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Drug Interactions between diflunisal and tinzaparin

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

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Major

diflunisal tinzaparin

Applies to: diflunisal and tinzaparin

GENERALLY AVOID: In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during low molecular weight heparin (LMWH) or heparinoid therapy may be increased by the concomitant use of other drugs that affect coagulation, including nonsteroidal anti-inflammatory drugs (NSAIDs). The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

GENERALLY AVOID: Theoretically, NSAIDs may potentiate the risk of bleeding complications associated with LMWH or heparinoid therapy. NSAIDs interfere with platelet adhesion and aggregation and may prolong bleeding time in healthy individuals. While these effects are generally slight and of relatively short duration with most NSAIDs (except aspirin) at recommended dosages, they may be of pronounced clinical significance when combined with the inhibitory effects of LMWHs or heparinoids on the clotting cascade. However, little clinical data exist regarding an actual interaction. In a controlled, randomized prospective study, 60 patients undergoing total hip replacement received enoxaparin (40 mg subcutaneously 12 hours pre- and every 24 hours postoperatively for 10 days) and analgesia with either ketorolac (30 mg IM on induction of anesthesia and every 24 hours postoperatively for 4 days) or an opioid plus acetaminophen. The authors reported no significant differences between the two groups for intraoperative blood loss, postoperative drainage, transfusion requirements, bruising, wound oozing, and leg swelling. However, there have been anecdotal reports of hemorrhagic complications in surgical patients treated with NSAIDs alone and in combination with a LMWH. In addition, NSAIDs are known to cause dose-related gastrointestinal bleeding, which may be complicated by anticoagulant therapy.

MANAGEMENT: Products containing NSAIDs, especially if given chronically and in high dosages, should preferably be avoided in patients receiving LMWHs or heparinoids. Close clinical and laboratory observation for bleeding complications is recommended if concurrent therapy is necessary. In patients undergoing neuraxial intervention, coadministration of these agents should be approached with caution and only after thorough assessment of risks and benefits. Besides bleeding complications, patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.

References

  1. Bang CJ, Riedel B, Talstad I, Berstad A (1992) "Interaction between heparin and acetylsalicylic acid on gastric mucosal and skin bleeding in humans." Scand J Gastroenterol, 27, p. 489-94
  2. (2002) "Product Information. Lovenox (enoxaparin)." Rhone Poulenc Rorer
  3. Walker AM (1980) "Predictors of bleeding during heparin therapy." JAMA, 244, p. 1209-12
  4. Heiden D, Rodvien R, Mielke CH (1981) "Heparin bleeding, platelet dysfunction, and aspirin." JAMA, 246, p. 330-1
  5. Theroux P, Ouimet H, McCans J, et al. (1988) "Aspirin, heparin, or both to treat acute unstable angina." N Engl J Med, 319, p. 1105-6
  6. (2001) "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn
  7. Weale AE, Warwick DJ, Durant N, Prothero D (1995) "Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?" Ann R Coll Surg Engl, 77, p. 35-7
  8. Price AJ, Frcpath DO (1995) "Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?" Ann R Coll Surg Engl, 77, p. 395
  9. (2001) "Product Information. Orgaran (danaparoid)." Organon
  10. (2001) "Product Information. Normiflo (ardeparin)." Wyeth-Ayerst Laboratories
  11. Klinkhardt U, Breddin HK, Esslinger HU, Haas S, Kalatzis A, Harder S (2000) "Interaction between the LMWH reviparin and aspirin in healthy volunteers." Br J Clin Pharmacol, 49, p. 337-41
  12. (2001) "Product Information. Innohep (tinzaparin)." DuPont Pharmaceuticals
View all 12 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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.