Naproxen Sodium + Esomeprazole Magnesium interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

  What to do: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

  1 source

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):

• food

  Moderate

  Absorption

  Food may interfere with the absorption of esomeprazole. The manufacturer reports that the area under the concentration-time curve for esomeprazole following a single 40 mg dose was 33% to 53% lower when administered after food intake as opposed to during fasting conditions.

  What to do: Esomeprazole should be taken at least one hour before meals. When administered to patients receiving continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of esomeprazole is given.

  2 sources

  1. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm 66 (2009): 1438-67

Conditions

Conditions in which Naproxen Sodium + Esomeprazole Magnesium needs care, as documented in this source.

• Asthma

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. A subpopulation of patients with asthma may have aspirin-sensitive asthma which may include chronic rhinosinusitis complicated by nasal polyps, severe potentially fatal bronchospasm, and/or intolerance to aspirin and other NSAIDs. Since cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, therapy with any NSAID should be avoided in patients with this form of aspirin sensitivity. NSAIDs should be used with caution in patients with preexisting asthma (without known aspirin sensitivity), and these patients should be monitored for changes in the signs and symptoms of asthma.

  15 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 15 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Clostridium Infections

  Major

  Published observational studies suggest that proton pump inhibitor (PPI) use may be associated with an increased risk of Clostridium difficile-associated diarrhea (CDAD), especially in hospitalized patients. This diagnosis should be considered for diarrhea that does not improve. It is recommended that patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Close monitoring is recommended in patients with diarrhea and in those taking antibacterial agents as CDAD has been reported with the use of nearly all these agents. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile. C. difficile produces toxins A and B, which contribute to the development of CDAD. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.

  8 sources

  1. "Product Information. PriLOSEC (omeprazole)." Merck & Co., Inc (2022):
  2. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  3. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  4. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Protonix IV (pantoprazole)." Wyeth-Ayerst Laboratories
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):
  7. "Product Information. NexIUM I.V. (esomeprazole)." Astra-Zeneca Pharmaceuticals (2014):
  8. "Product Information. Esomeprazole Strontium (esomeprazole)." Amneal Pharmaceuticals (2014):

• Exanthema

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious skin adverse reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis), which can be fatal. These serious events may occur without warning. Patients should be advised to discontinue the NSAID and seek medical attention promptly at the first sign of skin rash or any other sign of hypersensitivity. NSAIDs are contraindicated in patients with previous serious skin reactions to these drugs.

  16 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Celebrex (celecoxib)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
  16. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):

• Kidney Diseases

  Major

  Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) has resulted in renal papillary necrosis and other renal injury. Renal toxicity has been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion: in such patients, NSAIDs may cause a dose-dependent reduction in prostaglandin synthesis and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk for this reaction include the elderly, those with impaired renal function, dehydration, hypovolemia, heart failure, or liver dysfunction, and those taking diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; discontinuation of NSAID therapy will usually lead to recovery to the pretreatment state. No information is available regarding use NSAIDs in patients with advanced renal disease; the renal effects of NSAIDs may hasten the progression of renal dysfunction in patients with preexisting renal disease. Volume status should be corrected in dehydrated or hypovolemic patients prior to initiating treatment. Renal function should be monitored during therapy in patients with renal or liver dysfunction, heart failure, dehydration, or hypovolemia. NSAIDs should be avoided in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function; if an NSAID is used in such patients, they should be monitored for signs of worsening renal function.

  16 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Celebrex (celecoxib)." Searle (2001):
  16. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Peptic Ulcer

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal. These serious adverse events can develop at any time, with or without warning symptoms. Only 1 in 5 patients who develop a serious upper GI side effect on NSAIDs is symptomatic. NSAIDs should be used with caution in patients with history of peptic ulcer disease and/or GI bleeding, as these patients had a greater than 10-fold increased risk for developing a GI bleed compared to patients without these risk factors. Caution is also advised if NSAIDs are prescribed to patients with other factors that increase risk of GI bleeding, such as: prolonged NSAID therapy; concomitant use of oral corticosteroids, antiplatelet agents (e.g., aspirin), anticoagulants, selective serotonin reuptake inhibitors; alcohol use; smoking; history of gastrointestinal surgery or anastomosis, older age; poor general health status; and advanced liver disease and/or coagulopathy. Particular vigilance is necessary when treating elderly or debilitated patients since most postmarketing reports of fatal GI events occurred in these patients.

