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.

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.