INTERACTIONS INVOLVING NSAIDS INCLUDE ENHANCEMENT OF THE EFFECTS OF ORAL ANTICOAGULANTS (ESPECIALLY BY AZAPROPAZONE AND PHENYLBUTAZONE) AND INCREASED PLASMA CONCENTRATIONS OF LITHIUM, METHOTREXATE, AND CARDIAC GLYCOSIDES. THE RISK OF NEPHROTOXICITY MAY BE INCREASED IF GIVEN WITH ACE INHIBITORS, CICLOSPORIN, TACROLIMUS, OR DIURETICS. EFFECTS ON RENAL FUNCTION MAY LEAD TO REDUCED EXCRETION OF SOME DRUGS. THERE MAY ALSO BE AN INCREASED RISK OF HYPERKALAEMIA WITH ACE INHIBITORS AND POTASSIUM-SPARING DIURETICS. THE ANTIHYPERTENSIVE EFFECTS OF SOME ANTIHYPERTENSIVES INCLUDING ACE INHIBITORS, BETA BLOCKERS, AND DIURETICS MAY BE REDUCED. CONVULSIONS MAY OCCUR DUE TO AN INTERACTION WITH QUINOLONES. NSAIDS MAY ENHANCE THE EFFECTS OF PHENYTOIN AND SULFONYLUREA ANTIDIABETICS.
USE OF MORE THAN ONE NSAID TOGETHER (INCLUDING ASPIRIN) SHOULD BE AVOIDED BECAUSE OF THE INCREASED RISK OF ADVERSE EFFECTS. THE RISK OF GASTROINTESTINAL BLEEDING AND ULCERATION ASSOCIATED WITH NSAIDS IS INCREASED WHEN USED WITH CORTICOSTEROIDS, THE SSRIS, THE ANTIPLATELETS CLOPIDOGREL AND TICLOPIDINE, OR, POSSIBLY, ALCOHOL, BISPHOSPHONATES, OR PENTOXIFYLLINE. THERE MAY BE AN INCREASED RISK OF HAEMATOTOXICITY IF ZIDOVUDINE IS USED WITH NSAIDS. RITONAVIR MAY INCREASE THE PLASMA CONCENTRATIONS OF NSAIDS. LICENSED PRODUCT INFORMATION FOR MIFEPRISTONE ADVISES OF A THEORETICAL RISK THAT PROSTAGLANDIN SYNTHETASE INHIBITION BY NSAIDS OR ASPIRIN MAY ALTER THE EFFICACY OF MIFEPRISTONE. THERE HAVE BEEN OCCASIONAL REPORTS OF INCREASED ADVERSE EFFECTS WHEN NSAIDS WERE GIVEN WITH MISOPROSTOL ALTHOUGH SUCH COMBINATIONS HAVE SOMETIMES BEEN USED TO DECREASE THE GASTROINTESTINAL TOXICITY OF NSAIDS.
PROBENECID DELAYS THE EXCRETION OF KETOPROFEN AND DECREASES ITS EXTENT OF PROTEIN BINDING RESULTING IN INCREASED PLASMA-KETOPROFEN CONCENTRATIONS.