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Drug Interactions between Amino-Opti-E and aspirin / hydrocodone

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

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Interactions between your drugs

Moderate

aspirin vitamin E

Applies to: aspirin / hydrocodone and Amino-Opti-E (vitamin e)

MONITOR: Vitamin E may potentiate the effects of anticoagulants and platelet inhibitors. Vitamin E is thought to inhibit the oxidation of reduced vitamin K and interfere with the functions of vitamin K-dependent clotting factors. These effects appear to be dose-dependent and greater in individuals with preexisting vitamin K deficiency. In one study, administration of vitamin E 42 units/day for one month increased the hypoprothrombinemic effect of a single dose of dicumarol in 3 healthy volunteers, as demonstrated by a decrease in prothrombin activity from 52% to 33% thirty-six hours postdose. The interaction was also suspected in a patient who developed ecchymoses and hematuria following two months of vitamin E supplementation at a dosage of 800 to 1200 units/day while taking warfarin. In contrast, two studies found no significant effect of vitamin E on the hypoprothrombinemic effect of chronic warfarin therapy when administered at relatively high dosages (800 or 1200 units/day) to 21 subjects for one month or at low dosages (100 or 400 units/day) to 12 subjects for four weeks. With respect to antiplatelet activities, data from in vitro and ex vivo human studies suggest that vitamin E can inhibit collagen-induced platelet activation and protein kinase C-dependent platelet aggregation. Clinically significant antiplatelet effects have not been consistently observed in published studies, particularly at dosages below 400 units/day. However, there have been isolated reports of excessive bleeding in surgical patients who had taken vitamin E regularly prior to surgery, and one controlled clinical trial found that supplementation with only 50 mg/day of vitamin E resulted in an increase in subarachnoid hemorrhage in male smokers aged 55 to 74 years (n=409). In a random sampling of that same population of male smokers, gingival bleeding was also more common in subjects who received vitamin E with aspirin compared to those who received either agent alone or neither.

MANAGEMENT: Patients should consult a healthcare provider before taking any nutritional supplements like vitamin E. Close clinical and laboratory observation for hematologic complications may be appropriate when vitamin E supplementation at dosages greater than 400 units/day is initiated in patients stabilized on anticoagulant or antiplatelet therapy. The dose of the anticoagulant or antiplatelet drug may require adjustment during and after treatment with vitamin E. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. Corrigan JJ "The effect of vitamin E on warfarin-induced vitamin K deficiency." Ann N Y Acad Sci 393 (1982): 361-8
  2. Corrigan JJ, Ulfers LL "Effect of vitamin E on prothrombin levels in warfarin-induced vitamin K deficiency." Am J Clin Nutr 34 (1981): 1701-5
  3. Schrogie JJ "Coagulopathy and fat-soluble vitamins." JAMA 232 (1975): 19
  4. "Vitamin K, vitamin E and the coumarin drugs." Nutr Rev 40 (1982): 180-2
  5. "Megavitamin E supplementation and vitamin K-dependent carboxylation." Nutr Rev 41 (1983): 268-70
  6. Kim JM, White RH "Effect of vitamin E on the anticoagulant response to warfarin." Am J Cardiol 77 (1996): 545-6
  7. Helson L "The effect of intravenous vitamin E and menadiol sodium diphosphate on vitamin K dependent clotting factors." Thromb Res 35 (1984): 11-8
  8. Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30
  9. Celestini A, Pulcinelli FM, Pignatelli P, et al. "Vitamin E potentiates the antiplatelet activity of aspirin in collagen-stimulated platelets." Haematologica 87 (2002): 420-6
  10. Kakishita E, Suehiro A, Oura Y, Nagai K "Inhibitory effect of vitamin E (alpha-tocopherol) on spontaneous platelet aggregation in whole blood." Thromb Res 60 (1990): 489-99
  11. Mardla V, Kobzar G, Samel N "Potentiation of antiaggregating effect of prostaglandins by alpha-tocopherol and quercetin." Platelets 15 (2004): 319-24
  12. Gonzalez-Correa JA, Arrebola MM, Guerrero A, et al. "Influence of vitamin E on the antiplatelet effect of acetylsalicylic acid in human blood." Platelets 16(3-4) (2005): 171-9
  13. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  14. Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C "Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis." Pharmacotherapy 27 (2007): 1237-47
  15. Booth SL, Golly I, Sacheck JM, Roubenoff R, Dallal GE, et al. "Effect of vitamin E supplementation on vitamin K status in adults with normal coagulation status." Am J Clin Nutr 80 (2004): 143-8
  16. Freedman JE, Farhat JH, Loscalzo J, Keaney JF "Alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C--dependent mechanism." Circulation 94 (1996): 2434-40
  17. Stampfer MJ, Jakubowski JA, Faigel D, Vaillancourt R, Deykin D "Vitamin E supplementation effect on human platelet function, arachidonic acid metabolism, and plasma prostacyclin levels." Am J Clin Nutr 47 (1988): 700-6
  18. Murohara T, Ikeda H, Otsuka Y, Aoki M, Takajo Y, et al. "Inhibition of platelet adherence to Mononuclear cells by alpha-tocopherol: role of P-selection." Circulation 110 (2004): 141-8
  19. Jandak J, Steiner M, Richardson PD "Alpha-tocopherol, an effective inhibitor of platelet adhesion." Blood 73 (1989): 141-9
  20. Liu M, Wallmon A, Olsson-Mortlock C, Wallin R, Saldeen T "Mixed tocopherols inhibit platelet aggregation in humans: potential mechanisms." Am J Clin Nutr 77 (2003): 700-6
View all 20 references

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Drug and food interactions

Major

HYDROcodone food

Applies to: aspirin / hydrocodone

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References

  1. "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc (2013):

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Moderate

aspirin food

Applies to: aspirin / hydrocodone

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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Minor

aspirin food

Applies to: aspirin / hydrocodone

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

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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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