Skip to main content

Drug Interactions between Advil Children's and pemetrexed

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

ibuprofen PEMEtrexed

Applies to: Advil Children's (ibuprofen) and pemetrexed

ADJUST DOSING INTERVAL: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the plasma concentrations of pemetrexed. The mechanism has not been described but may be related to NSAID inhibition of renal prostaglandins. Use of NSAIDs has been associated with nephropathy manifested as elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. Since pemetrexed is primarily eliminated unchanged by renal excretion, coadministration with NSAIDs may result in delayed and/or decreased clearance. Daily ibuprofen dosage of 400 mg four times a day has been shown to reduce pemetrexed clearance by about 20% in patients with normal renal function, whereas aspirin at 325 mg every 6 hours did not. The effect of higher dosages of ibuprofen or aspirin is unknown.

MANAGEMENT: Ibuprofen at 400 mg and aspirin at 325 mg four times a day, or less, may be used with pemetrexed in patients with normal renal function. However, caution is advised in patients with mild to moderate renal insufficiency (creatinine clearance 45 to 79 mL/min). These patients should avoid taking NSAIDs with short elimination half-lives (e.g., diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, sulindac, tolmetin, low dosages of salicylates) 2 days before to 2 days after pemetrexed administration. If concomitant administration is necessary, patients should be monitored closely for toxicity, especially myelosuppression, nephrotoxicity, and gastrointestinal toxicity. In the absence of data regarding use with NSAIDs with longer half-lives, withholding NSAID dosing for at least 5 days before to 2 days after pemetrexed administration is recommended.

