narcotic Analgesics (Includes Xylon 10) ↔ Seizure Disorders

Moderate Potential Hazard, Low plausibility

Applies to: Seizures

Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

References

  1. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  2. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  3. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  4. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  5. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  6. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  7. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  8. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  9. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  10. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  12. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  14. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  15. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  16. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  17. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  18. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  19. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  21. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  22. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  23. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  24. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  25. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  26. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  27. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  28. Kaiko RF, Foley KM, Grabinski PY, et al "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  29. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  30. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  32. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  33. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  34. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  35. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  36. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  37. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  38. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  39. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  40. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  41. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  42. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  43. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
View all 43 references
Moderate

Narcotic Analgesics (Includes Xylon 10) ↔ Urinary Retention

Moderate Potential Hazard, Moderate plausibility

Applies to: Urinary Retention

Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in elderly patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.

References

  1. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  4. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceutical, Richmond, VA.
  5. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  7. "Product Information. Orlaam (levomethadyl acetate)" Roxanne Laboratories Inc, Columbus, OH.
  8. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  11. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  13. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  14. Petersen TK, Husted SE, Rybro L, et al "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  15. "Product Information. Nubain (nalbuphine)." Endo Laboratories, Texarkana, TX.
  16. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  17. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  18. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc, Columbus, OH.
  19. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  20. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company, Vernon Hills, IL.
  22. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Dalgan (dezocine)." Astra USA, Westborough, MA.
  24. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  25. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  26. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  27. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  28. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  29. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
View all 29 references
Moderate

Nsaids (Includes Xylon 10) ↔ Anemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Anemia, 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. Johnson FP Jr, Hamilton HE, Liesch MR "Immune hemolytic anemia associated with sulindac." Arch Intern Med 145 (1985): 1515-6
  2. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  3. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  5. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  6. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. 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
  8. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  9. 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
  10. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  11. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  12. Squires JE, Mintz PD, Clark S "Tolmetin-induced hemolysis." Transfusion 25 (1985): 410-3
  13. Randi ML, Tison T, Luzzatto G "Haemolytic uraemic syndrome during treatment with ketorolac trometamol." BMJ 306 (1993): 186
  14. Kornberg A, Rachmilewitz EA "Aplastic anemia after prolonged ingestion of indomethacin." Acta Haematol 67 (1982): 136-8
  15. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  16. Bennett L, Schlossman R, Rosenthal J, et al "Aplastic anemia and sulindac." Ann Intern Med 92 (1980): 874
  17. Ashraf M, Pearson RM, Winfield DA "Aplastic anaemia associated with fenoprofen." Br Med J 284 (1982): 1301-2
  18. 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
  19. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
  20. Lee SH, Fawcett V, Preece JM "Aplastic anaemia associated with piroxicam." Lancet 1 (1982): 1186
  21. Arnold R, Heimpel H "Aplastic anaemia after naproxen?" Lancet 02/09/80 (1980): 321
  22. Miller JL "Marrow aplasia and sulindac." Ann Intern Med 92 (1980): 129
  23. Hughes JA, Sudell W "Hemolytic anemia associated with naproxen." Arthritis Rheum 26 (1983): 1054
  24. Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
  25. Reitz CL, Bottomley SS "Pure red cell aplasia associated with fenoprofen." Am J Med Sci 287 (1984): 62-3
  26. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  27. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  28. McNeil P, MacKenzie I, Manoharan A "Naproxen-associated aplastic anaemia." Med J Aust 145 (1986): 53-5
  29. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  30. Angeles ML, Reid ME, Yacob UA, Cash KL, Fetten JV "Sulindac-induced immune hemolytic anemia." Transfusion 34 (1994): 255-8
  31. van Dijk BA, Rico PB, Hoitsma A, Kunst VA "Immune hemolytic anemia associated with tolmetin and suprofen." Transfusion 29 (1989): 638-41
  32. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  33. Sanada M, Takai K "Aplastic anaemia associated with piroxicam." Br J Haematol 77 (1991): 256-7
  34. 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
  35. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  36. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  37. Lopez A, Linares M, Sanchez H, Blanquer A "Autoimmune hemolytic anemia induced by diclofenac." Ann Pharmacother 29 (1995): 787
  38. 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
  39. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  40. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  41. 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
  42. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  43. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  44. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  45. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  46. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  47. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  48. 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
  49. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
View all 49 references
Moderate

