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Drug Interactions between Humulin R and Orphengesic

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

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Moderate

aspirin insulin regular

Applies to: Orphengesic (aspirin / caffeine / orphenadrine) and Humulin R (insulin regular)

MONITOR: The hypoglycemic effect of insulin may be potentiated by certain drugs, including ACE inhibitors, angiotensin receptor blockers (ARBs), 4-aminoquinolines, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs, including linezolid), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinidine, quinine, and ginseng. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, ARBs, fibrates, ginseng); stimulating insulin secretion (salicylates, disopyramide, pentoxifylline, propoxyphene, quinidine, quinine, MAOIs, ginseng); decreasing insulin clearance and resistance (4-aminoquinolines); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor); slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin analogs). Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or insulin secretagogues. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin, particularly in patients with advanced age and/or renal impairment. The insulin dosage may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their physician if it occurs. Patients should be observed for loss of glycemic control when these drugs are withdrawn.

References

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  2. Salmela PI, Sotaniemi EA, Viikari J, et al. (1981) "Fenfluramine therapy in non-insulin-dependent diabetic patients effects on body weight, glucose homeostasis, serum lipoproteins, and antipyrine metabolism." Diabetes Care, 4, p. 535-40
  3. Verdy M, Charbonneau L, Verdy I, Belanger R, Bolte E, Chiasson JL (1983) "Fenfluramine in the treatment of non-insulin-dependent diabetics: hypoglycemic versus anorectic effect." Int J Obes, 7, p. 289-97
  4. Baciewicz AM, Swafford WB Jr (1984) "Hypoglycemia induced by the interaction of chlorpropamide and co-trimoxazole." Drug Intell Clin Pharm, 18, p. 309-10
  5. Richardson T, Foster J, Mawer GE (1986) "Enhancement by sodium salicylate of the blood glucose lowering effect of chlorpropamide-drug interaction or summation of similar effects." Br J Clin Pharmacol, 22, p. 43-8
  6. Johnson J, Dobmeier M (1990) "Symptomatic hypoglycemia secondary to a glipizide-trimethoprim/sulfamethoxazole drug interaction." DICP, 24, p. 250-1
  7. Goldberg IJ, Brown LK, Rayfield EJ (1980) "Disopyramide (norpace)-induced hypoglycemia." Am J Med, 69, p. 463-6
  8. Quevedo SF, Krauss DS, Chazan JA, et al. (1981) "Fasting hypoglycemia secondary to disopyramide therapy." JAMA, 245, p. 2424
  9. Semel JD, Wortham E, Karl DM (1983) "Fasting hypoglycemia associated with disopyramide." Am Heart J, 106, p. 1160-1
  10. Nappi JM, Dhanani S, Lovejoy JR, VanderArk C (1983) "Severe hypoglycemia associated with disopyramide." West J Med, 138, p. 95-7
  11. Rubin M, Zakheim B, Pitchumoni C (1983) "Disopyramide-induced profound hypoglycemia." N Y State J Med, July,Aug,S, p. 1057-8
  12. Croxson MS, Shaw DW, Henley PG, Gabriel HDLL (1987) "Disopyramide-induced hypoglycaemia and increased serum insulin." N Z Med J, July, p. 407-8
  13. Giugliano D, Ceriello A, Saccomanno F, et al. (1985) "Effects of salicylate, tolbutamide, and prostaglandin E2 on insulin responses to glucose in noninsulin-dependent diabetes mellitus." J Clin Endocrinol Metab, 61, p. 160-6
  14. Wiederholt IC, Genco M, Foley JM (1967) "Recurrent episodes of hypoglycemia induced by propoxyphene." Neurology, 17, p. 703-6
  15. Barbato M (1984) "Another problem with Kinidin." Med J Aust, 141, p. 685
  16. Arauz-Pacheco C, Ramirez LC, Rios JM, Raskin P (1990) "Hypoglycemia induced by angiotensin-converting enzyme inhibitors in patients with non-insulin-dependent diabetes receiving sulfonylurea therapy." Am J Med, 89, p. 811-3
  17. Murakami K, Nambu S, Koh H, Kobayashi M, Shigeta Y (1984) "Clofibrate enhances the affinity of insulin receptors in non-insulin dependent diabetes mellitus." Br J Clin Pharmacol, 17, p. 89-91
  18. Daubresse JC, Daigneux D, Bruwier M, Luyckx A, Lefebvre PJ (1979) "Clofibrate and diabetes control in patients treated with oral hypoglycaemic agents." Br J Clin Pharmacol, 7, p. 599-603
  19. Whitcroft IA, Thomas JM, Rawsthorne A, et al. (1990) "Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics." Horm Metab Res Suppl, 22, p. 42-6
