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Drug Interactions between aspirin / caffeine / salicylamide and esmolol

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

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Interactions between your drugs

Moderate

aspirin salicylamide

Applies to: aspirin / caffeine / salicylamide and aspirin / caffeine / salicylamide

MONITOR: The combined use of low-dose or high-dose aspirin with other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the potential for serious gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and perforation. Aspirin at anti-inflammatory dosages or higher may also decrease the plasma concentrations of many NSAIDs. The decreases have ranged from none or small (piroxicam, meloxicam, naproxen, tolmetin) to substantial (flurbiprofen, ibuprofen). However, the therapeutic response does not appear to be affected. Investigators theorize that aspirin may displace NSAIDs from plasma protein binding sites, resulting in increased concentration of unbound, or free, drug available for clearance. The increase in NSAID free fraction, and possibly some contributory anti-inflammatory effect from aspirin, may account for the lack of overall effect on therapeutic response.

MANAGEMENT: Caution is advised if aspirin, particularly at anti-inflammatory dosages, is used with other NSAIDs. Concomitant administration of NSAIDs is considered contraindicated or not recommended with aspirin at analgesic/anti-inflammatory dosages by many NSAID manufacturers. During concomitant therapy, patients should be advised to take the medications with food and to immediately report signs and symptoms of GI ulceration and bleeding such as abdominal pain, bloating, sudden dizziness or lightheadedness, nausea, vomiting, hematemesis, anorexia, and melena.

References

  1. Furst DE, Sarkissian E, Blocka K, et al. (1987) "Serum concentrations of salicylate and naproxen during concurrent therapy in patients with rheumatoid arthritis." Arthritis Rheum, 30, p. 1157-61
  2. Abdel-Rahman MS, Reddi AS, Curro FA, Turkall RM, Kadry AM, Hansrote JA (1991) "Bioavailability of aspirin and salicylamide following oral co-administration in human volunteers." Can J Physiol Pharmacol, 69, p. 1436-42
  3. Gruber CM (1976) "Clinical pharmacology of fenoprofen: a review." J Rheumatol, 2, p. 8-17
  4. Cressman WA, Wortham GF, Plostnieks J (1976) "Absorption and excretion of tolemetin in man." Clin Pharmacol Ther, 19, p. 224-33
  5. Kwan KC, Breault GO, Davis RL, et al. (1978) "Effects of concomitant aspirin administration on the pharmacokinetics of indomethacin in man." J Pharmacokinet Biopharm, 6, p. 451-76
  6. Rubin A, Rodda BE, Warrick P, Gruber CM Jr, Ridolfo RS (1973) "Interactions of aspirin with nonsteroidal antiinflammatory drugs in man." Arthritis Rheum, 16, p. 635-45
  7. Brooks PM, Walker JJ, Bell MA, Buchanan WW, Rhymer AR (1975) "Indomethacin--aspirin interaction: a clinical appraisal." Br Med J, 3, p. 69-11
  8. Tempero KF, Cirillo VJ, Steelman SL (1977) "Diflunisal: a review of pharmacokinetic and pharmacodynamic properties, drug interactions, and special tolerability studies in humans." Br J Clin Pharmacol, 4, s31-6
  9. Willis JV, Kendall MJ, Jack DB (1980) "A study of the effect of aspirin on the pharmacokinetics of oral and intravenous diclofenac sodium." Eur J Clin Pharmacol, 18, p. 415-8
  10. Muller FO, Hundt HK, Muller DG (1977) "Pharmacokinetic and pharmacodynamic implications of long-term administration of non-steroidal anti-inflammatory agents." Int J Clin Pharmacol Biopharm, 15, p. 397-402
  11. Hobbs DC, Twomey TM (1979) "Piroxicam pharmacokinetics in man: aspirin and antacid interaction studies." J Clin Pharmacol, 19, p. 270-81
  12. Pawlotsky Y, Chales G, Grosbois B, Miane B, Bourel M (1978) "Comparative interaction of aspirin with indomethacin and sulindac in chronic rheumatic diseases." Eur J Rheumatol Inflamm, 1, p. 18-20
  13. Segre EJ, Chaplin M, Forchielli E, Runkel R, Sevelius H (1973) "Naproxen-aspirin interactions in man." Clin Pharmacol Ther, 15, p. 374-9
  14. Bird HA, Hill J, Leatham P, Wright V (1986) "A study to determine the clinical relevance of the pharmacokinetic interaction between aspirin and diclofenac." Agents Actions, 18, p. 447-9
  15. Brooks PM, Khong T (1977) "Flurbiprofen-aspirin interaction: a double-blind crossover study." Curr Med Res Opin, 5, p. 53-7
  16. Grennan DM, Ferry DG, Ashworth ME, Kenny RE, Mackinnnon M (1979) "The aspirin-ibuprofen interaction in rheumatoid arthritis." Br J Clin Pharmacol, 8, p. 497-503
  17. Williams RL, Upton RA, Buskin JN, Jones RM (1981) "Ketoprofen-aspirin interactions." Clin Pharmacol Ther, 30, p. 226-31
  18. Kaiser DG, Brooks CD, Lomen PL (1986) "Pharmacokinetics of flurbiprofen." Am J Med, 80, p. 10-5
  19. Kahn SB, Hubsher JA (1983) "Effects of oxaprozin alone or in combination with aspirin on hemostasis and plasma protein binding." J Clin Pharmacol, 23, p. 139-46
  20. (2001) "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim
  21. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  22. Cerner Multum, Inc. "Australian Product Information."
View all 22 references

