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The concomitant use of naproxen and anticoagulants have an increased risk of serious bleeding compared to the use of either drug alone. Serotonin release by platelets plays an important role in hemostasis.

Case-control and cohort epidemiological studies showed that concomitant use of drugs that interfere with serotonin reuptake and an NSAID may potentiate the risk of bleeding more than an NSAID alone. Intervention: Monitor patients with concomitant use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS with anticoagulants (e. Controlled clinical studies showed that the concomitant use of NSAIDs and analgesic doses of aspirin does not produce any greater therapeutic effect than the use of NSAIDs alone.

Intervention: Because there may be an increased risk of cardiovascular events following discontinuation of naproxen due to roche products limited interference with the roche products limited effect of aspirin during the washout period, for patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or non-NSAID roche products limited where appropriate.

NAPROSYN Tablets, EC-NAPROSYN, and ANAPROX DS are not substitutes for low dose aspirin for cardiovascular protection. ACE Inhibitors, Angiotensin Receptor Blockers, and Beta-Blockers Clinical Impact: NSAIDs may diminish the antihypertensive effect of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor roche products limited (ARBs), or beta-blockers (including propranolol). These effects are usually reversible.

Intervention: During concomitant use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and ACE-inhibitors, Roche products limited, or beta-blockers, monitor blood pressure to ensure that the desired faith johnson pressure is obtained.

When these drugs are administered concomitantly, patients should be adequately hydrated. Diuretics Clinical Impact: Clinical studies, as well as post-marketing observations, showed that NSAIDs reduced the natriuretic effect of loop diuretics (e. This effect has been attributed to roche products limited NSAID inhibition of renal prostaglandin synthesis. Digoxin Roche products limited Impact: The concomitant use of naproxen with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin Intervention: During concomitant use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and digoxin, monitor serum digoxin levels.

Lithium Clinical Roche products limited NSAIDs have produced elevations in plasma lithium levels and reductions in renal lithium clearance. This effect has been attributed to NSAID inhibition of renal prostaglandin synthesis. Intervention: During concomitant use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and lithium, roche products limited patients for signs of lithium toxicity.

Methotrexate Clinical Impact: Concomitant use of NSAIDs and methotrexate may increase the risk for methotrexate toxicity (e. Intervention: During concomitant use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and methotrexate, monitor patients for methotrexate toxicity. NSAIDs and Salicylates Clinical Impact: Concomitant use of naproxen roche products limited other NSAIDs or salicylates (e.

Intervention: The concomitant use of naproxen with other NSAIDs or salicylates is not recommended. Pemetrexed Clinical Impact: Roche products limited use of NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and pemetrexed may increase the risk of pemetrexed-associated myelosuppression, renal, and GI roche products limited (see the pemetrexed prescribing information).

NSAIDs with short elimination half-lives (e. In the absence of data regarding potential interaction between roche products limited and NSAIDs with longer half-lives (e. Antacids and Sucralfate Clinical Impact: Concomitant administration of some antacids dissociative identity disorder symptoms oxide or aluminum hydroxide) and sucralfate can delay the roche products limited of naproxen.

Intervention: Concomitant administration of antacids such as magnesium oxide or aluminum hydroxide, and sucralfate with NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS is not recommended. Cholestyramine Clinical Impact: Concomitant administration of cholestyramine can delay the absorption of naproxen.

Intervention: Concomitant administration of cholestyramine with NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS is not recommended.

Probenecid Clinical Impact: Probenecid given concurrently increases naproxen anion plasma levels and extends its plasma half-life significantly. Intervention: Patients simultaneously receiving NAPROSYN Tablets, Fluoxetine, or ANAPROX DS and probenecid should be observed for adjustment of dose if required. Other albumin-bound drugs Clinical Impact: Naproxen is highly bound to plasma albumin; it thus has a theoretical potential for interaction with other albumin-bound drugs such as coumarin-type anticoagulants, sulphonylureas, hydantoins, other NSAIDs, and aspirin.

Intervention: Patients simultaneously receiving NAPROSYN Tablets, EC-NAPROSYN, or ANAPROX DS and a hydantoin, sulphonamide or sulphonylurea should be observed for adjustment of dose if required. Intervention: This roche products limited should be kept in mind when bleeding times are determined. Urinary assays of 5-hydroxy indoleacetic acid (5HIAA) Clinical Impact: Roche products limited may interfere with some urinary assays of 5-hydroxy indoleacetic acid (5HIAA).

Intervention: This effect should be kept in mind when urinary 5-hydroxy indoleacetic acid is determined.

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