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Drug Interactions between Byvalson and Cap-Profen

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

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Interactions between your drugs

Moderate

ibuprofen valsartan

Applies to: Cap-Profen (ibuprofen) and Byvalson (nebivolol / valsartan)

MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effects of angiotensin II receptor antagonists. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis, which results in unopposed pressor activity producing hypertension. In addition, NSAIDs can cause fluid retention, which also affects blood pressure. Clinical data are limited.

MONITOR: Concomitant use of NSAIDs and angiotensin II receptor antagonists may cause deterioration in renal function, particularly in patients who are elderly or volume-depleted (including those on diuretic therapy) or have compromised renal function. Acute renal failure may occur, although effects are usually reversible. Chronic use of NSAIDs alone may be associated with renal toxicities, including elevations in serum creatinine and BUN, tubular necrosis, glomerulitis, renal papillary necrosis, acute interstitial nephritis, nephrotic syndrome, and renal failure. Additionally, in patients with prerenal conditions whose renal perfusion may be dependent on the function of prostaglandins, NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Angiotensin II receptor antagonists can further worsen renal function by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration.

MANAGEMENT: Patients receiving angiotensin II receptor antagonists who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation, discontinuation, or change of dosage of the NSAID. Renal function should also be evaluated periodically during prolonged coadministration. The interaction is not expected to occur with low doses (e.g., low-dose aspirin) or intermittent short-term administration of NSAIDs.

References

  1. Radack KL, Deck CC, Bloomfield SS "Ibuprofen interferes with the efficacy of antihypertensive drugs: a randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen." Ann Intern Med 107 (1987): 628-35
  2. "Product Information. Toradol (ketorolac)." Roche Laboratories PROD (2002):
  3. "Multum Information Services, Inc. Expert Review Panel"
  4. "Product Information. Celebrex (celecoxib)." Searle PROD (2001):
View all 4 references

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Moderate

ibuprofen nebivolol

Applies to: Cap-Profen (ibuprofen) and Byvalson (nebivolol / valsartan)

MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effect of beta-blockers. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis, which results in unopposed pressor activity producing hypertension. In addition, NSAIDs can cause fluid retention, which also affects blood pressure. Indomethacin and piroxicam have been reported to have greater attenuating effects than other NSAIDs, and indomethacin effects may be significant in patients with eclampsia.

MANAGEMENT: Patients receiving a beta-blocker who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation, discontinuation, or change of dosage of the NSAID. The interaction is not expected to occur with low doses (e.g., low-dose aspirin) or intermittent short-term administration of NSAIDs.

References

  1. Salvetti A, Pedrinelli R, Alberici P, Magagna A, Abdel-Haq B "The influence of indomethacin and sulindac on some pharmacological actions of atenolol in hypertensive patients." Br J Clin Pharmacol 17 Suppl 1 (1984): s108-11
  2. Ylitalo P, Pitkajarvi T, Pyykonen ML, Nurmi AK, Seppala E, Vapaatalo H "Inhibition of prostaglandin synthesis by indomethacin interacts with the antihypertensive effect of atenolol." Clin Pharmacol Ther 38 (1985): 443-9
  3. Radack KL, Deck CC, Bloomfield SS "Ibuprofen interferes with the efficacy of antihypertensive drugs." Ann Intern Med 107 (1987): 628-35
  4. Wong DG, Spence JD, Lamki L, Freeman D, McDonald JW "Effect of non-steroidal anti-inflammatory drugs on control of hypertension by beta-blockers and diuretics." Lancet 1 (1986): 997-1001
  5. Durao V, Prata MM, Goncalves LM "Modification of antihypertensive effect of beta-adrenoceptor-blocking agents by inhibition of endogenous prostaglandin synthesis." Lancet 2 (1977): 1005-7
  6. Abate MA, Neely JL, Layne RD, D'Allessandri R "Interaction of indomethacin and sulindac with labetalol." Br J Clin Pharmacol 31 (1991): 363-6
  7. Salvetti A, Arzilli F, Pedrinelli R, Beggi P, Motolese M "Interaction between oxprenolol and indomethacin on blood pressure in essential hypertensive patients." Eur J Clin Pharmacol 22 (1982): 197-201
  8. Durao V, Prata MM, Concalves LM "Modification of antihypertensive effect of B-adrenoceptor-blocking agents by inhibition of endogenous prostaglandin synthesis." Lancet 2 (1977): 1005-7
  9. Hartmann D, Stief G, Lingenfelder M, Guzelhan C, Horsch AK "Study on the possible interaction between tenoxicam and atenolol in hypertensive patients." Arzneimittelforschung 45-1 (1995): 494-8
View all 9 references

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Moderate

valsartan nebivolol

Applies to: Byvalson (nebivolol / valsartan) and Byvalson (nebivolol / valsartan)

GENERALLY AVOID: In the Valsartan Heart Failure Trial, the combination of valsartan with a beta-blocker and an ACE inhibitor was associated with unfavorable outcomes on morbidity and mortality in heart failure patients. The mechanism is unknown.

MANAGEMENT: The manufacturer recommends that the triple combination of valsartan with a beta-blocker and an ACE inhibitor be avoided in heart failure patients.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0

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Drug and food interactions

Moderate

valsartan food

Applies to: Byvalson (nebivolol / valsartan)

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Moderate

ibuprofen food

Applies to: Cap-Profen (ibuprofen)

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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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

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