  16 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Celebrex (celecoxib)." Searle (2001):
  16. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Thrombosis

  Major

  Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Clinical trials of several cyclooxygenase-2 (COX-2) selective and nonselective NSAIDs of up to 3 years duration have supported this increased risk. It is unclear from available data if the risk for cardiovascular thrombotic events is similar for all NSAIDs. Therapy with NSAIDs should be administered cautiously in patients with a history of cardiovascular or cerebrovascular disease. Patients should be treated with the lowest effective dosage for the shortest duration necessary. Appropriate antiplatelet therapy should be administered to patients requiring cardioprotection; however, there is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious cardiovascular thrombotic events associated with NSAID use, while the risk of serious gastrointestinal events is increased. Physicians and patients should remain alert for the development of adverse cardiovascular events throughout the entire duration of therapy, even without prior cardiovascular symptoms. Patients should be advised to promptly seek medical attention if they experience symptoms of cardiovascular thrombotic events (including chest pain, shortness of breath, weakness, or slurring of speech).NSAIDs are contraindicated in the setting of coronary artery bypass graft (CABG) surgery. Two large clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10 to 14 days following CABG surgery found an increased incidence of myocardial infarction and stroke.The use of NSAIDs should be avoided in patients with a recent myocardial infarction unless the benefits are expected to outweigh the risk of recurrent cardiovascular thrombotic events. If an NSAID is used in patients with a recent myocardial infarction, they should be monitored for signs of cardiac ischemia.

  8 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  5. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Celebrex (celecoxib)." Searle (2001):
  7. "Product Information. Ponstel (mefenamic acid)." Pfizer U.S. Pharmaceuticals Group (2006):
  8. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):

• Water-Electrolyte Imbalance

  Major

  Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

  14 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Anaprox (naproxen)." Roche Laboratories (2006):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 14 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle (2001):
  14. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Anemia

  Moderate

  Anemia has been reported in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). This may be due to fluid retention, occult/gross blood loss, or an incompletely described effect on erythropoiesis. Hemoglobin or hematocrit should be monitored in patients with any signs/symptoms of anemia or blood loss, especially during long-term therapy. NSAIDs may increase risk of bleeding events; comorbid conditions (e.g., coagulation disorders; concomitant use of warfarin/other anticoagulants, antiplatelet agents, serotonin/serotonin norepinephrine reuptake inhibitors) may increase this risk, and patients with these conditions should be monitored for signs of bleeding. Therapy with NSAIDs should be administered cautiously in patients with or predisposed to anemia. Clinical monitoring of hematopoietic function may be appropriate, particularly during chronic therapy.

  17 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Blood Platelet Disorders

  Moderate

  Nonsteroidal anti-inflammatory drugs (NSAIDs) reversibly inhibit platelet adhesion and aggregation and may prolong bleeding time in some patients. With the exception of aspirin, the platelet effects seen with most NSAIDs at usual recommended dosages are generally slight and of relatively short duration but may be more pronounced in patients with underlying hemostatic abnormalities. Thrombocytopenia has also been reported rarely during NSAID use. Therapy with NSAIDs should be administered cautiously in patients with significant active bleeding or a hemorrhagic diathesis, including hemostatic and/or coagulation defects associated with hemophilia, vitamin K deficiency, hypoprothrombinemia, thrombocytopenia, thrombocytopathy, or severe hepatic impairment. NSAIDs that selectively inhibit cyclooxygenase-2 (i.e., COX-2 inhibitors) do not appear to affect platelet function or bleeding time at indicated dosages and may be preferable if risk of bleeding is a concern.

  16 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  6. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  7. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):
  8. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  11. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  12. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  13. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Daypro (oxaprozin)." Searle (2001):
  15. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):
  16. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):

• Fractures, Bone

  Moderate

  Various published observational studies have reported that PPI therapy may be associated with an increased risk for osteoporosis related fractures of the hip, wrist or spine. The risk was increased in patients who received high doses (multiple daily doses), and long term treatment (a year or longer). Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Caution should be used in patients at risk for osteoporosis related fractures and should be managed according to established treatment guidelines.

  6 sources

  1. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  2. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Omeprazole (omeprazole)." Mylan Pharmaceuticals Inc (2003):
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):

• Heart Failure

  Moderate

  Anaprox and Anaprox DS (brands of naproxen sodium) contain 25 mg and 50 mg of sodium per tablet (approximately 1 mEq/250 mg naproxen), respectively, and Naprosyn suspension contains 39 mg per teaspoonful (approximately 1.5 mEq/125 mg naproxen). The sodium content should be considered when these products are used in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

  2 sources

  1. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  2. "Product Information. Anaprox (naproxen)." Roche Laboratories (2006):

• Heart Failure

  Moderate

  Fluid retention and edema have been observed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs), including some topical formulations. These drugs should be avoided in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. If an NSAID is used in patients with severe heart failure, they should be monitored for signs of worsening heart failure.