References

  1. Wendland ML, Wagoner RD, Holley KE (1980) "Renal failure associated with fenoprofen." Mayo Clin Proc, 55, p. 103-7
  2. Curt GA, Kaldany A, Whitley LG, et al. (1980) "Reversible rapidly progressive renal failure with nephrotic syndrome due to fenoprofen calcium." Ann Intern Med, 92, p. 72-3
  3. Artinano M, Etheridge WB, Stroehlein KB, Barcenas CG (1986) "Progression of minimal-change glomerulopathy to focal glomerulosclerosis in a patient with fenoprofen nephropathy." Am J Nephrol, 6, p. 353-7
  4. Shah GM, Muhalwas KK, Winer RL (1981) "Renal papillary necrosis due to ibuprofen." Arthritis Rheum, 24, p. 1208-10
  5. Fong HJ, Cohen AH (1982) "Ibuprofen-induced acute renal failure with acute tubular necrosis." Am J Nephrol, 2, p. 28-31
  6. Gary NE, Dodelson R, Eisinger RP (1980) "Indomethacin-associated acute renal failure." Am J Med, 69, p. 135-6
  7. Blackshear JL, Davidman M, Stillman MT (1983) "Identification of risk for renal insufficiency from nonsteroidal anti-inflammatory drugs." Arch Intern Med, 143, p. 1130-4
  8. Poitirt TI (1984) "Reversible renal failure associated with ibuprofen: case report and review of the literature." Drug Intell Clin Pharm, 18, p. 27-32
  9. Moss AH, Riley R, Murgo A, Skaff LA (1986) "Over-the-counter ibuprofen and nephrotic syndrome." Ann Intern Med, 105, p. 303
  10. Bonney SL, Northington RS, Hedrich DA, Walker BR (1986) "Renal safety of two analgesics used over the counter: ibuprofen and aspirin." Clin Pharmacol Ther, 40, p. 373-7
  11. Zawada ET (1982) "Renal consequences of nonsteroidal antiinflammatory drugs." Postgrad Med J, 71, p. 223-30
  12. Munn E, Lynn KL, Bailey RR (1982) "Renal papillary necrosis following regular consumption of non-steroidal anti-inflammatory drugs." N Z Med J, 95, p. 213-4
  13. McCarthy JT, Torres VE, Romero JC, et al. (1982) "Acute intrinsic renal failure induced by indomethacin." Mayo Clin Proc, 57, p. 289-96
  14. Marasco WA, Gikas PW, Azziz-Baumgartner R, et al. (1987) "Ibuprofen-associated renal dysfunction: pathophysiologic mechanisms of acute renal failure, hyperkalemia, tubular necrosis, and proteinuria." Arch Intern Med, 147, p. 2107-16
  15. Morgenstern SJ, Bruns FJ, Fraley DS, et al. (1989) "Ibuprofen-associated lipoid nephrosis without interstitial nephritis." Am J Kidney Dis, 14, p. 50-2
  16. Handa SP (1986) "Drug-induced acute interstitial nephritis: report of 10 cases." Can Med Assoc J, 135, p. 1278-81
  17. Boiskin I, Saven A, Mendez M, Raja RM (1987) "Indomethacin and the nephrotic syndrome." Ann Intern Med, 106, p. 776-7
  18. Sennesael J, Van den Houte K, Verbeelen D (1986) "Reversible membranous glomerulonephritis associated with ketoprofen." Clin Nephrol, 26, p. 213-5
  19. Pazmino PA, Pazmino PB (1988) "Ketoprofen-induced irreversible renal failure." Nephron, 50, p. 70-1
  20. Schwarz A, Krause PH, Keller F, et al. (1988) "Granulomatous interstitial nephritis after nonsteroidal anti-inflammatory drugs." Am J Nephrol, 8, p. 410-6
  21. Kharasch MS, Johnson KM, Strange GR (1990) "Cardiac arrest secondary to indomethacin-induced renal failure: a case report." J Emerg Med, 8, p. 51-4
  22. Brezin JH, Katz SM, Schwartz AB, Chinitz JL (1979) "Reversible renal failure and nephrotic syndrome associated with nonsteroidal anti-inflammatory drugs." N Engl J Med, 301, p. 1271-4
  23. Ling BN, Bourke E, Campbell WG, Delaney VB (1990) "Naproxen-induced nephropathy in systemic lupus erythematosus." Nephron, 54, p. 249-55
  24. Shpilberg O, Douer D, Ehrenfeld M, et al. (1990) "Naproxen-associated fatal acute renal failure in multiple myeloma." Nephron, 55, p. 448-9
  25. Turner R (1988) "Hepatic and renal tolerability of long-term naproxen treatment in patients with rheumatoid arthritis." Semin Arthritis Rheum, 17, p. 29-35
  26. Watson WA, Freer JP, Katz RS, Basch C (1988) "Kidney function during naproxen therapy in patients at risk for renal insufficiency." Semin Arthritis Rheum, 17, p. 12-6
  27. Caruana RJ, Semble EL (1984) "Renal papillary necrosis due to naproxen." J Rheumatol, 11, p. 90-1
  28. Reeve PA, Moshiri M, Bell GD (1987) "Pulmonary oedema, jaundice and renal impairment with naproxen." Br J Rheumatol, 26, p. 70-1
  29. Vitting KE, Nichols NJ, Seligson GR (1986) "Naproxen and acute renal failure in a runner." Ann Intern Med, 105, p. 144
  30. Schwartzman M, D'Agati V (1987) "Spontaneous relapse of naproxen-related nephrotic syndrome." Am J Med, 82, p. 329-32
  31. Brater DC, Anderson SA, Brown D (1987) "Reversible acute decrease in renal function by NSAIDs in cirrhosis." Am J Med Sci, 294, p. 168-74