  20. Ahmad S (1991) "Gemfibrozil: interaction with glyburide." South Med J, 84, p. 102
  21. Konttinen A, Kuisma I, Ralli R, Pohjola S, Ojala K (1979) "The effect of gemfibrozil on serum lipids in diabetic patients." Ann Clin Res, 11, p. 240-5
  22. de Salcedo I, Gorringe AL, Silva JL, Santos JA (1976) "Gemfibrozil in a group of diabetics." Proc R Soc Med, 69, p. 64-70
  23. Phillips RE, Looareesuwan S, White NJ, et al. (1986) "Hypoglycaemia and antimalarial drugs: quinidine and release of insulin." Br Med J, 292, p. 1319-21
  24. Davis TM, Karbwang J, Looareesuwan S, et al. (1990) "Comparative effects of quinine and quinidine on glucose metabolism in healthy volunteers." Br J Clin Pharmacol, 30, p. 397-403
  25. Wu B, Sato T, Kiyosue T, Arita M (1992) "Blockade of 2,4-dinitrophenol induced ATP sensitive potassium current in guinea pig ventricular myocytes by class I antiarrhythmic drugs." Cardiovasc Res, 26, p. 1095-101
  26. Nakabayashi H, Ito T, Igawa T, Hiraiwa Y, Imamura T, Seta T, Kawato M, Usukura N, Takeda R (1989) "Disopyramide induces insulin secretion and plasma glucose diminution: studies using the in situ canine pancreas." Metabolism, 38, p. 179-83
  27. Strathman I, Schubert EN, Cohen A, Nitzberg DM (1983) "Hypoglycemia in patients receiving disopyramide phosphate." Drug Intell Clin Pharm, 17, p. 635-8
  28. Cacoub P, Deray G, Baumelou A, Grimaldi A, Soubrie C, Jacobs C (1989) "Disopyramide-induced hypoglycemia: case report and review of the literature." Fundam Clin Pharmacol, 3, p. 527-35
  29. Asplund K, Wiholm BE, Lithner F (1983) "Glibenclamide-associated hypoglycaemia: a report on 57 cases." Diabetologia, 24, p. 412-7
  30. Slade IH, and Iosefa RN (1967) "Fatal hypoglycemic coma from the use of tolbutamide in elderly patients: report of two cases." J Am Geriatr Soc, 15, p. 948-50
  31. Cattaneo AG, Caviezel F, Pozza G (1990) "Pharmacological interaction between tolbutamide and acetylsalicylic acid: study on insulin secretion in man." Int J Clin Pharmacol Ther Toxicol, 28, p. 229-34
  32. Christensen LK, Hansen JM, Kristensen M (1963) "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Lancet, 2, p. 1298-301
  33. Turtle JR, Burgess JA (1973) "Hypoglycemic action of fenfluramine in diabetes mellitus." Diabetes, 22, p. 858-67
  34. Ferriere M, Lachkar H, Richard JL, Bringer J, Orsetti A, Mirouze J (1985) "Captopril and insulin sensitivity." Ann Intern Med, 102, p. 134-5
  35. Johnson JA, Kappel JE, Sharif MN (1993) "Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient." Ann Pharmacother, 27, p. 304-6
  36. Almirall J, Montoliu J, Torras A, Revert L (1989) "Propoxyphene-induced hypoglycemia in a patient with chronic renal failure." Nephron, 53, p. 273-5
  37. Hayashi S, Horie M, Tsuura Y, Ishida H, Okada Y, Seino Y, Sasayama S (1993) "Disopyramide blocks pancreatic ATP-sensitive K+ channels and enhances insulin release." Am J Physiol, 265, c337-42
  38. Phillips AF, Matty PJ, Porte PJ, Raye JR (1984) "Inhibition of glucose-induced insulin secretion by indomethacin and sodium salicylate in the fetal lamb." Am J Obstet Gynecol, 148, p. 481-7
  39. Baron SH (1982) "Salicylates as hypoglycemic agents." Diabetes Care, 5, p. 64-71
  40. Prince RL, Larkins RG, Alford FP (1981) "The effect of acetylsalicylic acid on plasma glucose and the response of glucose regulatory hormones to intravenous glucose and arginine in insulin treated diabetics and normal subjects." Metabolism, 30, p. 293-8
  41. Ferrari C, Fressati S, Romussi M, et al. (1977) "Effects of short-term clofibrate administration on glucose tolerance and insulin secretion in patients with chemical diabetes or hypertriglyceridemia." Metabolism, 26, p. 129-39
  42. Storlien LH, Thorburn AW, Smythe GA, Jenkins AB, Chisholm DJ, Kraegen EW (1989) "Effect of d-fenfluramine on basal glucose turnover and fat-feeding-induced insulin resistance in rats." Diabetes, 38, p. 499-503
  43. Pestell RG, Crock PA, Ward GM, Alford FP, Best JD (1989) "Fenfluramine increases insulin action in patients with NIDDM." Diabetes Care, 12, p. 252-8
  44. Harrison LC, King-Roach A, Martin FI, Melick RA (1975) "The effect of fenfluramine on insulin binding and on basal and insulin-stimulated oxidation of 1-C-glucose by human adipose tissue." Postgrad Med J, 51 Suppl 1, p. 110-4
  45. Feldman JM, Chapman B (1975) "Monoamine oxidase inhibitors: nature of their interaction with rabbit pancreatic islets to alter insulin secretion." Diabetologia, 11, p. 487-94
