Drug Interactions between Alka-Seltzer Lemon-Lime and heparin flush

MONITOR: Agents that cause urinary alkalinization can reduce serum salicylate concentrations in patients receiving anti-inflammatory dosages of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to increased urinary pH, resulting in increased renal salicylate clearance especially above urine pH of 7. This interaction is sometimes exploited in the treatment of salicylate toxicity.

MANAGEMENT: Patients treated chronically with urinary alkalinizers and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

MONITOR: Concomitant use of heparin flush and drugs that interfere with platelet function or coagulation or drugs that commonly cause thrombocytopenia may potentiate the risk of bleeding complications. Although uncommon, inadvertent anticoagulation resulting in hemorrhagic events may occur with heparin flushes, particularly during repeated or excessive use or administration of higher concentration flush solutions.

MANAGEMENT: Caution and monitoring (e.g., platelet counts, hematocrits, tests for occult blood in stools) are advised when heparin flushes are given to patients receiving systemic anticoagulants, platelet inhibitors, antithrombotic agents, thrombolytics, or drugs with known risks of thrombocytopenia or bleeding. An unexplained fall in hematocrit, fall in blood pressure, or any other unexplained symptom should lead to serious consideration of a hemorrhagic event.