Drug Interactions between Aleve and cycloserine

GENERALLY AVOID: Coadministration with alcohol may potentiate some of the central nervous system adverse effects of cycloserine and its prodrug, terizidone. These effects may include dizziness, drowsiness, depression, anxiety, psychoses, memory impairment, confusion, and convulsions.

MANAGEMENT: Patients should be advised to avoid the consumption of alcohol during treatment with cycloserine or terizidone. The use of these medications is contraindicated in patients with chronic alcohol consumption or alcoholism.

MONITOR CLOSELY: Coadministration with caffeine may potentiate some of the central nervous system adverse effects of cycloserine and its prodrug, terizidone. These effects may include insomnia, excitability, irritability, anxiety, tremor, psychoses, and convulsions.

MANAGEMENT: Caution is advised when cycloserine or terizidone is used with caffeine. Consumption of certain beverages or stimulants with very high caffeine levels should be avoided as a precautionary measure.

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.

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.