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Drug Interactions between Combiflex and Eskalith

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

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Interactions between your drugs

Major

lithium salicylamide

Applies to: Eskalith (lithium) and Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Consumer information for this interaction is not currently available.

MONITOR CLOSELY: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase serum lithium levels and induce toxicity in some patients. The exact mechanism of interaction is unknown, but is thought to involve inhibition of renal prostaglandin synthesis by NSAIDs, resulting in decreased renal blood flow and lithium excretion. There have been numerous published reports of lithium toxicity, including severe cases, following the introduction of various NSAIDs including diclofenac, ibuprofen, indomethacin, ketorolac, mefenamic acid, piroxicam, and COX-2 inhibitors. However, pharmacokinetic studies have been somewhat inconsistent, with no significant effects reported for benoxaprofen and etodolac, and up to a 58% increase in serum lithium levels reported for indomethacin. Both decreased serum concentrations of lithium and no effect have been reported for sulindac and aspirin. The interaction is apparently subject to marked interpatient variability.

MANAGEMENT: Given the narrow therapeutic index of lithium, caution is advised during coadministration with NSAIDs, particularly in the elderly or patients with other risk factors (e.g., sodium restriction; renal impairment; congestive heart failure; dehydration; concomitant use of diuretics, ACE inhibitors, or angiotensin II receptor antagonists). Close monitoring for clinical signs of lithium toxicity is recommended if concomitant treatment with NSAIDs is required. Serum lithium levels should be checked every 4 to 5 days after starting an NSAID until the extent of any potential interaction can be evaluated. A reduction in lithium dosage may be needed in some cases. Renal function should also be monitored regularly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, muscle weakness, vomiting, diarrhea, polydipsia, polyuria, tinnitus, tremor, ataxia, and blurred vision.

Moderate

lithium caffeine

Applies to: Eskalith (lithium) and Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Using caffeine together with lithium may increase the effects of caffeine. Contact your doctor if you experience nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

lithium phenyltoloxamine

Applies to: Eskalith (lithium) and Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Using lithium together with phenyltoloxamine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Drug and food interactions

Major

acetaminophen food

Applies to: Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Ask your doctor before using acetaminophen together with ethanol (alcohol). This can cause serious side effects that affect your liver. Call your doctor immediately if you experience a fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes. If your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

lithium food

Applies to: Eskalith (lithium)

Alcohol can increase the nervous system side effects of lithium such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lithium. Do not use more than the recommended dose of lithium, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

phenyltoloxamine food

Applies to: Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Alcohol can increase the nervous system side effects of phenyltoloxamine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with phenyltoloxamine. Do not use more than the recommended dose of phenyltoloxamine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

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Moderate

salicylamide food

Applies to: Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Ask your doctor before using salicylamide together with ethanol (alcohol). Do not drink alcohol while taking salicylamide. Alcohol can increase your risk of stomach bleeding caused by salicylamide. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Moderate

lithium food

Applies to: Eskalith (lithium)

Using caffeine together with lithium may increase the effects of caffeine. Contact your doctor if you experience nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Minor

caffeine food

Applies to: Combiflex (acetaminophen / caffeine / phenyltoloxamine / salicylamide)

Information for this minor interaction is available on the professional version.

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.


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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.