Drug Interaction Report

GENERALLY AVOID: Theoretically, the coadministration of nonsteroidal anti-inflammatory drugs (NSAIDs) and thrombin inhibitors may potentiate the risk of bleeding. NSAIDs interfere with platelet adhesion and aggregation and may prolong bleeding time in healthy individuals. While these effects are generally slight and of relatively short duration for most NSAIDs (except aspirin) at recommended dosages, they may be of pronounced clinical significance when combined with the effects of thrombin inhibitors on the clotting cascade. NSAIDs are also known to cause dose-related gastrointestinal bleeding, which may be complicated by anticoagulant therapy. However, little clinical data exist regarding an actual interaction.

MANAGEMENT: Until further data are available, products containing NSAIDs, especially if given chronically or in high dosages, should preferably be avoided in patients receiving thrombin inhibitors. Close clinical and laboratory observation for bleeding complications is recommended if concurrent therapy is necessary.

ADJUST DOSE: In-vivo studies have demonstrated that the absorption of bromfenac is greatly reduced if the drug is taken within three and one-half hours following a high fat meal. The concomitant administration of a high fat meal has led to a 75% reduction in peak plasma concentrations and a 60% reduction in total area under the curve. The mechanism has not been described.

MANAGEMENT: An increased dosage of bromfenac (from 25 to 50 mg) may be needed if a high fat meal is consumed. The clinician may want to warn the patient about subtherapeutic analgesic effects if high fat meals are regularly consumed.