  46. Aleyassine H, Gardiner RJ (1975) "Dual action of antidepressant drugs (MAO inhibitors) on insulin release." Endocrinology, 96, p. 702-10
  47. Aleyassine H, Lee SH (1972) "Inhibition of insulin release by substrates and inhibitors of monoamine oxidase." Am J Physiol, 222, p. 565-9
  48. Cooper AJ, Ashcroft G (1966) "Potentiation of insulin hypoglycaemia by M.A.O.I. antidepressant drugs." Lancet, 1, p. 407-9
  49. Herings RMC, Deboer A, Stricker BHC, Leufkens HGM, Porsius A (1995) "Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme." Lancet, 345, p. 1195-8
  50. Ahmad S (1995) "Drug interaction induces hypoglycemia." J Fam Pract, 40, p. 540-1
  51. Feher MD, Amiel S (1995) "ACE inhibitors and hypoglycaemia." Lancet, 346, p. 125-6
  52. Paolisso G, Balbi V, Gambardella A, Varricchio G, Tortoriello R, Saccomanno F, Amato L, Varricchio M (1995) "Lisinopril administration improves insulin action in aged patients with hypertension." J Hum Hypertens, 9, p. 541-6
  53. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  54. Kubacka RT, Antla EJ, Juhl RP, Welshman IR (1996) "Effects of aspirin and ibuprofen on the pharmacokinetics and pharmacodynamics of glyburide in healthy subjects." Ann Pharmacother, 30, p. 20-6
  55. Deeg MA, Lipkin EW (1996) "Hypoglycemia associated with the use of fluoxetine." West J Med, 164, p. 262-3
  56. Hellman B (1974) "Potentiating effects of drugs on the binding of glibenclamide to pancreatic beta cells." Metabolism, 23, p. 839-46
  57. Hekimsoy Z, Biberoglu S, Comlekci A, Tarhan O, Mermut C, Biberoglu K (1997) "Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection." Eur J Endocrinol, 136, p. 3046
  58. Iida H, Morita T, Suzuki E, Iwasawa K, Toyooka T, Nakajima T (1999) "Hypoglycemia induced by interaction between clarithromycin and disopyramide." Jpn Heart J, 40, p. 91-6
  59. Morris AD, Newton RW, Boyle DI, et al. (1997) "ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes." Diabetes Care, 20, p. 1363-7
  60. Abad S, Moachon L, Blanche P, Bavoux F, Sicard D, Salmon-Ceron D (2001) "Possible interaction between glicazide, fluconazole and sulfamethoxazole resulting in severe hypoglycaemia." Br J Clin Pharmacol, 52, p. 456-7
  61. (2002) "Product Information. Humalog (insulin lispro)." Lilly, Eli and Company
  62. (2002) "Product Information. Humulin 70/30 (insulin isophane-insulin regular)." Lilly, Eli and Company
  63. Pollak PT, Mukherjee SD, Fraser AD (2001) "Sertraline-induced hypoglycemia." Ann Pharmacother, 35, p. 1371-4
  64. Hundal RS, Petersen KF, Mayerson AB, et al. (2002) "Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes." J Clin Invest, 109, p. 1321-6
  65. (2004) "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals
  66. Fogari R, Zoppi A, Corradi L, Pierangelo L, Mugellini A, Lusardi P (1998) "Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertension." Br J Clin Pharmacol, 46, p. 467-71
  67. Vuorinen-Markkola H, Yki-Jarvinen H (1995) "Antihypertensive therapy with enalapril improves glucose storage and insulin sensitivity in hypertensive patients with non-insulin-dependent diabetes mellitus." Metabolism, 44, p. 85-9
  68. (2005) "Product Information. Increlex (mecasermin)." Tercica Inc
  69. Vuksan V, Sievenpiper JL, Koo VY, et al. (2000) "American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus." Arch Intern Med, 160, p. 1009-13
  70. Vuksan V, Stavro MP, Sievenpiper JL, et al. (2000) "Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes." Diabetes Care, 23, p. 1221-6
  71. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V (2003) "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.) with a depressed ginsenoside profile does not affect postprandial glycemia." Eur J Clin Nutr, 57, p. 243-8
  72. Ben Salem C, Fathallah N, Hmouda H, Bouraoui K (2011) "Drug-induced hypoglycaemia: an update." Drug Saf, 34, p. 21-45
  73. (2014) "Product Information. Afrezza (insulin inhalation, rapid acting)." MannKind Corporation
  74. (2015) "Product Information. Ryzodeg 70/30 FlexTouch (insulin aspart-insulin degludec)." Novo Nordisk Pharmaceuticals Inc
  75. (2015) "Product Information. Tresiba FlexTouch (insulin degludec)." Novo Nordisk Pharmaceuticals Inc
  76. World Health Organization (2020) WHO Public Assessment Reports (WHOPARs) https://extranet.who.int/pqweb/medicines/prequalification-reports/whopars
View all 76 references

