Drug Interaction Report

Using ibuprofen together with naproxen is generally not recommended. Combining these medications may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Talk to your doctor before using aspirin together with ibuprofen. Frequent or regular use of ibuprofen may reduce the effectiveness of aspirin if you are taking it to prevent heart attacks or strokes. In addition, combining these medications may increase your risk of developing gastrointestinal ulcers and bleeding. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor immediately if you develop severe abdominal pain, bloating, sudden dizziness or lightheadedness, nausea, vomiting (especially with blood), loss of appetite, and/or black, tarry stools. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Before using ibuprofen, tell your doctor if you also use clopidogrel. This combination may cause unusual bleeding, severe abdominal pain, weakness, and the appearance of black, tarry stools. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. You should also avoid any other over-the-counter NSAID products. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Before using naproxen, tell your doctor if you also use clopidogrel. This combination may cause unusual bleeding, severe abdominal pain, weakness, and the appearance of black, tarry stools. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. You should also avoid any other over-the-counter NSAID products. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Talk to your doctor before using atorvastatin and clopidogrel. This combination may reduce the effects of clopidogrel. Call your doctor promptly if you have any signs of blood clots such as chest pain, shortness of breath, sudden loss of vision, or pain, redness or swelling in an extremity. You may need a dose adjustment or special test if you take both medications. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor.

Using calcium carbonate together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and calcium carbonate by at least 4 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Before using aspirin, tell your doctor if you also use clopidogrel. This combination may cause unusual bleeding, severe abdominal pain, weakness, and the appearance of black, tarry stools. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment if you take both medications. You should also avoid any other over-the-counter NSAID products. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Before taking aspirin, tell your doctor if you also use lisinopril. You may need dose adjustments or special tests in order to safely take both medications together. If you are receiving therapy with this combination you should check your blood pressure and may need your kidney function monitored. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using your medications without first talking to your doctor.

Using calcium carbonate together with aspirin may decrease the effects of aspirin. Contact your doctor if your condition changes. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Using metoprolol together with calcium carbonate may decrease the effects of metoprolol. Separate the administration times of metoprolol and calcium carbonate by at least 2 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Talk to your doctor before using lisinopril together with naproxen. Combining these medications may reduce the effects of lisinopril in lowering blood pressure. In addition, these medications may affect your kidney function, especially when they are used together frequently or chronically. You are more likely to develop impaired kidney function during treatment with these medications if you are also using a diuretic ("water pill") or if you are elderly or have preexisting kidney disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience signs and symptoms that may suggest kidney damage such as nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Talk to your doctor before using aspirin together with naproxen. Frequent or regular use of naproxen may reduce the effectiveness of aspirin if you are taking it to prevent heart attacks or strokes. In addition, combining these medications may increase your risk of developing gastrointestinal ulcers and bleeding. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor immediately if you develop severe abdominal pain, bloating, sudden dizziness or lightheadedness, nausea, vomiting (especially with blood), loss of appetite, and/or black, tarry stools. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

If you use metoprolol for the treatment of high blood pressure, talk to your doctor before using it together with naproxen. Combining these medications may reduce the effects of metoprolol in lowering your blood pressure, especially if you use naproxen frequently or regularly (for example, to treat arthritis or chronic pain). You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Talk to your doctor before using lisinopril together with ibuprofen. Combining these medications may reduce the effects of lisinopril in lowering blood pressure. In addition, these medications may affect your kidney function, especially when they are used together frequently or chronically. You are more likely to develop impaired kidney function during treatment with these medications if you are also using a diuretic ("water pill") or if you are elderly or have preexisting kidney disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience signs and symptoms that may suggest kidney damage such as nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

If you use metoprolol for the treatment of high blood pressure, talk to your doctor before using it together with ibuprofen. Combining these medications may reduce the effects of metoprolol in lowering your blood pressure, especially if you use ibuprofen frequently or regularly (for example, to treat arthritis or chronic pain). You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Information for this minor interaction is available on the professional version.

Information for this minor interaction is available on the professional version.

Information for this minor interaction is available on the professional version.

Information for this minor interaction is available on the professional version.

Food can enhance the levels of metoprolol in your body. You should take metoprolol at the same time each day, preferably with or immediately following meals. This will make it easier for your body to absorb the medication. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking metoprolol. Metoprolol is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

The timing of meals relative to your oral levothyroxine dose can affect the absorption of the medication. Therefore, levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of levothyroxine may be decreased and/or delayed by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, calcium fortified juices and grapefruit or grapefruit juice. These foods should be avoided within several hours of dosing if possible. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Calcium absorption may be increased by taking it with food. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption. Calcium may be taken with food to increase absorption. Consider spacing calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

It is recommended that if you are taking lisinopril you should be advised to avoid moderately high or high potassium dietary intake. This can cause high levels of potassium in your blood. Do not use salt substitutes or potassium supplements while taking lisinopril, unless your doctor has told you to.

Grapefruit juice can increase the blood levels of atorvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. In some cases, rhabdomyolysis can cause kidney damage and even death. You should limit your consumption of grapefruit juice to no more than 1 quart per day during treatment with atorvastatin. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness during treatment, especially if these symptoms are accompanied by fever or dark colored urine. You should also seek immediate medical attention if you develop fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Ask your doctor before using ibuprofen together with ethanol (alcohol). Do not drink alcohol while taking ibuprofen. Alcohol can increase your risk of stomach bleeding caused by ibuprofen. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Ask your doctor before using naproxen together with ethanol (alcohol). Do not drink alcohol while taking naproxen. Alcohol can increase your risk of stomach bleeding caused by naproxen. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Ask your doctor before using aspirin together with ethanol (alcohol). Do not drink alcohol while taking aspirin. Alcohol can increase your risk of stomach bleeding caused by aspirin. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Lisinopril and ethanol (alcohol) may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Using metoprolol together with multivitamin with minerals may decrease the effects of metoprolol. Separate the administration times of metoprolol and multivitamin with minerals by at least 2 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Using multivitamin with minerals together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and multivitamin with minerals by at least 4 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Consumer information for this interaction is not currently available.

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

Information for this minor interaction is available on the professional version.

The recommended maximum number of medicines in the 'non-narcotic analgesics' category to be taken concurrently is usually two. Your list includes three medicines belonging to the 'non-narcotic analgesics' category:

• ibuprofen
• Naproxen Sodium DS (naproxen)
• Aspirin Low Strength (aspirin)

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.

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

• ibuprofen
• Naproxen Sodium DS (naproxen)
• Aspirin Low Strength (aspirin)

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.