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Minor

aspirin esmolol

Applies to: aspirin / caffeine / salicylamide and esmolol

High doses of salicylates may blunt the antihypertensive effects of beta-blockers. The proposed mechanism is inhibition of prostaglandin synthesis. Low-dose aspirin does not appear to affect blood pressure. In addition, beta-blockers may exert an antiplatelet effect, which may be additive with the effects of some salicylates. Metoprolol may also increase aspirin absorption and/or plasma concentrations of salicylates; however, the clinical significance of this effect is unknown. Data have been conflicting. Until more information is available, patients who require concomitant therapy should be monitored for altered antihypertensive response whenever a salicylate is introduced or discontinued, or when its dosage is modified.

References

  1. Spahn H, Langguth P, Kirch W, et al. (1986) "Pharmacokinetics of salicylates administered with metoprolol." Arzneimittelforschung, 36, p. 1697-9
  2. Sziegoleit W, Rausch J, Polak G, et al. (1982) "Influence of acetylsalicylic acid on acute circulatory effects of the beta-blocking agents pindolol and propranolol in humans." Int J Clin Pharmacol Ther Toxicol, 20, p. 423-30
  3. Keber I, Jerse M, Keber D, Stegnar M (1979) "The influence of combined treatment with propranolol and acetylsalicylic acid on platelet aggregation in coronary heart disease." Br J Clin Pharmacol, 7, p. 287-91
  4. Sziegoleit W, Rausch J, Polak G, Gyorgy M, Dekov E, Bekes M (1982) "Influence of acetylsalicylic acid on acute circulatory effects of the beta-blocking agents pindolol and propranolol." Int J Clin Pharmacol Ther Toxicol, 20, p. 423-30
  5. Hartmann D, Stief G, Lingenfelder M, Guzelhan C, Horsch AK (1995) "Study on the possible interaction between tenoxicam and atenolol in hypertensive patients." Arzneimittelforschung, 45-1, p. 494-8
  6. Zanchetti A, Hansson L, Leonetti G, et al. (2002) "Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy." J Hypertens, 20, p. 1015-1022
View all 6 references

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Minor

aspirin caffeine

Applies to: aspirin / caffeine / salicylamide and aspirin / caffeine / salicylamide

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 (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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Drug and food interactions

Moderate

aspirin food

Applies to: aspirin / caffeine / salicylamide

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

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Moderate

esmolol food

Applies to: esmolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

salicylamide food

Applies to: aspirin / caffeine / salicylamide

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

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Minor

caffeine food

Applies to: aspirin / caffeine / salicylamide

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR (1996) "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy, 16, p. 1046-52

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Minor

aspirin food

Applies to: aspirin / caffeine / salicylamide

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 (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 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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