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Drug Interactions between hydrocodone / ibuprofen and piroxicam

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

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Interactions between your drugs

Major

ibuprofen piroxicam

Applies to: hydrocodone / ibuprofen and piroxicam

GENERALLY AVOID: The use of piroxicam in combination with another nonsteroidal anti-inflammatory drug (NSAID) may increase the risk of serious and potentially fatal gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, or intestines. These events can occur at any time during NSAID use, with or without warning symptoms, but the incidence may increase with dosage and duration of therapy. Administration of piroxicam at dosages greater than 20 mg per day carries an increased risk of GI side effects, and evidence from observational studies suggests that piroxicam may also be associated with a higher risk of serious GI toxicity relative to other NSAIDs. In clinical trials of several months to two years duration, NSAID-associated upper GI ulcers, gross bleeding, or perforation occurred in approximately 1% of patients treated for 3 to 6 months and in 2% to 4% of patients treated for one year. Patients with a prior history of peptic ulcer disease and/or GI bleeding have a greater than 10-fold increased risk of developing a GI bleed during NSAID use compared to patients without a history. Additional risk factors include advanced age (especially over 70 years), Helicobacter pylori infection, excessive alcohol use, smoking, a history of GI inflammatory conditions, advanced liver disease, coagulopathy, and poor general health status. GI toxicity aside, clinical studies have also failed to demonstrate greater therapeutic benefit from the coadministration of piroxicam with another NSAID than the use of piroxicam alone.

MANAGEMENT: Concomitant use of piroxicam with other NSAIDs, except for low-dose aspirin for cardiovascular prophylaxis, should generally be avoided. Patients treated with a NSAID should be advised to take it with food and to immediately report signs and symptoms of GI ulceration or bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools. The lowest effective dosage should be used for the shortest possible duration. Selective use of prophylactic anti-ulcer therapy (e.g., misoprostol, proton pump inhibitors) may be considered in high-risk patients.

References (4)
  1. (2023) "Product Information. APO Piroxicam (piroxicam)." Apotex Incorporated
  2. (2024) "Product Information. Feldene (piroxicam)." Pfizer Ltd
  3. (2024) "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals Group, SUPPL-53
  4. (2024) "Product Information. moBILis (piroxicam)." Alphapharm Pty Ltd

Drug and food interactions

Major

HYDROcodone food

Applies to: hydrocodone / ibuprofen

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References (1)
  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc
Moderate

ibuprofen food

Applies to: hydrocodone / 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
Moderate

piroxicam food

Applies to: piroxicam

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

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Nonsteroidal anti-inflammatories

Therapeutic duplication

The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category:

  • hydrocodone/ibuprofen
  • piroxicam

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

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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