  32. Lomvardias S, Pinn VW, Wadhwa ML, et al. (1981) "Nephrotic syndrome associated with sulindac." N Engl J Med, 304, p. 424
  33. Whelton A, Bender W, Vaghaiwalla F, et al. (1983) "Sulindac and renal impairment." JAMA, 249, p. 2892-3
  34. Turner GA, Walker RJ, Bailey RR, et al. (1984) "Sulindac-induced acute interstitial nephritis." N Z Med J, 97, p. 239-40
  35. de Crespigny PJ, Becker GJ, Ihle BU, et al. (1988) "Renal failure and nephrotic syndrome associated with sulindac." Clin Nephrol, 30, p. 52-5
  36. Chatterjee GP (1981) "Nephrotic syndrome induced by tolmetin." JAMA, 246, p. 1589
  37. Katz SM, Capaldo R, Everts EA, DiGregorio JG (1981) "Tolmetin: association with reversible renal failure and acute interstitial nephritis." JAMA, 246, p. 243-5
  38. Wellborne FR, Claypool RG, Copley JB (1983) "Nephrotic range pseudoproteinuria in a tolmetin-treated patient." Clin Nephrol, 19, p. 211-2
  39. Pascoe MD, Gordon GD, Temple-Camp CR (1986) "Tolmetin-induced acute renal failure." S Afr Med J, 70, p. 232-3
  40. Tietjen DP (1989) "Recurrence and specificity of nephrotic syndrome due to tolmetin." Am J Med, 87, p. 354-5
  41. Kimberly RP, Plotz PH (1977) "Aspirin-induced depression of renal function." N Engl J Med, 296, p. 418-24
  42. Riegger GA, Kahles HW, Elsner D, Kromer EP, Kochsiek K (1991) "Effects of acetylsalicylic acid on renal function in patients with chronic heart failure." Am J Med, 90, p. 571-5
  43. Murray MD, Greene PK, Brater DC, et al. (1992) "Effects of flurbiprofen on renal function in patients with moderate renal insufficiency." Br J Clin Pharmacol, 33, p. 385-93
  44. Aitken HA, Burns JW, McArdle CS, Kenny GNC (1992) "Effects of ketorolac trometamol on renal function." Br J Anaesth, 68, p. 481-5
  45. Boras-Uber LA, Brackett NC Jr (1992) "Ketorolac-induced acute renal failure." Am J Med, 92, p. 450-2
  46. Carmichael J, Shankel SW (1985) "Effects of nonsteroidal anti-inflammatory drugs on prostaglandins and renal function." Am J Med, 78, p. 992-1000
  47. Perazella MA, Buller GK (1991) "Can ibuprofen cause acute renal failure in a normal individual? A case of acute overdose." Am J Kidney Dis, 18, p. 600-2
  48. Bergamo RR, Cominelli F, Kopple JD, Zipser RD (1989) "Comparative acute effects of aspirin, diflunisal, ibuprofen and indomethacin on renal function in healthy men." Am J Nephrol, 9, p. 460-3
  49. Berg KJ, Talseth T (1985) "Acute renal effects of sulindac and indomethacin in chronic renal failure." Clin Pharmacol Ther, 37, p. 447-52
  50. Shand DG, Epstein C, Kinberg-Calhoun J, et al. (1986) "The effect of etodolac administration on renal function in patients with arthritis." J Clin Pharmacol, 26, p. 269-74
  51. Feinfeld DA, Olesnicky L, Pirani CL, Appel GB (1984) "Nephrotic syndrome associated with use of the nonsteroidal anti-inflammatory drugs: case report and review of the literature." Nephron, 37, p. 174-9
  52. Chan XM (1987) "Fatal renal failure due to indomethacin." Lancet, 2, p. 340
  53. Maher JF (1984) "Analgesic nephropathy. Observations, interpretations, and perspective on the low incidence in America." Am J Med, 76, p. 345-8
  54. Kaufhold J, Wilkowski M, McCabe K (1991) "Flurbiprofen-associated acute tubulointerstitial nephritis." Am J Nephrol, 11, p. 144-6
  55. Colome Nafria E, Solans R, Espinach J, Delgadillo J, Fonollosa V (1991) "Renal papillary necrosis induced by flurbiprofen ." DICP, 25, p. 870-1
  56. Beun GD, Leunissen KM, Van Breda Vriesman PJ, Van Hooff JP, Grave W (1987) "Isolated minimal change nephropathy associated with diclofenac." Br Med J (Clin Res Ed), 295, p. 182-3
  57. Schwartz J, Altshuler E, Madjar J, Habot B (1988) "Acute renal failure associated with diclofenac treatment in an elderly woman ." J Am Geriatr Soc, 36, p. 482
  58. Tattersall J, Greenwood R, Farrington K (1992) "Membranous nephropathy associated with diclofenac ." Postgrad Med J, 68, p. 392-3
  59. Hannedouche T, Dehaine V, Noel LH, Jungers P (1987) "Acute tubular necrosis associated with acute pyelonephritis and concomitant diclofenac therapy ." Clin Nephrol, 28, p. 103-4
  60. Rossi E, Ferraccioli GF, Cavalieri F, Menta R, Dall'Aglio PP, Migone L (1985) "Diclofenac-associated acute renal failure. Report of 2 cases." Nephron, 40, p. 491-3
  61. Wong F, Massie D, Hsu P, Dudley F (1993) "Indomethacin-induced renal dysfunction in patients with well- compensated cirrhosis." Gastroenterology, 104, p. 869-76
  62. Pearce CJ, Gonzalez FM, Wallin JD (1993) "Renal failure and hyperkalemia associated with ketorolac tromethamine." Arch Intern Med, 153, p. 1000-2
