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.

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.