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Drug Interactions between famotidine / ibuprofen and ramelteon

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

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Interactions between your drugs

Moderate

famotidine ramelteon

Applies to: famotidine / ibuprofen and ramelteon

MONITOR: Coadministration with inhibitors of CYP450 1A2 may increase the plasma concentrations and pharmacologic effects of ramelteon, which is primarily metabolized by the isoenzyme. In healthy volunteers, administration of a single 16 mg dose of ramelteon following pretreatment with the potent CYP450 1A2 inhibitor fluvoxamine (100 mg orally twice daily for 3 days) resulted in a 70-fold increase in ramelteon peak plasma concentration (Cmax) and a 190-fold increase in systemic exposure (AUC) compared to administration of ramelteon alone. However, fluvoxamine is known to also inhibit CYP450 2C9 and 3A4, both of which contribute significantly to the metabolism of ramelteon. Concomitant administration of ramelteon with less potent CYP450 1A2 inhibitors has not been evaluated.

MANAGEMENT: Caution is advised when ramelteon is used with CYP450 1A2 inhibitors. A reduction in the ramelteon dosage may be necessary in patients who experience excessive sedation or other adverse effects.

References (1)
  1. (2005) "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America
Minor

ibuprofen famotidine

Applies to: famotidine / ibuprofen and famotidine / ibuprofen

H2 antagonists may alter the pharmacokinetic disposition of some nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in increased or decreased plasma concentrations. Data have been varied, even for the same NSAID. The mechanism may involve inhibition of metabolism, changes in gastric pH resulting in altered absorption, and/or reduced urinary elimination of the affected NSAIDs. Statistically significant changes have been small and of limited clinical significance when interactions have been observed.

References (5)
  1. Said SA, Foda AM (1989) "Influence of cimetidine on the pharmacokinetics of piroxicam in rat and man." Arzneimittelforschung, 39, p. 790-2
  2. Scavone JM, Greenblatt DJ, Matlis R, Harmatz JS (1986) "Interaction of oxaprozin with acetaminophen, cimetidine, and ranitidine." Eur J Clin Pharmacol, 31, p. 371-4
  3. (2001) "Product Information. Daypro (oxaprozin)." Searle
  4. "Product Information. DurAct (bromfenac)." Wyeth-Ayerst Laboratories
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics."

Drug and food interactions

Moderate

ramelteon food

Applies to: ramelteon

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of ramelteon. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

ADJUST DOSING INTERVAL: Administration of ramelteon with or immediately after a high-fat/heavy meal may delay the onset of hypnotic effects. In study subjects, administration of a 16 mg dose of ramelteon with a high-fat meal decreased the peak plasma drug concentration (Cmax) by 22% and delayed the median time to reach peak plasma drug concentration (Tmax) by approximately 45 minutes compared to administration in a fasted state.

MANAGEMENT: Patients receiving ramelteon should be advised to avoid the consumption of alcohol. For faster sleep onset, ramelteon should not be administered with or immediately after a high-fat/heavy meal.

References (1)
  1. (2005) "Product Information. Rozerem (ramelteon)." Takeda Pharmaceuticals America
Moderate

ibuprofen food

Applies to: famotidine / 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)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
Minor

famotidine food

Applies to: famotidine / ibuprofen

H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.

References (1)
  1. Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM (1990) "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol, 38, p. 165-9

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.

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