Nosmen Drug Interactions

Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin II Antagonists (AIIAs): NSAIDs may decrease the antihypertensive of ACEI and/or AIIAs. The co-administration medication may be the risk of nephrotoxicity increased. Consider discontinuation of NOSMEN if patient is uncontrolled blood pressure. Periodically measure renal function during concomitant use.
Azole antifungals (Fluconazole, Ketoconazole): Increase in NOSMEN plasma concentration may occur, increasing the pharmacologic effect and adverse reactions.
Corticosteroid oral (Prednisone): The risk of GI bleeding may be increased. Use corticosteroid oral and NOSMEN with caution.
Antiplatelet therapy (Clopidogrel, Prasugrel): The risk of bleeding may be increased. Use antiplatelet and NOSMEN with caution.
Anticoagulant (Warfarin): Co-administration with NOSMEN may increase the risk of anticoagulant-induced bleeding (eg. GI bleeding). Monitor prothrombin time and International Normalized Ratio (INR) and patients closely, especially the first few days.
Beta-blockers: The antihypertensive effect of beta-blockers with NOSMEN may be impaired, possibly because of NOSMEN as the NSAIDs inhibition of renal prostaglandin synthesis, thereby allowing unopposed pressure systems. Monitor blood pressure and adjust beta-blocker dose as needed to treat.
Cyclosporin and tacrolimus: Co-administration with NOSMEN may increase nephrotoxicity. Monitor renal function frequently and consider avoiding concurrent use.
Diuretics (Thiazides, Potassium-sparing diuretics, Loop diuretics): The effects of diuretics may be decreased, the risk of acute renal failure may be increased when coadministration. Closely monitor renal function if coadministration cannot be avoided. If renal function decreases, consider stopping one or both drugs.
Lithium: Concomitant administration with NOSMEN may increase plasma lithium levels. This interaction should be given consideration in patients taking NOSMEN concomitantly with lithium.
Methotrexate: Concomitant administration with NOSMEN may increase risk of methotrexate toxicity (eg. stomatitis, bone marrow suppression, nephrotoxicity). This interaction should be given low-dose methotrexate in patients taking NOSMEN concomitantly.
Rifampin: Rifampin, a potent CYP3A4 inducer, resulted in a 65% reduction in etoricoxib blood concentrations. The co-administration of etoricoxib and rifampin may require etoricoxib dose increases beyond current recommendations for each indication, and therefore is not recommended.
Oral Contraceptives: Clinical studies showed that concomitant use of ethinyl estradiol (EE)/norethindrone, an oral contraceptive, and etoricoxib, a COX-2 inhibitor, increased the steady-state AUC _{(0 to 24 hours)} of ethinyl estradiol between 37% and 60%, depending on the etoricoxib dosage. Consider the increased risk for adverse effects (e.g. venous thromboembolic events) with higher ethinyl estradiol exposure in at-risk patients when selecting an oral contraceptive to be used concurrently with etoricoxib.
Hormone Replacement Therapy: Clinical studies showed that concomitant use of conjugated estrogens and etoricoxib 120 mg/day increased the mean steady-state AUC of several estrogenic components. While the clinical significance of these AUC increases is unknown, consider the increased risk of adverse effects associated with higher exposures to conjugated estrogens with hormone replacement therapy during postmenopausal hormone therapy selection.
Digoxin: Co-administration of digoxin and NSAIDs may increase digoxin plasma concentrations and prolong the half-life of digoxin. If concurrent use is required, monitoring of serum digoxin levels is recommended.