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Drug Interactions between Actiprofen and eplerenone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ibuprofen eplerenone

Applies to: Actiprofen (ibuprofen) and eplerenone

MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effect of eplerenone. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis, which results in unopposed pressor activity producing hypertension. In addition, NSAIDs can cause fluid retention, which also affects blood pressure. Although the interaction has not specifically been studied with eplerenone, it has been reported with other potassium-sparing antihypertensive drugs such as ACE inhibitors. In patients with renal impairment receiving these antihypertensive agents, concomitant use of NSAIDs has also resulted in severe hyperkalemia.

MANAGEMENT: Patients receiving eplerenone who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation, discontinuation, or change of dosage of the NSAID. The interaction is not expected to occur with low doses (e.g., low-dose aspirin) or intermittent short-term administration of NSAIDs.

References

  1. Moore TJ, Crantz FR, Hollenberg NK "Contribution of prostaglandins to the antihypertensive action of captopril in essential hypertension." Hypertension 3 (1981): 168-73
  2. Radack KL, Deck CC, Bloomfield SS "Ibuprofen interferes with the efficacy of antihypertensive drugs: a randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen." Ann Intern Med 107 (1987): 628-35
  3. Silberbauer K, Stanek B, Templ H "Acute hypotensive effect of captopril in man modified by prostaglandin synthesis inhibition." Br J Clin Pharmacol 14 (1982): s87-93
  4. Ahmad S "Indomethacin-enalapril interaction: an alert." South Med J 84 (1991): 411-2
  5. Allon M, Pasque CB, Rodriguez M "Interaction of captopril and ibuprofen on glomerular and tubular function in humans." Am J Physiol 259 (1990): f233-8
  6. Seto S, Aoi W, Iwami K, et al. "Effect of propranolol and indomethacin on the depressor action of captopril in patients with essential hypertension." Clin Exp Hypertens 9 (1987): 623-7
  7. Abdel-Haq B, Magagna A, Favilla S, Salvetti A "Hemodynamic and humoral interactions between perindopril and indomethacin in essential hypertensive subjects." J Cardiovasc Pharmacol 18 (1991): s33-6
  8. Morgan T, Anderson A "Interaction of indomethacin with felodipine and enalapril." J Hypertens 11 (1993): S338-9
  9. Townend JN, Doran J, Lote CJ, Davies MK "Peripheral haemodynamic effects of inhibition of prostaglandin synthesis in congestive heart failure and interactions with captopril." Br Heart J 73 (1995): 434-41
  10. Polonia J, Boaventura I, Gama G, Camoes I, Bernardo F, Andrade P, Nunes JP, Brandao F, Cerqueiragomes M "Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients." J Hypertens 13 (1995): 925-31
  11. "Product Information. Inspra (eplerenone)." Searle (2002):
View all 11 references

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Drug and food interactions

Major

eplerenone food

Applies to: eplerenone

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma concentrations of eplerenone. The primary mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Inhibition of hepatic CYP450 3A4 may also contribute. In drug interaction studies, administration of a single 100 mg dose of eplerenone in combination with grapefruit juice resulted in a 25% increase in eplerenone systemic exposure (AUC). High blood levels of eplerenone can increase the risk of side effects including hyperkalemia. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition.

MANAGEMENT: It may be advisable for patients to avoid the consumption of grapefruit, grapefruit juice, or supplements that contain grapefruit during treatment with eplerenone.

References

  1. "Product Information. Inspra (eplerenone)." Searle (2002):
  2. "Product Information. Eplerenone (eplerenone)." MSN Laboratories Europe Ltd (2021):
  3. "Product Information. Eplerenone (Apotex) (eplerenone)." Apotex Pty Ltd (2023):

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Moderate

ibuprofen food

Applies to: Actiprofen (ibuprofen)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

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

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

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

Further information

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

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