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Drug-Drug
Interactions
The following charts are divided into categories with examples of some of the most commonly prescribed drugs for arthritis and related conditions, along with possible interactions between these drugs and others, including the kind you buy without a prescription. Because of the sheer volume of drugs that can be prescribed, all possible drug interactions cannot be listed. So if your drugs are not listed here, don't assume they're free from interactions. Check with your doctor or pharmacist.
Analgesics
| NSAIDs | Corticosteroids
| Fibromyalgia Meds |
DMARDs | Gout Meds | Osteoporosis
Meds
Analgesics
IF
YOU TAKE THESE COMBOS... |
THIS
MIGHT HAPPEN |
| Propoxyphene + carbamazepine |
increased risk of body spasms, convulsions, fast or irregular heartbeat, low or high blood pressure |
| Narcotic analgesics + naltrexone |
no pain relief |
| Analgesics + tricylic antidepressants, such as amitriptyline
(Elavil) or doxepin (Adapin) |
increased risk of side effects of both drugs, including drowsiness and weakness |
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NSAIDs
(Nonsteroidal Anti-Inflammatory Drugs)
IF
YOU MIX NSAIDs WITH... |
THIS
MIGHT HAPPEN |
| Corticosteroids |
increased risk of stomach ulcers |
| Warfarin
(Coumadin) |
increased risk of bleeding |
| Diuretic medications |
increased risk of fluid retention and high blood pressure |
| Antihypertensives |
reduced effectiveness of antihypertensives |
| Lithium |
increased risk of muscle weakness, irregular pulse, slurred speech |
| Methotrexate |
increased risk of liver damage |
| Cyclosporine |
possible kidney toxicity |
|
IF YOU
TAKE THESE COMBOS |
|
| Aspirin and other salicylate-type NSAIDs + probenecid |
decreased effectiveness of probenecid |
| Any two NSAIDs |
increased risk of stomach ulcers |
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Corticosteroids
IF
YOU MIX
CORTICOSTEROIDS WITH... |
THIS
MIGHT HAPPEN |
| Insulin or oral diabetes medications |
decreased effectiveness of diabetes drugs |
| Antacids or growth hormones |
decreased effectiveness of those drugs |
| Antacids, diuretics or seizure medications, such as carbamazepine
(Tegretol), phenytoin (Dilantin) and primidone (Mysoline) |
decreased effectiveness of corticosteroids |
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Fibromyalgia
Meds
IF
YOU MIX TRICYCLIC ANTIDEPRESSANTS WITH... |
THIS
MIGHT HAPPEN |
| Thyroid medications or ulcer medications |
increased risk and frequency of side effects of the thyroid or ulcer medications |
| Monoamine oxidase
(MAO) inhibitors, such as phenelzine sulfate (Nardil) or tranylcypromine sulfate
(Parnate) |
risk of sudden high body temperature, extremely high blood pressure, severe convulsions and death |
|
IF YOU
TAKE SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) WITH... |
THIS
MIGHT HAPPEN |
| The antihistamine astemizole (Hismanal) |
increased risk of a serious heart rhythm abnormality |
| Monoamine oxidase (MAO) inhibitors |
risk of sudden high body temperature, extremely high blood pressure, severe convulsions and death |
|
IF YOU
TAKE THESE COMBOS... |
THIS
MIGHT HAPPEN |
| Amitryptiline
(Elavil) or doxepin (Adapin) + amphetamines, appetite suppressants or asthma or cold medications |
risk of heart damage
|
| Fluoxetine
(Prozac) and sertraline (Zoloft) + other antidepressants |
increased risk of constipation, dizziness, drowsiness, trembling or shaking |
| Zolpidem
(Ambien) + monoamine oxidase (MAO) inhibitors |
risk of sudden high body temperature, extremely high blood pressure, severe convulsions and even death |
| Benzodiazepines + fluvoxamine
(Luvox), itraconazole (Sporanox), ketoconazole (Nizoral) or nefazodone
(Serzone) |
increased risk of dizziness, drowsiness and lightheadedness |
| Zaleplon
(Sonata) + carbamazepine (Tegretol), phenytoin (Dilantin) or primidone
(Mysoline) |
