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Drug Interactions between aspirin / pravastatin and feverfew

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

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Interactions between your drugs

Minor

aspirin feverfew

Applies to: aspirin / pravastatin and feverfew

Theoretically, feverfew extracts may potentiate the effects of anticoagulants, platelet inhibitors, and thrombolytic agents, possibly increasing the risk of bleeding. In vitro studies have shown feverfew to interfere with hemostasis and platelet aggregation by neutralizing platelet sulfhydryl groups as well as preventing prostaglandin synthesis. However, bleeding complications and interactions with hematologic agents have not been reported. Moreover, pharmacologic effects may be highly variable due to inconsistencies in formulation and potency of commercial herbal products. Patients should consult a healthcare provider before taking any herbal or alternative medicine. In patients who have used feverfew extensively prior to receiving anticoagulation, antiplatelet, or thrombolytic therapy, the potential for an interaction should be considered. Clinical and laboratory observation for hematologic complications is recommended. 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 (6)
  1. Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
  2. Heck AM, DeWitt BA, Lukes AL (2000) "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm, 57, 1221-7; quiz 1228-30
  3. Heptinstall S, Groenewegen WA, Spangenberg P, Loesche W (1987) "Extracts of feverfew may inhibit platelet behavior via neutralization of sulphydryl groups." J Pharm Pharmacol, 39, p. 459-65
  4. Groenewegen WA, Heptinstall S (1990) "A comparison of the effects of an extract of feverfew and parthenolide, a component of feverfew, on human platelet activity in-vitro." J Pharm Pharmacol, 42, p. 553-7
  5. Biggs MJ, Johnson ES, Persaud NP, Ratclife DM (1982) "Platelet aggregation in patients using feverfew for migraine." Lancet, 2, p. 776
  6. Heptinstall S, White A, Williamson L, Mitchell JR (1985) "Extracts of feverfew inhibit granule secretion in blood platelets and polymorphonuclear leucocytes." Lancet, 1, p. 1071-2

Drug and food interactions

Moderate

aspirin food

Applies to: aspirin / pravastatin

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

pravastatin food

Applies to: aspirin / pravastatin

MONITOR: Concomitant use of statin medication with substantial quantities of alcohol may increase the risk of hepatic injury. Transient increases in serum transaminases have been reported with statin use and while these increases generally resolve or improve with continued therapy or a brief interruption in therapy, there have been rare postmarketing reports of fatal and non-fatal hepatic failure in patients taking statins. Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury. Active liver disease or unexplained transaminase elevations are contraindications to statin use.

MANAGEMENT: Patients should be counseled to avoid substantial quantities of alcohol in combination with statin medications and clinicians should be aware of the increased risk for hepatotoxicity in these patients.

References (9)
  1. (2001) "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb
  2. (2001) "Product Information. Zocor (simvastatin)." Merck & Co., Inc
  3. (2001) "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals
  4. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  5. (2002) "Product Information. Altocor (lovastatin)." Andrx Pharmaceuticals
  6. (2003) "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
  9. (2010) "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic)
Minor

aspirin food

Applies to: aspirin / pravastatin

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

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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