Nsaids (Includes Xylon 10) ↔ 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 Xylon 10) ↔ Hepatotoxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: 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. Whittaker SJ, Amar JN, Wanless IR, Heathcote J "Sulindac hepatotoxicity." Gut 23 (1982): 875-7
  2. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  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. Mroszczak EJ, Lee FW, Combs D, Sarnquist FH, Huang BL, Wu AT, Tokes LG, Maddox ML, Cho DK "Ketorolac tromethamine absorption, distribution, metabolism, excretion, and pharmacokinetics in animals and humans." Drug Metab Dispos 15 (1987): 618-26
  6. Selley ML, Madsen BW, Thomas J "Protein binding of tolmetin." Clin Pharmacol Ther 24 (1978): 694-705
  7. Davies NM "Clinical pharmacokinetics of flurbiprofen and its enantiomers." Clin Pharmacokinet 28 (1995): 100-14
  8. Reeve PA, Moshiri M, Bell GD "Pulmonary oedema, jaundice and renal impairment with naproxen." Br J Rheumatol 26 (1987): 70-1
  9. Breen EG, McNicholl J, Cosgrove E, McCabe J, Stevens FM "Fatal hepatitis associated with diclofenac." Gut 27 (1986): 1390-3
  10. Chamouard JM, Barre J, Urien S, Houin G, Tillement JP "Diclofenac binding to albumin and lipoproteins in human serum." Biochem Pharmacol 34 (1985): 1695-700
  11. 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
  12. 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
  13. 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
  14. Haddock RE, Jeffery DJ, Lloyd JA, Thawley AR "Metabolism of nabumetone (BRL 14777) by various species including man." Xenobiotica 14 (1984): 327-37
  15. Helfgott SM, Sandberg-Cook J, Zakim D, Nestler J "Diclofenac-associated hepatotoxicity." JAMA 264 (1990): 2660-2
  16. Lockwood GF, Albert KS, Szpunar GJ, Wagner JG "Pharmacokinetics of ibuprofen in man III: plasma protein binding." J Pharmacokinet Biopharm 11 (1983): 469-82
  17. Hepps KS, Maliha GM, Estrada R, Goodgame RW "Severe cholestatic jaundice associated with piroxicam." Gastroenterology 101 (1991): 1737-40
  18. Ramakrishna B, Viswanath N "Diclofenac-induced hepatitis - case report and literature review." Liver 14 (1994): 83-4
  19. 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
  20. 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
  21. Jick H, Derby LE, Rodriguez LA, et al "Liver disease associated with diclofenac, naproxen, and piroxicam." Pharmacotherapy 12 (1992): 207-12
  22. Purdum PP, Shelden SL, Boyd JW, Shiffman ML "Oxaprozin-induced fulminant hepatitis." Ann Pharmacother 28 (1994): 1159-61
  23. 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
  24. 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
  25. Riess W, Stierlin H, Degen P, et al "Pharmacokinetics and metabolism of the anti-inflammatory agent Voltaren." Scand J Rheumatol Suppl 22 (1978): 17-29
  26. Duggan DE, Hogans AF, Kwan KC, McMahon FG "The metabolism of indomethacin in man." J Pharmacol Exp Ther 181 (1972): 563-75
  27. 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
  28. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  29. Paterson D, Kerlin P, Walker N, et al "Piroxicam induced submassive necrosis of the liver." Gut 33 (1992): 1436-8
  30. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  31. Helleberg L "Clinical pharmacokinetics of indomethacin." Clin Pharmacokinet 6 (1981): 245-58
  32. Caballeria E, Masso RM, Arago JV, Sanchis A "Piroxicam hepatotoxicity." Am J Gastroenterol 85 (1990): 898-9
  33. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  34. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  35. Brocks DR, Jamali F "Clinical pharmacokinetics of ketorolac tromethamine." Clin Pharmacokinet 23 (1992): 415-27
  36. 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
  37. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  38. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  39. 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
  40. 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
  41. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  42. O'Brien WM, Bagby GF "Rare adverse reactions to nonsteroidal antiinflammatory drugs." J Rheumatol 12 (1985): 562-7
  43. 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
  44. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  45. Gerber D "Adverse reactions of piroxicam." Drug Intell Clin Pharm 21 (1987): 707-10
  46. Gallanosa AG, Spyker DA "Sulindac hepatotoxicity: a case report and review." Clin Toxicol 23 (1985): 205-38