increased effects, including drowsiness |
| Gabapentin
(Neurontin) + antacids |
decreased effectiveness of gabapentin |
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DMARDs
(Disease-Modifying Antirheumatic Drugs)
IF
YOU MIX METHOTREXATE WITH... |
THIS
MIGHT HAPPEN |
| Sulfonamides, such as sulfamethoxazole and phenazopyridine (Azo Gantanol) and sulfamethoxazole and trimethoprim
(Bactrim, Septra) |
increased risk of liver problems, low blood counts or malaise |
| NSAIDs, aspirin or other salicylate medications |
increased levels of methotrexate |
| Penicillin |
increased risk of intestinal toxicity |
| Probenecid |
high levels of methotrexate in the bloodstream |
|
IF YOU
TAKE THESE COMBOS... |
THIS
MIGHT HAPPEN |
| Gold preparations, such as auranofin + penicillamine
(Cuprimine). |
increased risk of such as abdominal pain or upset, headache, sensitivity to sunlight, skin rash |
| Azathioprine
(Imuran) + allopurinol |
increased risk of liver problems, low blood cell counts, malaise |
| Cyclophosphamide
(Cytoxan) + probenecid (Benemid) or sulfinpyrazone (Anturane) |
decreased effectiveness of gout medications |
| Cyclophosphamide +
antithyroid, antifungal or antiviral medications |
decreased effectiveness of those other medications |
| Cyclosporine
(Sandimmune, Neoral) + hormonal medications allopurinol (Zyloprim) or cimetidine
(Tagamet) |
increased risk of high blood pressure, kidney problems, trembling and shaking |
| Cyclosporine + lovastatin
(Mevacor) or simvastatin (Zocor) |
increased risk of muscle and kidney problems |
| Cyclosporine + amiloride
(Midamor) or triamterene |
high blood levels of potassium |
| Sulfasalazine + acetaminophen
(Tylenol), male or female hormones, lovastatin (Mevacor) and pravastatin
(Pravachol) or carbamazepine (Tegretol) |
increased risk of liver damage |
| Sulfasalazine + oral diabetes medications or blood-thinning medications |
increased risk of side effects of those other medications |
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Gout
Meds
IF
YOU TAKE THESE COMBOS... |
THIS
MIGHT HAPPEN |
| Allopurinol (Zyloprim) + blood-thinning medications |
increased bleeding risk |
| Allopurinol + immunosuppressive drugs, such as azathioprine
(Imuran) or mercaptopurine (Purinethol) |
greater risk of side effects from the immunosuppressive drug, including serious infection |
| Colchicine + immunosuppressive drugs, such as cyclophosphamide
(Cytoxan), azathioprine (Imuran) or methotrexate |
increased risk of serious infection |
| Probenecid
(Benemid, Probalan) + aspirin or other salicylate medications |
decreased effectiveness of probenecid |
| Probenecid + NSAIDs or blood-thinning drugs |
increased risk of serious side effects from those drugs |
| Sulfinpyrazone
(Anturane) + blood-thinning drugs or other sulfa-containing drugs, such as celecoxib
(Celebrex), sulfasalazine (Azulfidine) or sulfamethoxazole
(Bactrim) |
increased risk of serious side effects from those drugs |
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Osteoporosis
Meds
IF
YOU TAKE THESE COMBOS... |
THIS
MIGHT HAPPEN |
| Alendronate
(Fosamax) + aspirin or aspirin-containing products |
problems (or worsening of problems) with the esophagus, stomach or intestines |
| Estrogen medications + acetaminophen
(Tylenol), antithyroid medications; antimalarial drugs or seizure medications divalproex
(Depakote) and valproic acid (Depakene) |
increased risk of liver damage |
| Estrogen medications + cyclosporine |
increased risk of liver or kidney problems |
| Raloxifene hydrochloride
(Evista) + cholesterol drug cholestyramine (Questran) |
reduced effectiveness of cholestyramine |
| Raloxifene + warfarin
(Coumadin) |
reduced effectivness of warfarin |
| Teriparatide
(Forteo) + blood pressure medication furosemide (Lasix) |
increased calcium levels in blood, potentially causing damage to the heart, kidneys and other internal organs |
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