CONCURRENT USE WITH ACE INHIBITORS, CYCLOSPORIN, TACROLIMUS, OR DIURETICS THE RISK OF NEPHROTOXICITY MAY BE INCREASED. THE ACE INHIBITORS AND POTASSIUM-SPARING DIURETICS MAY PRODUCE HYPERKALAEMIA. QUINOLONES MAY PRODUCE CONVULSIONS. NSAIDS MAY ENHANCE THE EFFECTS OF PHENYTOIN AND SULPHONYLUREA. WITH CONCURRENT ADMINISTRATION OF CORTICOSTERIOIDS, ALCOHOL, AND BISPHOSPHONATES OR PENTOXIFYLLINE THERE MAY BE RISK OF G.I. BLEEDING OR ULCERATION.
NSAIDS HAVE BEEN SHOWN TO INTERACT WITH
ANTICOAGULANTS OF THE WARFARIN TYPE, AND INCREASE THEIR EFFECT. NSAIDS, MAY AFFECT RENAL PROSTAGLANDINS AND INCREASE THE TOXICITY OF CERTAIN DRUGS. INGESTION OF NSAIDS MAY INCREASE SERUM CONCENTRATIONS OF DIGOXIN AND METHOTREXATE AND INCREASE CYCLOSPORINE'S NEPHROTOXICITY. NSAIDS DECREASE LITHIUM RENAL CLEARANCE AND INCREASES LITHIUM PLASMA LEVELS.
THERE ARE RARE REPORTS, HOWEVER, FROM MARKETING EXPERIENCES OF CHANGES IN EFFECTS OF INSULIN OR ORAL HYPOGLYCEMIC AGENTS IN THE PRESENCE OF NSAIDS THAT NECESSITATED CHANGES IN THE DOSES OF SUCH AGENTS. BOTH HYPO- AND HYPERGLYCEMIC EFFECTS HAVE BEEN REPORTED. NSAIDS CAN INHIBIT THE ACTIVITY OF DIURETICS. DIMETHYL SULPHOXIDE REDUCES PLASMA CONCENTRATION OF THE ACTIVE METABOLITE OF SULINDEC & CONCOMITANT ADMINISTRATION OF BOTH DRUGS HAS RESULTED IN PERIPHERAL NEUROPATHY. DIFLUNISAL & ASPIRIN ARE REPORTED TO REDUCE THE PLASMA CONC OF THE ACTIVE METABOLITE. UNLIKE OTHER NSAIDS SULINDAC IS REPORTED NOT TO REDUCE THE ANTIHYPERTENSIVE EFFECTS OF THIAZIDE DIURETICS OR OTHER DRUGS BUT CARE SHOULD BE TAKEN EVEN THAN.