  47. Mabee CL, Mabee SW, Baker PB, Kirkpatrick RB, Levine EJ "Fulminant hepatic failure associated with etodolac use." Am J Gastroenterol 90 (1995): 659-61
  48. 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
  49. 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
  50. Julh RP, Van Thiel DH, Dittert LW, et al "Ibuprofen and sulindac kinetics in alcoholic liver disease." Clin Pharmacol Ther 34 (1983): 104-9
  51. Victorino RM, Baptista A, Silveira JC, de Moura MC "Jaundice associated with naproxen." Postgrad Med J 56 (1980): 368-70
  52. Sallie RW, McKenzie T, Reed WD, Quinlan MF, Shilkin KB "Diclofenac hepatitis." Aust N Z J Med 21 (1991): 251-5
  53. Janssen FW, Jusko WJ, Chiang ST, Kirkman SK, Southgate PJ, Coleman AJ, Ruelius HW "Metabolism and kinetics of oxaprozin in normal subjects." Clin Pharmacol Ther 27 (1980): 352-62
  54. Cappell MS, Kozicky O, Competiello LS "Indomethacin-induced cholestasis." J Clin Gastroenterol 10 (1988): 445-7
  55. Brocks DR, Jamali F "Etodolac clinical pharmacokinetics." Clin Pharmacokinet 26 (1994): 259-74
  56. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
  57. Verbeeck RK, Richardson CJ, Blocka KL "Clinical pharmacokinetics of piroxicam." J Rheumatol 13 (1986): 789-96
  58. Williams RL, Upton RA, Cello JP, et al "Naproxen disposition in patients with alcoholic cirrhosis." Eur J Clin Pharmacol 27 (1984): 291-6
  59. "Product Information. Toradol (ketorolac)." Roche Laboratories, Nutley, NJ.
  60. 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
  61. Selley ML, Glass J, Triggs EJ, Thomas J "Pharmacokinetic studies of tolmetin in man." Clin Pharmacol Ther 17 (1975): 599-605
  62. Giroux Y, Moreau M, Kass TG "Cholestatic jaundice caused by sulindac." Can J Surg 25 (1982): 334-5
  63. Klein SM, Khan MA "Hepatitis, toxic epidermal necrolysis and pancreatitis in association with sulindac therapy." J Rheumatol 10 (1983): 513-3
  64. 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
  65. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  66. Bhogaraju A, Nazeer S, AlBaghdadi Y, Rahman M, Wrestler F, Patel N "Diclofenac-associated hepatitis." South Med J 92 (1999): 711-3
  67. Turner R "Hepatic and renal tolerability of long-term naproxen treatment in patients with rheumatoid arthritis." Semin Arthritis Rheum 17 (1988): 29-35
  68. Purcell P, Henry D, Melville G "Diclofenac hepatitis." Gut 32 (1991): 1381-5
  69. Singh G, Ramey DR, Morfeld D, Fries JF "Comparative toxicity of non-steroidal anti-inflammatory agents." Pharmacol Ther 62 (1994): 175-91
  70. Alvan G, Orme M, Bertilsson L, et al "Pharmacokinetics of indomethacin." Clin Pharmacol Ther 18 (1975): 364-73
  71. Willis JV, Kendall MJ, Flinn RM, Thornhill DP, Welling PG "The pharmacokinetics of diclofenac sodium following intravenous and oral administration." Eur J Clin Pharmacol 16 (1979): 405-10
  72. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  73. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  74. Sherman KE, Jones C "Hepatotoxicity associated with piroxicam use." Gastroenterology 103 (1992): 354-5
  75. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  76. 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
  77. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  78. Park GD, Spector R, Headstream T, Goldberg M "Serious adverse reactions associated with sulindac." Arch Intern Med 142 (1982): 1292-4
  79. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  80. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  81. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  82. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  83. Stierlin H, Faigle JW, Sallmann A, et al "Biotransformationm of diclofenac sodium (Voltaren) in animal and in man. I. Isolation and identification of principal metabolites." Xenobiotica 9 (1979): 601-10
  84. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  85. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  86. 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
  87. Hyneck ML "An overview of the clinical pharmacokinetics of nabumetone." J Rheumatol 19 (1992): 20-4
  88. 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
  89. Daniele B, Pignata S, D'Agostino L, et al "Sulindac-induced severe hepatitis." Am J Gastroenterol 83 (1988): 1429-31
  90. Hvidberg E, Lausen HH, Jansen JA "Indomethacin: plasma concentrations and protein binding in man." Eur J Clin Pharmacol 4 (1972): 119-24
  91. Zimmerman HJ "Hepatic effects of oxaprozin." Semin Arthritis Rheum 15 (1986): 35-9
  92. 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
View all 92 references
Moderate

