Drug interactions of NSAIDs

drug to drug interactions involving NSAIDs

Drug AffectedNSAID ImplicatedEffect
WarfarinNSAIDs that inhibit COX-1Inhibits metabolism of warfarin; increases risk of bleeding owing to inhibition of platelet function and gastric mucosal damage
SulfonylureaHigh-dose salicylatePotentiates hypoglycemia
Beta-blockerAll PG-inhibiting NSAIDsBlunts hypotensive but not negative chronotropic or inotropic effect
Angiotensin-converting enzyme inhibitor
All PG-inhibiting NSAIDsAll PG-inhibiting NSAIDsAll PG-inhibiting NSAIDsLoss of hypotensive effectsLoss of hypotensive effectsLoss of hypotensive effects
DiureticsAll PG-inhibiting NSAIDsLoss of natriuretic, diuretic, hypotensive effects of furosemide
Loss of natriuretic effect of spironolactone
Loss of hypotensive but not natriuretic or diuretic effects of thiazide
PhenytoinMost NSAIDsDisplaces phenytoin from plasma protein, reducing total concentration for the same active concentration
LithiumMost NSAIDsIncreases plasma lithium level
DigoxinMost NSAIDsMay increase digoxin levels
AminoglycosidesMost NSAIDsMay increase aminoglycoside level
MethotrexateMost NSAIDsMay increase methotrexate plasma concentration
CholestyramineMost NSAIDsAnion exchange resin binds NSAIDs in gut, ↓absorption
Sodium valproateASAInhibits valproate metabolism, increasing plasma valproate concentration
ProbenecidMost NSAIDsReduces metabolism and renal clearance of NSAIDs

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