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Drug Interactions between aspirin / pentazocine and piroxicam

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

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Interactions between your drugs

Major

aspirin piroxicam

Applies to: aspirin / pentazocine and piroxicam

GENERALLY AVOID: The use of piroxicam in combination with another nonsteroidal anti-inflammatory drug (NSAID) may increase the risk of serious and potentially fatal gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, or intestines. These events can occur at any time during NSAID use, with or without warning symptoms, but the incidence may increase with dosage and duration of therapy. Administration of piroxicam at dosages greater than 20 mg per day carries an increased risk of GI side effects, and evidence from observational studies suggests that piroxicam may also be associated with a higher risk of serious GI toxicity relative to other NSAIDs. In clinical trials of several months to two years duration, NSAID-associated upper GI ulcers, gross bleeding, or perforation occurred in approximately 1% of patients treated for 3 to 6 months and in 2% to 4% of patients treated for one year. Patients with a prior history of peptic ulcer disease and/or GI bleeding have a greater than 10-fold increased risk of developing a GI bleed during NSAID use compared to patients without a history. Additional risk factors include advanced age (especially over 70 years), Helicobacter pylori infection, excessive alcohol use, smoking, a history of GI inflammatory conditions, advanced liver disease, coagulopathy, and poor general health status. GI toxicity aside, clinical studies have also failed to demonstrate greater therapeutic benefit from the coadministration of piroxicam with another NSAID than the use of piroxicam alone.

MANAGEMENT: Concomitant use of piroxicam with other NSAIDs, except for low-dose aspirin for cardiovascular prophylaxis, should generally be avoided. Patients treated with a NSAID should be advised to take it with food and to immediately report signs and symptoms of GI ulceration or bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools. The lowest effective dosage should be used for the shortest possible duration. Selective use of prophylactic anti-ulcer therapy (e.g., misoprostol, proton pump inhibitors) may be considered in high-risk patients.

References (4)
  1. (2023) "Product Information. APO Piroxicam (piroxicam)." Apotex Incorporated
  2. (2024) "Product Information. Feldene (piroxicam)." Pfizer Ltd
  3. (2024) "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals Group, SUPPL-53
  4. (2024) "Product Information. moBILis (piroxicam)." Alphapharm Pty Ltd

Drug and food interactions

Moderate

pentazocine food

Applies to: aspirin / pentazocine

MONITOR: Smoking tobacco may decrease the plasma concentrations and effects of pentazocine by enhancing its metabolic clearance.

MANAGEMENT: The possibility of reduced therapeutic effects of pentazocine should be considered in smokers.

References (3)
  1. Miller LG (1989) "Recent developments in the study of the effects of cigarette smoking on clinical pharmacokinetics and clinical pharmacodynamics." Clin Pharmacokinet, 17, p. 90-108
  2. D'Arcy PF (1984) "Tobacco smoking and drugs: a clinically important interaction?" Drug Intell Clin Pharm, 18, p. 302-7
  3. (2006) "Product Information. Talacen (acetaminophen-pentazocine)." Sanofi-Synthelabo Inc
Moderate

aspirin food

Applies to: aspirin / pentazocine

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)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
Moderate

pentazocine food

Applies to: aspirin / pentazocine

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. 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.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References (9)
  1. Linnoila M, Hakkinen S (1974) "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther, 15, p. 368-73
  2. Sturner WQ, Garriott JC (1973) "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA, 223, p. 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. (1991) "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol, 41, p. 147-52
  4. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL (1985) "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol, 19, p. 398-401
  6. Carson DJ (1977) "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet, 1, p. 894-7
  7. Rosser WW (1980) "The interaction of propoxyphene with other drugs." Can Med Assoc J, 122, p. 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM (1982) "Distalgesic and ethanol-impaired function." Lancet, 2, p. 384
  9. Kiplinger GF, Sokol G, Rodda BE (1974) "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther, 212, p. 175-80
Moderate

piroxicam food

Applies to: piroxicam

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)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
Minor

aspirin food

Applies to: aspirin / pentazocine

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

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Nonsteroidal anti-inflammatories

Therapeutic duplication

The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category:

  • aspirin/pentazocine
  • piroxicam

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

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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