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Minor

aspirin caffeine

Applies to: Orphengesic (aspirin / caffeine / orphenadrine) and Orphengesic (aspirin / caffeine / orphenadrine)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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Drug and food interactions

Moderate

orphenadrine food

Applies to: Orphengesic (aspirin / caffeine / orphenadrine)

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

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

insulin regular food

Applies to: Humulin R (insulin regular)

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO (1981) "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand, 656, p. 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. (1983) "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol, 24, p. 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. (1983) "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia, 24, p. 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A (1987) "Interaction of ethanol and glipizide in humans." Diabetes Care, 10, p. 683-6
  5. (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
  6. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM (1981) "The pharmacology of sulfonylureas." Am J Med, 70, p. 361-72
  9. (2002) "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care, 25(Suppl 1), S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 10 references

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Moderate

aspirin food

Applies to: Orphengesic (aspirin / caffeine / orphenadrine)

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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Minor

caffeine food

Applies to: Orphengesic (aspirin / caffeine / orphenadrine)

The effect of grapefruit juice on the pharmacologic activity of caffeine is controversial. One report suggests that grapefruit juice increases the effect of caffeine. The proposed mechanism is inhibition of cytochrome P-450 metabolism of caffeine. However, a well-conducted pharmacokinetic/pharmacodynamic study did not demonstrate this effect. The clinical significance of this potential interaction is unknown.

References

  1. (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
  2. Maish WA, Hampton EM, Whitsett TL, Shepard JD, Lovallo WR (1996) "Influence of grapefruit juice on caffeine pharmacokinetics and pharmacodynamics." Pharmacotherapy, 16, p. 1046-52

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Minor

aspirin food

Applies to: Orphengesic (aspirin / caffeine / orphenadrine)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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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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