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Drug Interactions between Combogesic and vancomycin

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

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Interactions between your drugs

Moderate

ibuprofen vancomycin

Applies to: Combogesic (acetaminophen / ibuprofen) and vancomycin

MONITOR: When administered concomitantly, vancomycin and ketorolac may have additive nephrotoxic effects. Ketorolac, like other nonsteroidal anti-inflammatory drugs (NSAIDs), inhibits vasodilatory renal prostaglandin synthesis. Renal dysfunction associated with ketorolac has been reported to be dose-related and reversible following treatment discontinuation. In addition, chronic use of NSAIDs may also be associated with renal toxicities, including renal failure. The mechanism of vancomycin-induced nephrotoxicity is unknown; however, the risk may be increased in patients with preexisting risk factors for nephrotoxicity, high vancomycin blood levels, or prolonged treatment. Data for this interaction are limited to a case report of acute transient renal failure and gastrointestinal bleeding requiring transfusion following uncomplicated surgery and treatment with ketorolac and IV vancomycin in a previously healthy middle-aged man. Data are not available for other NSAIDs.

MANAGEMENT: Caution is recommended in patients receiving ketorolac or other NSAIDs in combination with IV vancomycin, particularly in patients with preexisting risk factors for nephrotoxicity. Renal function and vancomycin therapeutic drug monitoring is recommended according to local policies and protocols. The dose and duration of concomitant NSAID therapy should also be minimized where possible.

References

  1. (2002) "Product Information. Toradol (ketorolac)." Roche Laboratories
  2. (2001) "Product Information. Vancocin (vancomycin)." Lilly, Eli and Company
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
  5. Hazlewood KA, Brouse SD, Pitcher WD, Hall RG (2010) "Vancomycin-associated nephrotoxicity: grave concern or death by character assassination?" Am J Med, 123, 182.e1-7
  6. Murray RP, Watson RC (1993) "Acute renal failure and gastrointestinal bleed associated with postoperative toradol and vancomycin." Orthopedics, 16, p. 1361-3
View all 6 references

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Drug and food interactions

Major

acetaminophen food

Applies to: Combogesic (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 (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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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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