Drug Interaction Report

MONITOR: Nonsteroidal anti-inflammatory drugs may be absorbed systemically following topical administration. Concomitant use with systemic nonsteroidal anti-inflammatory drugs may result in increased adverse effects such as gastrointestinal toxicity (inflammation, bleeding, ulceration, perforation), cardiovascular thrombotic events, hepatotoxicity (liver enzyme elevations), renal toxicity, fluid retention, edema, hypertension, and inhibition of platelet aggregation.

MANAGEMENT: Patients treated with topical preparations of nonsteroidal anti-inflammatory drugs should avoid or limit the use of systemic nonsteroidal anti-inflammatory drugs. Although systemic exposure is generally low following topical administration, absorption may be increased with frequent applications; use of large quantities or over large areas of skin; use on compromised or diseased skin or open wounds; and use of occlusive dressings or heating pads over application areas.

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.