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Drug Interactions between Combogesic IV and hydroflumethiazide

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

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Interactions between your drugs

Moderate

ibuprofen hydroflumethiazide

Applies to: Combogesic IV (acetaminophen / ibuprofen) and hydroflumethiazide

MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics may adversely affect renal function due to NSAID inhibition of the renal synthesis of prostaglandins that help maintain renal perfusion in dehydrated states. The risk may be increased in patients on dietary sodium restriction. At the same time, hypotensive effect of the diuretics may be reduced because inhibition of prostaglandins can lead to unopposed pressor activity and, consequently, elevation in blood pressure. Natriuretic and diuretic effects may also be reduced, as NSAIDs have been reported to cause sodium and water retention, which may account for the increased risk of congestive heart failure associated with the combination. One study showed an increase in the incidence density of congestive heart failure (in patients over 55 years of age) from 9.3 per 1,000 person-years in patients on diuretics to 23.3 per 1,000 person-years in patients on both diuretic and NSAID therapy. NSAIDs may also increase the risk of hyperkalemia associated with potassium-sparing diuretics.

MANAGEMENT: In patients receiving both diuretic and NSAID therapy, management consists of avoiding dehydration and carefully monitoring the patient's renal function and blood pressure. If renal insufficiency or hyperkalemia develops, both drugs should be discontinued until the condition is corrected.

References

  1. Allan SG, Knox J, Kerr F (1981) "Interaction between diuretics and indomethacin." Br Med J, 283, p. 1611
  2. McCarthy JT, Torres VE, Romero JC, et al. (1982) "Acute intrinsic renal failure induced by indomethacin." Mayo Clin Proc, 57, p. 289-96
  3. Favre L, Glasson P, Vallotton MB (1982) "Reversible acute renal failure from combined triamterene and indomethacin." Ann Intern Med, 96, p. 317-20
  4. Poe TE, Scott RB, Keith JF Jr (1983) "Interaction of indomethacin with furosemide." J Fam Pract, 16, p. 610-6
  5. Ahmad S (1984) "Indomethacin-bumetanide interaction: an alert." Am J Cardiol, 54, p. 246-7
  6. Dixey JJ, Noormohamed FH, Lant AF, Brewerton DA (1987) "The effects of naproxen and sulindac on renal function and their interaction with hydrochlorothiazide and piretanide in man." Br J Clin Pharmacol, 23, p. 55-63
  7. Brater DC, Fox WR, Chennavasin P (1981) "Interaction studies with bumetanide and furosemide: effects of probenecid and of indomethacin on response to bumetanide in man." J Clin Pharmacol, 21, p. 647-53
  8. Smith DE, Brater DC, Lin ET, Benet LZ (1979) "Attenuation of furosemide's diuretic effect by indomethacin: pharmacokinetic evaluation." J Pharmacokinet Biopharm, 7, p. 265-74
  9. Mor R, Pitlik S, Rosenfeld JB (1983) "Indomethacin- and Moduretic--induced hyperkalemia." Isr J Med Sci, 19, p. 535-7
  10. Kaufman J, Hamburger R, Matheson J, Flamenbaum W (1981) "Bumetanide-induced diuresis and natriuresis: effect of prostaglandin synthetase inhibition." J Clin Pharmacol, 21, p. 663-7
  11. Favre L, Glasson P, Riondel A, Vallotton MB (1983) "Interaction of diuretics and non-steroidal anti-inflammatory drugs in man." Clin Sci, 64, p. 407-15
  12. Pedrinelli R, Magagna A, Arzilli F, et al. (1980) "Influence of indomethacin on the natriuretic and renin-stimulating effect of bumetanide in essential hypertension." Clin Pharmacol Ther, 28, p. 722-31
  13. Weinberg MS, Quigg RJ, Salant DJ, Bernard DB (1985) "Anuric renal failure precipitated by indomethacin and triamterene." Nephron, 40, p. 216-8
  14. Furst DE (1988) "Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications." J Rheumatol Suppl, 17, p. 58-62
  15. Gehr T, Sica DA, Steigler BW, Marshall C (1990) "Interaction of triamterene-hydrochlorothiazide (T-H) and ibuprofen (I)." Clin Pharmacol Ther, 47, p. 200
  16. (2002) "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co., Inc
  17. Watkins J, Abbot EC, Hensby CN, Webster J, Dollery CT (1980) "Attenuation of hypotensive effect of propranolol and thiazide diuretics by indomethacin." Br Med J, 281, p. 702-5
  18. Ripley EB, Gehr TW, Wallace H, Wade J, Kish C, Sica DA (1994) "The effect of nonsteroidal agents (NSAIDs) on the pharmacokinetics and pharmacodynamics of metolazone." Int J Clin Pharmacol Ther, 32, p. 12-8
  19. Desaulles E, Schwartz J (1979) "A comparative study of the action of frusemide and methyclothiazide on renin release by rat kidney slices and the interaction with indomethacin." Br J Pharmacol, 65, p. 193-6
  20. Muller FO, Schall R, Devaal AC, Groenewoud G, Hundt HKL, Middle MV (1995) "Influence of meloxicam on furosemide pharmacokinetics and pharmacodynamics in healthy volunteers." Eur J Clin Pharmacol, 48, p. 247-51
  21. Gurwitz JH, Everitt DE, Monane M, et al. (1996) "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci, 51, m74-9
  22. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A (1998) "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med, 158, p. 1108-12
  23. Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
  24. Bennett WM (1997) "Drug interactions and consequences of sodium restriction." Am J Clin Nutr, 65, S678-81
  25. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
  26. Perazella MA (2000) "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med, 109, p. 307-14
View all 26 references

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Drug and food interactions

Major

acetaminophen food

Applies to: Combogesic IV (acetaminophen / ibuprofen)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA (1985) "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med, 145, p. 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA (1986) "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA, 255, p. 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB (1986) "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med, 104, p. 399-404
  4. Thummel KE, Slattery JT, Nelson SD (1988) "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther, 245, p. 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL (1980) "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA, 244, p. 251-3
  6. Kartsonis A, Reddy KR, Schiff ER (1986) "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med, 105, p. 138-9
  7. Prescott LF, Critchley JA (1983) "Drug interactions affecting analgesic toxicity." Am J Med, 75, p. 113-6
  8. (2002) "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical
  9. Whitcomb DC, Block GD (1994) "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA, 272, p. 1845-50
  10. Bonkovsky HL (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  11. Nelson EB, Temple AR (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301
  12. Zimmerman HJ, Maddrey WC (1995) "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology, 22, p. 767-73
View all 12 references

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Moderate

ibuprofen food

Applies to: Combogesic IV (acetaminophen / 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. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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Moderate

hydroflumethiazide food

Applies to: hydroflumethiazide

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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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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