Nsaids (Includes Xylon 10) ↔ Hyperkalemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperkalemia, 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 (Includes Xylon 10) ↔ 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 Xylon 10) ↔ Platelet Aggregation Inhibition

Moderate Potential Hazard, Moderate plausibility

Applies to: 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. 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
  4. Bernhard GC "Worldwide safety experience with nabumetone." J Rheumatol 19 (1992): 48-57
  5. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  6. Katz ME, Wang P "Fenoprofen-associated thrombocytopenia." Ann Intern Med 92 (1980): 262
  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. Hyson CP, Kazakoff MA "A severe multisystem reaction to sulindac." Arch Intern Med 151 (1991): 387-8
  10. 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
  11. Robb PJ, Rollin AM, Saunders DA "Diclofenac and post-tonsillectomy haemorrhage." Clin Otolaryngol 20 (1995): 483
  12. 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
  13. 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
  14. Rosenbaum JT, O'Connor M "Thrombocytopenia associated with sulindac." Arthritis Rheum 24 (1981): 753-4
  15. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  16. Camba L, Joyner MV "Acute thrombocytopenia following ingestion of indomethacin." Acta Haematol 71 (1984): 350-2
  17. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
  18. Green D, Davies RO, Holmes GI et al "Effects of diflunisal on platelet function and fecal blood loss." Pharmacotherapy 3 (1983): s65-9
  19. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  20. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  21. 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
  22. Bobrove AM "Diflunisal-associated thrombocytopenia in a patient with rheumatoid arthritis ." Arthritis Rheum 31 (1988): 148-9
  23. Bjornstad H, Vik O "Thrombocytopenic purpura associated with piroxicam." Br J Clin Pract 40 (1986): 42
  24. "Product Information. Dolobid (diflunisal)." Merck & Co, Inc, West Point, PA.
  25. Catalano MA "Worldwide safety experience with diclofenac." Am J Med 80 (1986): 81-7
  26. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  27. 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
  28. Concannon MJ, Meng L, Welsh CF, Puckett CL "Inhibition of perioperative platelet aggregation using toradol (ketorolac)." Ann Plast Surg 30 (1993): 264-6
  29. Bondeson J, Berglund S "Diclofenac-induced thrombocytopenic purpura with renal and hepatic involvement." J Intern Med 230 (1991): 543-7
  30. Price AJ, Obeid D "Spontaneous non-gastrointestinal bleeding associated with diclofenac ." Lancet 2 (1989): 1520
  31. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  32. 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
  33. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  34. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  35. Sanz MA, Martinez JA, Gomis F, Garcia-Borras JJ "Sulindac-induced bone marrow toxicity." Lancet 2 (1980): 802-3
  36. Kramer MR, Levene C, Hershko C "Severe reversible autoimmune haemolytic anaemia and thrombocytopenia associated with diclofenac therapy." Scand J Haematol 36 (1986): 118-20
  37. Karachalios GN, Parigorakis JG "Thrombocytopenia and sulindac." Ann Intern Med 104 (1986): 128
  38. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  39. Schattenkirchner M "An updated safety profile of etodolac in several thousand patients." Eur J Rheumatol Inflamm 10 (1990): 56-65
  40. 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
  41. Shojania AM, Rusen SD "Thrombocytopenia secondary to sulindac therapy." Can Med Assoc J 125 (1981): 1313
  42. Stambaugh JE Jr, Gordon RL, Geller R "Leukopenia and thrombocytopenia secondary to clinoril therapy." Lancet 2 (1980): 594
  43. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals, East Hanover, NJ.
  44. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  45. Epstein M, Vickars L, Stein H "Diclofenac induced immune thrombocytopenia." J Rheumatol 17 (1990): 1403-4
  46. 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
  47. Robinson PM, Ahmed I "Diclofenac and post-tonsillectomy haemorrhage." Clin Otolaryngol 19 (1994): 344-5
  48. Kim HL, Kovacs MJ "Diclofenac-associated thrombocytopenia and neutropenia." Ann Pharmacother 29 (1995): 713-5
  49. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  50. Schafer AI "Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis." J Clin Pharmacol 35 (1995): 209-19
  51. Khazan U, Toth M, Mutgi A "Diclofenac sodium and bruising ." Ann Intern Med 112 (1990): 472-3
  52. 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
  53. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  54. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  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
Moderate