  12 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):

• Hyperkalemia

  Moderate

  Increases in serum potassium concentration (including hyperkalemia) have been reported with use of nonsteroidal anti-inflammatory drugs (NSAIDs), even in some patients without renal impairment. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. Caution is advised in patients with hyperkalemia.

  3 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  3. "Product Information. Celebrex (celecoxib)." Searle (2001):

• Hypertension

  Moderate

  Nonsteroidal anti-inflammatory drugs (NSAIDs), including topicals, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. NSAIDs should be used with caution in patients with hypertension. Blood pressure should be monitored closely during the initiation of NSAID therapy and throughout the course of therapy.

  12 sources

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):

  Show all 12 sourcesShow fewer sources

  9. "Product Information. Daypro (oxaprozin)." Searle (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):

• Hypomagnesemia 1, Intestinal

  Moderate

  Symptomatic and asymptomatic hypomagnesemia has been reported rarely in patients treated with PPIs for at least 3 months, in most cases after a year of therapy. Serious adverse events can include tetany, seizures, and arrhythmias. Caution should be used in patients prone to magnesium imbalances such as patients taking other medications that can cause hypomagnesemia (e.g., diuretics). Regular monitoring is recommended.

  6 sources

  1. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc (2001):
  2. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Omeprazole (omeprazole)." Mylan Pharmaceuticals Inc (2003):
  6. "Product Information. Kapidex (dexlansoprazole)." Takeda Pharmaceuticals America (2009):

• Liver Diseases

  Moderate

  Borderline elevations of 1 or more liver tests may occur in up to 15% of patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These laboratory abnormalities may progress, remain unchanged, or regress with continuing therapy. Elevations of ALT or AST (at least 3 times the upper limit of normal) have been reported in about 1% of patients in clinical trials. In addition, rare (sometimes fatal) cases of severe hepatotoxicity, including liver necrosis, hepatic failure, jaundice, and fulminant hepatitis have been reported. Therapy with NSAIDs should be administered cautiously in patients with preexisting liver disease. Periodic monitoring of liver function is recommended during prolonged therapy. NSAIDs are also highly protein-bound and some are extensively metabolized by the liver. Metabolic activity and/or plasma protein binding may be altered in patients with hepatic impairment. A dosage reduction may be required in some cases.

  17 sources

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Toradol (ketorolac)." Roche Laboratories (2002):
  6. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc (2002):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals (2001):
  10. "Product Information. Relafen (nabumetone)." SmithKline Beecham (2001):
  11. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals (2001):
  12. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc (2001):
  13. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn (2001):
  14. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Daypro (oxaprozin)." Searle (2001):
  16. "Product Information. Celebrex (celecoxib)." Searle (2001):
  17. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim (2001):

• Liver Diseases

  Moderate

  Esomeprazole is primarily metabolized by the liver. In patients with mild to moderate hepatic impairment (Child Pugh Class A and B), little drug accumulation has been observed following once-daily, multiple-dose administration. No dosage adjustments are necessary in these patients. In severe hepatic impairment (Child Pugh Class C), however, substantial increases in plasma drug concentrations have been demonstrated. The manufacturer recommends a maximum dosage of 20 mg once daily in patients with severe liver disease.

  1 source

  1. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals (2001):

Therapeutic duplication

Drug classes that overlap with Naproxen Sodium + Esomeprazole Magnesium, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Prevpac

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Amoxicillin/clarithromycin/omeprazole

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Voquezna triple pak

• acid suppressant agents

  The recommended maximum number of medicines in the 'acid suppressant agents' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'acid suppressant agents' category.

  Example product in the source data (US market): Aspirin/omeprazole

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Reprexain

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Famotidine/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Consensi

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Synalgos-dc

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Phosphasal

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/pseudoephedrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Orphengesic forte

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Combunox

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Diclofenac/misoprostol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/citric acid/sodium bicarbonate

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Ibuprofen/pseudoephedrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Soma compound with codeine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Stanback

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/methocarbamol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Diphenhydramine/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/carisoprodol

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/butalbital/caffeine/codeine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Micrainin

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Acetaminophen/ibuprofen

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/dextromethorphan/phenylpropanolamine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Ibuprofen/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Seglentis

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Zynrelef

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Percodan

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/omeprazole

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/dipyridamole

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Migraine relief

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/chlorpheniramine/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Aspirin/hydrocodone

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Chlorpheniramine/ibuprofen/phenylephrine

• nonsteroidal anti-inflammatories

  The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category.

  Example product in the source data (US market): Laniroif