Interactions : אינטראקציות

4.5   Interaction with other medicinal products and other forms of interaction
Ibuprofen (like other NSAIDs) should be avoided in combination with: Acetylsalicylic Acid (Aspirin): Unless low-dose Acetylsalicylic Acid (aspirin) (not above 75mg daily) has been advised by a doctor, as this may increase the risk of adverse reactions (see section 4.4).

Experimental data suggest that ibuprofen may inhibit the effect of low dose Acetylsalicylic Acid (aspirin) on platelet aggregation when they are dosed concomitantly. However, the limitations of these data and the uncertainties regarding extrapolation of ex vivo data to the clinical situation imply that no firm conclusions can be made for regular ibuprofen use, and no clinically relevant effect is considered to be likely for occasional ibuprofen use (see section 5.1).

Other NSAIDs including cyclooxygenase-2 selective inhibitors: Avoid concomitant use of two or more NSAIDs as this may increase the risk of adverse effects (see section 4.4.).

Ibuprofen should be used with caution in combination with:
Anticoagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin (see section 4.4).

Antihypertensives and diuretics: NSAIDS and pseudoephedrine may diminish the effects of these drugs. Diuretics can increase the risk of nephrotoxicity of NSAIDs.

Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding (see section 4.4).
Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs): increased risk of gastrointestinal bleeding (see section 4.4).

Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.

Sympathomimetics     such    as   pseudoephedrine     may    increase   risk      of dysrhythmias.

Lithium: There is evidence for potential increases in plasma levels of lithium.

Methotrexate: There is a potential for an increase in plasma methotrexate.
Ciclosporin: Increased risk of nephrotoxicity.

Mifepristone: NSAIDs should not be used for 8-12 days after mifepristone administration as NSAIDs can reduce the effects of mifepristone.

Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus.

Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is evidence of an increased risk of haemarthroses and haematoma in HIV(+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen.

Quinolone antibiotics: animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of developing convulsions.

Monoamine oxidase inhibitors (MAOIs) and/or Reversible inhibitors of monoamine oxidase A (RIMAs): should not be given to patients receiving MAOI therapy or within 14 days of stopping treatment: increased risk of hypertensive crisis.

Ergot alkaloids (ergotamine & methysergide): increased risk of ergotism.

Other sympathomimetic agents such as decongestants, amphetamine-like psychostimulants and appetite suppressants: pseudoephedrine may potentiate their effects. Risk of hypertension (see section 4.3) Oxytocin: risk of hypertension.

Anticholinergics: the effect of pseudoephedrine may be diminished/enhanced by tricyclic antidepressants.

Guanethidine, reserpine and methyldopa: the effect of pseudoephedrine may be diminished.

Moclobemide: risk of hypertensive crisis