Opiate Agonists (Includes Xylon 10) ↔ Arrhythmias

Moderate Potential Hazard, Low plausibility

Applies to: Arrhythmias

Opiate agonists have cholinergic activity. Large doses and/or rapid intravenous administration may produce bradycardia and arrhythmia via stimulation of medullary vagal nuclei. Unlike other agents in the class, meperidine also has anticholinergic activity and may cause either bradycardia or tachycardia. Therapy with opiate agonists should be administered cautiously in patients with a history of arrhythmias. Clinical monitoring of cardiovascular status is recommended during therapy. Bradycardia and other cholinergic effects produced by these agents may be controlled with atropine.

References

  1. "Product Information. Opium Tincture (opium)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company, Norwalk, CT.
  5. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceutica, Titusville, NJ.
  6. Blair JR, Pruett JK, Crumrine RS, Balser JJ "Prolongation of QT interval in association with the administration of large doses of opiates." Anesthesiology 67 (1987): 442-3
  7. Hilgenberg JC, Johantgen WC "Bradycardia after intravenous fentanyl during subarachnoid anesthesia." Anesth Analg 59 (1980): 162-3
  8. "Product Information. Kadian (morphine)." Zeneca Pharmaceuticals, Wilmington, DE.
  9. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceutica, Titusville, NJ.
  10. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories, Nutley, NJ.
  11. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc), Canonsburg, PA.
  12. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
  13. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company, Whippany, NJ.
  15. Heaney RM "Left bundle branch block associated with propoxyphene hydrochloride poisoning." Ann Emerg Med 12 (1983): 780-2
  16. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company, Norwalk, CT.
  17. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.
  18. "Product Information. Numorphan (oxymorphone)" Endo Laboratories LLC, Chadds Ford, PA.
  19. "Product Information. Dolophine (methadone)." Lilly, Eli and Company, Indianapolis, IN.
  20. Sebel PS, Bovill JG, Boekhorst RA, Rog N "Cardiovascular effects of high-dose fentanyl anaesthesia." Acta Anaesthesiol Scand 26 (1982): 308-15
  21. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
View all 21 references

Xylon 10 (hydrocodone / ibuprofen) drug Interactions

There are 1168 drug interactions with Xylon 10 (hydrocodone / ibuprofen)

Xylon 10 (hydrocodone / ibuprofen) alcohol/food Interactions

There are 3 alcohol/food interactions with Xylon 10 (hydrocodone / ibuprofen)

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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