Drug Interaction Report

MONITOR: Ticlopidine has been reported to potentiate the effect of nonsteroidal anti-inflammatory agents (NSAIDs) on platelet aggregation. The risk of bleeding may be increased, especially in patients with a history of gastrointestinal (GI) ulceration or bleeding. The safety of concomitant use has not been established.

MANAGEMENT: Patients should be monitored for signs and symptoms of bleeding, especially GI bleeding, if NSAIDs and ticlopidine are coadministered. They should be advised to promptly report any signs of bleeding to their physician, including abdominal pain, vomiting blood, red or black stools, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, nosebleeds, bleeding of gums from brushing, red or brown urine, or other unusual bleeding or bruising. Patients should also be counseled to avoid any other over-the-counter NSAID products.

ADJUST DOSING INTERVAL: The bioavailability and gastrointestinal tolerance of ticlopidine is enhanced by food.

MANAGEMENT: Patients may be advised to take ticlopidine with meals.

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.

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.