NSAID + corticosteroid dramatically increases risk of GI ulceration and perforation
Management: AVOID concurrent use. Allow 3-5 day washout between drugs. If overlap unavoidable, add GI protectant (omeprazole + sucralfate).
Corticosteroid + NSAID: dramatically increased risk of GI ulceration and perforation
Management: AVOID concurrent use. Allow 3-5 day washout between drugs.
NSAIDs reduce renal clearance of methotrexate, increasing methotrexate toxicity risk
Management: Avoid NSAIDs during methotrexate therapy. If pain management needed, use opioids.
Toceranib has anti-VEGF activity causing GI mucosal damage; NSAIDs compound GI ulceration risk
Management: Avoid concurrent NSAIDs. If anti-inflammatory needed, use low-dose prednisolone with GI protectants.
Gentamicin (Systemic)
majorNSAID reduces renal prostaglandin-mediated blood flow + aminoglycoside direct nephrotoxicity: synergistic renal injury.
Management: Avoid combining. If both needed, ensure aggressive IV fluid therapy and monitor renal function q24h.
NSAID reduces renal prostaglandin-mediated blood flow + cisplatin direct nephrotoxicity: synergistic renal injury.
Management: Avoid NSAIDs during cisplatin cycles. If pain management needed, use opioids.
NSAIDs inhibit platelet function (COX-1 dependent TXA2) and displace warfarin from protein binding, greatly increasing hemorrhage risk.
Management: Avoid concurrent use. If NSAID essential, monitor PT/INR every 2-3 days. Use gastroprotectant. Watch for melena, petechiae.
NSAID prostaglandin inhibition reduces renal blood flow + amphotericin direct tubular toxicity: synergistic nephrotoxicity.
Management: Avoid NSAIDs during amphotericin therapy. Use opioids for pain management.
NSAID + corticosteroid: additive GI mucosal injury from prostaglandin inhibition combined with impaired mucosal healing.
Management: Do not combine. Allow washout before transitioning between drug classes.
Concurrent acetaminophen and NSAID: additive hepatotoxicity risk. Both are hepatically metabolized; NSAID-induced prostaglandin inhibition may reduce hepatic blood flow, concentrating acetaminophen metabolites.
Management: Avoid combining. Use one analgesic class. If combining, use lowest effective doses and monitor hepatic enzymes.
NSAID platelet dysfunction + LMWH anticoagulation: significantly increased bleeding risk.
Management: Avoid if possible. If both needed, monitor for bleeding (petechiae, melena, hematuria). Use gastroprotectant.
Same mechanism as enoxaparin: NSAID platelet dysfunction compounds LMWH anticoagulation, increasing hemorrhage risk.
Management: Avoid if possible. Monitor for bleeding signs.
Triamcinolone Acetonide
majorCorticosteroid + NSAID: additive GI ulceration. Depot triamcinolone injection effects last weeks — cannot be rapidly reversed if GI complications occur.
Management: Avoid. Do not use NSAID within 2-4 weeks of depot triamcinolone injection. Allow steroid to clear before NSAID.
Bismuth Subsalicylate
majorSalicylate component acts as a second NSAID — additive COX inhibition causing GI ulceration and renal injury.
Management: Do not combine bismuth subsalicylate with any NSAID. The salicylate content is clinically significant.
Fludrocortisone has both mineralocorticoid and glucocorticoid activity. NSAID + corticosteroid: GI ulceration risk.
Management: Avoid concurrent NSAIDs with fludrocortisone. Use non-NSAID analgesic.
Both are potentially nephrotoxic. NSAID reduces renal prostaglandin-mediated blood flow + ifosfamide has direct tubular toxicity.
Management: Avoid NSAIDs during ifosfamide cycles. Use opioids for pain management.