  63. Fong J, Gora ML (1993) "Reversible renal insufficiency following ketorolac therapy." Ann Pharmacother, 27, p. 510-2
  64. Jick H, Derby LE, Garcia Rodriguez LA, Jick SS, Dean AD (1993) "Nonsteroidal antiinflammatory drugs and certain rare, serious adverse events: a cohort study." Pharmacotherapy, 13, p. 212-7
  65. Frais MA, Burgess ED, Mitchell LB (1983) "Piroxicam-induced renal failure and hyperkalemia." Ann Intern Med, 99, p. 129-30
  66. Mitnick PD, Klein WJ, Jr (1984) "Piroxicam-induced renal disease." Arch Intern Med, 144, p. 63-4
  67. Loeffler M, Hanson G, Philp T (1989) "Piroxicam-induced renal failure following relief of chronic retention." Br J Urol, 63, p. 438-9
  68. Goebel KM, Mueller-Brodmann W (1982) "Reversible overt nephropathy with Henoch-Schonlein purpura due to piroxicam." Br Med J (Clin Res Ed), 284, p. 311-2
  69. Fellner SK (1985) "Piroxicam-induced acute interstitial nephritis and minimal-change nephrotic syndrome." Am J Nephrol, 5, p. 142-3
  70. Sarma PS (1989) "Fatal acute renal failure after piroxicam." Clin Nephrol, 31, p. 54
  71. Gerber D (1987) "Adverse reactions of piroxicam." Drug Intell Clin Pharm, 21, p. 707-10
  72. Brater DC, Brown-Cartwright D, Anderson SA, Uaamnuichai M (1987) "Effect of high-dose etodolac on renal function." Clin Pharmacol Ther, 42, p. 283-9
  73. Mitnick PD, Greenberg A, DeOreo PB, Weiner BM, Coffman TM, Walker BR, Agus ZS, Goldfarb S (1980) "Effects of two nonsteroidal anti-inflammatory drugs, indomethacin and oxaprozin, on the kidney." Clin Pharmacol Ther, 28, p. 680-9
  74. Quan DJ, Kayser SR (1994) "Ketorolac induced acute renal failure following a single dose." J Toxicol Clin Toxicol, 32, p. 305-9
  75. Haragsim L, Dalal R, Bagga H, Bastani B (1994) "Ketorolac-induced acute renal failure and hyperkalemia: report of three cases." Am J Kidney Dis, 24, p. 578-80
  76. Perneger TV, Whelton PK, Klag MJ (1994) "Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs." N Engl J Med, 331, p. 1675-9
  77. van Biljon G (1989) "Reversible renal failure associated with ibuprofen in a child. A case report." S Afr Med J, 76, p. 34-5
  78. Delmas PD (1995) "Non-steroidal anti-inflammatory drugs and renal function." Br J Rheumatol, 34 Suppl, p. 25-8
  79. Segasothy M, Chin GL, Sia KK, Zulfiqar A, Samad SA (1995) "Chronic nephrotoxicity of anti-inflammatory drugs used in the treatment of arthritis." Br J Rheumatol, 34, p. 162-5
  80. Whelton A (1995) "Renal effects of over-the-counter analgesics." J Clin Pharmacol, 35, p. 454-63
  81. Blackwell E, Loughlin K, Dumler F, Smythe M (1995) "Nabumetone-associated interstitial nephritis." Pharmacotherapy, 15, p. 669-72
  82. Jonsson CE, Ericsson F (1995) "Impairment of renal function after treatment of a burn patient with diclofenac, a non-steroidal anti-inflammatory drug." Burns, 21, p. 471-3
  83. Kelley M, Bastani B (1995) "Ketorolac-induced acute renal failure and hyperkalemia." Clin Nephrol, 44, p. 276-7
  84. Radford RG, Holley KE, Grande JP, Larson TS, Wagoner RD, Donadio JV, Mccarthy JT (1996) "Reversible membranous nephropathy associated with the use of nonsteroidal anti-inflammatory drugs." JAMA, 276, p. 466-9
  85. Buck ML, Norwood VF (1996) "Ketorolac-induced acute renal failure in a previously healthy adolescent." Pediatrics, 98, p. 294-6
  86. Ogawa M, Ueda S, Hamano Y, Ito K, Saisho H, Akikusa B (1996) "Membranous nephropathy associated with oxaprozin treatment." Nephron, 74, p. 439-40
  87. Feldman HI, Kinman JL, Berlin JA, et al. (1997) "Parenteral ketorolac: the risk for acute renal failure." Ann Intern Med, 126, p. 193-9
  88. Buller GK, Perazella MA (1997) "Acute renal failure and ketorolac." Ann Intern Med, 127, p. 493
  89. Feldman HI, Kinman JL, Strom BL (1997) "Acute renal failure and ketorolac." Ann Intern Med, 127, p. 493-4
  90. (2001) "Product Information. Celebrex (celecoxib)." Searle
  91. Cangiano JL, Figueroa J, Palmer R (1999) "Renal hemodynamic effects of nabumetone, sulindac, and placebo in patients with osteoarthritis." Clin Ther, 21, p. 503-12
  92. Wolf G, Porth J, Stahl RA (2000) "Acute renal failure associated with rofecoxib." Ann Intern Med, 133, p. 394
  93. (2004) "Product Information. Alimta (pemetrexed)." Lilly, Eli and Company
View all 93 references

Switch to consumer interaction data

Drug and food interactions

Moderate

ibuprofen food

Applies to: Advil Children's (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. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer