Drug Interactions between Eliquis and Salonpas Pain Relieving Patch

GENERALLY AVOID: Salicylates may be absorbed systemically following topical administration and may potentiate the effects of oral anticoagulants. Salicylates interfere with the action of vitamin K and induce a dose-dependent alteration in hepatic synthesis of coagulation factors VII, IX and X, occasionally increasing the prothrombin time. Altered coagulation parameters and/or bleeding have been reported in patients stabilized on warfarin following the use of topical analgesic preparations containing methyl salicylate.

MANAGEMENT: Patients treated with oral anticoagulants should avoid or limit self-medication with these products. Systemic absorption of topical medication may be increased with frequent applications; use of large quantities or over large areas of skin; use of ointment-based formulations; and use of occlusive dressings or heating pads over application areas. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools. Patients should also be counseled to avoid any other over-the-counter salicylate products.

Coadministration with orally administered menthol may decrease plasma concentrations of drugs that are substrates of the CYP450 3A4 and/or CYP450 2C9 isoenzymes. The proposed mechanism is increased clearance due to menthol-mediated induction of CYP450 3A4 and CYP450 2C9. In vivo data suggests that concomitant administration of oral menthol reduced the systemic exposure (AUC) of triazolam (a CYP450 3A4 substrate) by 40%, and phenytoin (a CYP450 2C9 substrate) by 20%. Until further data are available, no specific precautions are recommended.