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Drug Interactions between Lortab ASA and VP-Precip

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

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Interactions between your drugs

Minor

aspirin evening primrose

Applies to: Lortab ASA (aspirin / hydrocodone) and VP-Precip (bilberry / evening primrose / flax)

Theoretically, use of borage or evening primrose oil with anticoagulants or antiplatelet aggregation drugs may increase the risk of bleeding in some patients. In one study, 12 hyperlipidemic males took gamma linolenic acid 240 mg and linolenic acid 2200 mg (both main components of borage and evening primrose oil) daily for 4 months. After 4 months on this supplementation and compared to baseline, platelet aggregation decreased by 50% when platelets were aggregated with adenosine diphosphate (ADP), and by 60% with adrenaline. Also, in the same study platelet thromboxane B2 levels were reduced by 54% as compared to placebo. However, another study suggests platelet aggregation in healthy patients may not be affected by borage oil supplementation. Until further information is available, clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bruising, red or brown urine, or red or black stools.

References

  1. Kathy Wedig, Jeffrey Whitsett "Down the Primrose Path: Petechiae in a Neonate Exposed to Herbal Remedy for Parturition." J Pediatr 10 (2008): 2
  2. Guivernau M, Meza N, Barja P, Roman O "Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production." Prostaglandins Leukot Essent Fatty Acids 51 (1994): 311-6
  3. N. A. Michael Eskin "Borage and evening primrose oil." European Journal of Lipid Science and Technology 110 (2008): 1
  4. Bard JM, Luc G, Jude B, et al. "A therapeutic dosage (3 g/day) of borage oil supplementation has no effect on platelet aggregation in healthy volunteers." Fundam Clin Pharmacol 11 (1997): 143-4
  5. Asadi-Samani M, Bahmani M, Rafieian-Kopaei M "The chemical composition, botanical characteristic and biological activities of Borago officinalis: a review." Asian Pac J Trop Med 7S1 (2014): S22-8
View all 5 references

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Minor

HYDROcodone evening primrose

Applies to: Lortab ASA (aspirin / hydrocodone) and VP-Precip (bilberry / evening primrose / flax)

Some clinicians have suggested that evening primrose and borage oil, both of which contain the omega-6 fatty acid gamma linolenic acid (GLA), may lower the seizure threshold and increase the risk of seizures during co-administration with other epileptogenic agents. However, data regarding the effect of gamma linolenic acid on seizure threshold are conflicting and limited.

References

  1. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  2. Therapeutic Research Faculty "Natural Medicines Comprehensive Database. http://www.naturaldatabase.com" (2008):
  3. N. A. Michael Eskin "Borage and evening primrose oil." European Journal of Lipid Science and Technology 110 (2008): 1
  4. Asadi-Samani M, Bahmani M, Rafieian-Kopaei M "The chemical composition, botanical characteristic and biological activities of Borago officinalis: a review." Asian Pac J Trop Med 7S1 (2014): S22-8
View all 4 references

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Drug and food interactions

Major

HYDROcodone food

Applies to: Lortab ASA (aspirin / hydrocodone)

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. "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc (2013):

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Moderate

aspirin food

Applies to: Lortab ASA (aspirin / hydrocodone)

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. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Minor

aspirin food

Applies to: Lortab ASA (aspirin / hydrocodone)

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 "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 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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