Drug Interaction Report

MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) with potassium salts may increase the risk of hyperkalemia. NSAIDs may produce potassium retention by reducing renal synthesis of prostaglandin E and impairing the renin-angiotensin system.

MANAGEMENT: Closely monitor potassium levels in patients receiving both potassium salts and NSAID therapy, especially those with renal impairment, diabetes, older age, severe or worsening heart failure, dehydration, or concomitant therapy with other agents that increase serum potassium (e.g., beta-blockers, cyclosporine, heparin, tacrolimus, and trimethoprim). Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as nausea, vomiting, weakness, listlessness, tingling of the extremities, paralysis, confusion, weak pulse, and a slow or irregular heartbeat.

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.