Potent CYP2C9 inhibitors: Caution is recommended when co-prescribing diclofenac with potent CYP2C9 inhibitors (such as sulfinpyrazone and voriconazole), which could result in a significant increase in peak plasma concentration and exposure to diclofenac due to inhibition of diclofenac metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)escitalopram and fluoxetine both increase serotonin levels. Minor/Significance Unknown. Modify Therapy/Monitor Closely. Minor (1)aspirin rectal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. UW Medicine Anesthesiology and Pain Medicine. Use Caution/Monitor. Use Caution/Monitor. Voltaren will come with a dosing card that you can use to measure the correct dose of the gel. Modify Therapy/Monitor Closely.fluoxetine and alfuzosin both increase QTc interval. rilpivirine increases toxicity of fluoxetine by QTc interval. Use Caution/Monitor. The formation of 4'-hydroxy diclofenac is primarily mediated by CYP2C9. Modify Therapy/Monitor Closely. Hepatic impairment: netupitant/palonosetron, fluoxetine. Bullous eruptions, eczema, erythema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), dermatitis exfoliative, loss of hair, photosensitivity reaction, purpura , allergic purpura, pruritus. Monitor Closely (1)fluoxetine and L-tryptophan both increase serotonin levels. There are no standard dosing guidelines for flaxseed oil. Relief of all grades of pain and inflammation in a wide range of conditions, including: (i) arthritic conditions: rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout. Other (see comment). For pregnant women: Before 30 weeks of pregnancy, this drug is a pregnancy category C drug. You should always consult your doctor or other healthcare professional before taking any medication. SSRIs inhib. flurbiprofen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Either increases toxicity of the other by pharmacodynamic synergism. fluoxetine will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Examples of these drugs include: If you take lithium with diclofenac, it may increase the lithium in your body to harmful levels. Avoid with drugs known to prolong QT interval. SSRIs inhib. Use Caution/Monitor. (2016). It allows continued monitoring of the benefit/risk balance of the medicinal product. Use Caution/Monitor. It should be used for the shortest possible time to treat the problem. This can be a sign of serious liver problems that could lead to the need for a liver transplant or even be fatal if not treated. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of fluoxetine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Minor (1)aceclofenac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Monitor Closely (2)fluoxetine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Use Caution/Monitor. For instance, some can interfere with how well a drug works, while others can cause increased side effects. PENNSAID should be applied without massaging the knee (See Figures C and D). Use Caution/Monitor. Use Caution/Monitor. fluoxetine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Use Caution/Monitor. Do not take more than 4000 mg in 24 hours. Monitor Closely (1)fluoxetine and risperidone both increase QTc interval. Minor/Significance Unknown. Do not start taking new medicine without talking to your health care provider first. Increased risk of upper GI bleeding. fluoxetine and glasdegib both increase QTc interval. Use Caution/Monitor. Avoid or Use Alternate Drug. Monitor Closely (1)fluoxetine and isoniazid both increase serotonin levels. acyclovir will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors. defibrotide increases effects of fluoxetine by Other (see comment). Use Caution/Monitor. fluoxetine and levalbuterol both increase QTc interval. Use Caution/Monitor. (diclofenac sodium topical solution) 2%. acyclovir and streptomycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. serotonin uptake by platelets. 2015;29(3):151-7. doi:10.1097/HNP.0000000000000085. Voltaren can also cause you to have higher levels of a type of white blood cell (WBC) called eosinophils. Monitor Closely (1)fluoxetine and trimethoprim both increase QTc interval. Contraindicated. Contraindicated. crizotinib and fluoxetine both increase QTc interval. Respiratory, thoracic and mediastinal disorders. What Are My Options for Arthritis Treatment? Mechanism: pharmacodynamic synergism. green tea, fluoxetine. fluoxetine increases effects of rivaroxaban by pharmacodynamic synergism. Monitor Closely (1)fluoxetine increases effects of apixaban by anticoagulation. fluoxetine, zolmitriptan. By Lana Barhum fluoxetine, aceclofenac. Adults and teenagers who weigh at least 110 pounds (50 kilograms): Do not take more than 1000 milligrams (mg) at one time. SSRIs inhib. May increase bleeding. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Either increases toxicity of the other by Mechanism: unknown. Modify Therapy/Monitor Closely. Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. Minor (1)sulfasalazine will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Modify Therapy/Monitor Closely. Diclofenac Topical (arthritis pain). Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Minor (1)rose hips will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. For women who are breastfeeding: This drug may pass into the breast milk, which means it may pass to a child who is breastfed. Monitor Closely (1)fluoxetine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. SSRIs inhib. Use Caution/Monitor. Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or the embryo/foetal development. Minor/Significance Unknown. Monitor Closely (1)gemifloxacin and fluoxetine both increase QTc interval. Either increases toxicity of the other by serotonin levels. Serious - Use Alternative (2)gilteritinib will decrease the level or effect of fluoxetine by Other (see comment). Comment: Coadministration of emtricitabine with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of emtricitabine. fluoxetine will increase the level or effect of lofepramine by affecting hepatic enzyme CYP2D6 metabolism. Monitor Closely (1)acyclovir and amikacin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.propafenone will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. To protect your skin, use sunscreen with SPF 30 or greater. Monitor Closely (1)trimipramine and fluoxetine both increase QTc interval. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Minor/Significance Unknown. SSRIs inhib. Both drugs decrease blood glucose. serotonin uptake by platelets. Concomitant use of diclofenac with other NSAIDs or salicylates (e.g., diflunisal, salsalate) increases the risk of GI toxicity, with little or no increase in efficacy [see. fluoxetine and dextroamphetamine both increase serotonin levels. US residents can call their local poison control center at 1-800-222-1222. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and trazodone both increase serotonin levels. Avoid or Use Alternate Drug. Serious - Use Alternative (1)tipranavir will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Either increases toxicity of the other by Other (see comment). serotonin uptake by platelets. serotonin uptake by platelets. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. Do not use Voltaren gel when you're already taking oral NSAIDs or aspirin because it raises your risk of having adverse events. Combinations is contraindicated within 5 weeks of MAOI use. Avoid or Use Alternate Drug. evere CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI).SSRIs work by helping to restore the balance of certain natural substances in the brain (neurotransmitters such as serotonin). Use Caution/Monitor. fluoxetine and nefazodone both increase serotonin levels. Hypersensitivity reactions can also progress to Kounis syndrome, a serious allergic reaction that can result in myocardial infarction. Who can take NSAIDs? Modify Therapy/Monitor Closely. Serious - Use Alternative (1)fluoxetine and dosulepin both increase serotonin levels. Monitor Closely (1)remifentanil, fluoxetine. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin. Use Caution/Monitor. hypertension, hyperlipidaemia, diabetes mellitus, smoking) should only be treated with diclofenac after careful consideration. Monitor Closely (1)fluoxetine and posaconazole both increase QTc interval. No more than 16 gm per day should be used for any single joint of the knee, ankle or foot. fluoxetine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Minor/Significance Unknown. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval. Contraindicated. Minor/Significance Unknown. darifenacin will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Monitor Closely (1)lorcaserin will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.Serious - Use Alternative (1)fluoxetine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Monitor Closely (1)fluoxetine will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. serotonin uptake by platelets. Either increases levels of the other by decreasing renal clearance. Properly discard this product when it is expired or no longer needed. Monitor Closely (1)acyclovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Be sure to avoid doing this when the weather is very hot or very cold. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system. enalapril, diclofenac. Use Caution/Monitor. lemborexant, fluoxetine. Comment: Amifampridine can cause seizures. ketorolac intranasal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. The safety of PENNSAID 2% is based in part, on prior experience with PENNSAID 1.5%. SSRIs inhib. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Fluoxetine can stay in your body for many weeks after your last dose and may interact with many other medications. Symbyax is not approved for use by anyone younger than 10 years old. Contraindicated. serotonin uptake by platelets. Caution is recommended in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as systemic corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors (SSRIs) or anti-platelet agents such as acetylsalicylic acid (see section 4.5). Minor (1)fluoxetine will increase the level or effect of omeprazole by affecting hepatic enzyme CYP2C9/10 metabolism. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Store PENNSAID at room temperature between 68F to 77F (20C to 25C). Colestipol and cholestyramine: These agents can induce a delay or decrease in absorption of diclofenac. Breast, colorectal, and prostate cancer risk in the European Prospective Investigation into Cancer and Nutrition-Norfolk in relation to phytoestrogen intake derived from an improved database, Case-control and prospective studies of dietary -linolenic acid intake and prostate cancer risk: a meta-analysis, A systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality, A topical gel from flax seed oil compared with hand splint in carpal tunnel syndrome: A randomized clinical trial. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Patients treated with selinexor may experience neurological toxicities. Avoid or Use Alternate Drug. fluoxetine will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Active, or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding). Using it again could be fatal (cause death). Modify Therapy/Monitor Closely. Minor/Significance Unknown. Increases risk of torsades de pointes. fluoxetine and entrectinib both increase QTc interval. fluoxetine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. fluoxetine and pentazocine both increase serotonin levels. Like other NSAIDs, Voltaren gel can cause serious side effects and they can come on without warning. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Use Caution/Monitor. Avoid or Use Alternate Drug. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. Other drugs may interact with losartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Modify Therapy/Monitor Closely. Minor/Significance Unknown. Either increases toxicity of the other by pharmacodynamic synergism. acyclovir and capreomycin both increase nephrotoxicity and/or ototoxicity. Ashley Baumohl, MPH, RD, CDN, CNSC is a surgical dietitian. SSRIs inhib. Modify Therapy/Monitor Closely. 2010; 6(Suppl 2):P6. Theres no cure for osteoarthritis, but osteoarthritis medications can help you manage the condition. fluoxetine will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid with drugs known to prolong QT interval. Contraindicated. Use Caution/Monitor. For adult dosing, the dosing cup needs to be filled to 10 mL line twice. serotonin uptake by platelets. Mechanism: pharmacodynamic synergism. Concomitant use of insulin and fluoxetine may require insulin dosage adjustment and increased glucose monitoring. Either increases effects of the other by serotonin levels. Serious - Use Alternative (1)vemurafenib and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug.fluoxetine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, diabetes, low sodium in the blood (such as may occur while taking "water pills" - diuretics), dehydration, seizures, intestinal ulcers/bleeding (peptic ulcer disease), personal or family history of glaucoma (angle-closure type).This drug may make you dizzy or drowsy. During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may expose the foetus to: - cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension); - renal dysfunction, which may progress to renal failure with oligo-hydroamniosis; -The mother and the neonate, at the end of pregnancy, to: - possible prolongation of bleeding time, an anti-aggregating effect which may occur even at very low doses. Mechanism: pharmacodynamic synergism. Use lowest dose possible and monitor for respiratory depression and sedation. Modify Therapy/Monitor Closely. fluoxetine and olopatadine intranasal both increase sedation. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. fluoxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. chloroquine increases toxicity of fluoxetine by QTc interval. It may harm them. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Panobinostat is known to significantly prolong QT interval. Since cardiovascular risks with diclofenac may increase with dose and duration of exposure, the lowest effective daily dose should be used and for the shortest duration possible (see section 4.4 Special warnings and precautions for use). serotonin uptake by platelets. Concomitant use of insulin and fluoxetine may require insulin dosage adjustment and increased glucose monitoring. acyclovir and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Monitor Closely (1)gabapentin enacarbil, fluoxetine. What Are They? Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C19 metabolism. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. The absolute risk for cardiovascular malformation was increased from less than 1%, up to approximately 1.5 %. Monitor Closely (1)fluoxetine, mefenamic acid. informational and educational purposes only. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Monitor Closely (1)epinephrine racemic and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely. Studies have found that flaxseed oil supplements can increase levels of omega-3 fatty acids in the body, including eicosapentaenoicacid(EPA) and docosahexaenoic acid (DHA). hydroxychloroquine sulfate and fluoxetine both increase QTc interval. palonosetron, fluoxetine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Minor/Significance Unknown. 2014;51(9):1633-53. doi:10.1007/s13197-013-1247-9, Ren GY, Chen CY, Chen GC, et al. SSRIs inhib. SSRIs inhib. use sunlamp and tanning beds. Caution is advised when administering diclofenac to patients with mild to moderate hepatic impairment (see section 4.4 Special warnings and precautions for use). Serious - Use Alternative (1)fluoxetine, phentermine. If any of these effects last or get worse, tell your doctor promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Increased risk of upper GI bleeding. Avoid or Use Alternate Drug. first sign of any skin rash (no matter how mild). Use Caution/Monitor. Possible additive hyponatremia. Monitor for drug toxiticities when initiating or discontinuing methylphenidate. commonly, these are "non-preferred" brand drugs or specialty Use Caution/Monitor. SSRIs inhib. Monitor Closely (1)fluoxetine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. Use Caution/Monitor. Increased risk of upper GI bleeding. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system. serotonin uptake by platelets. Minor/Significance Unknown. Monitor Closely (1)mipomersen, fluoxetine. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. Monitor Closely (1)sunitinib and fluoxetine both increase QTc interval. Either increases toxicity of the other by Mechanism: unknown. Monitor Closely (1)dronedarone and fluoxetine both increase QTc interval. Remember, not all STIs will become an. Serious - Use Alternative (2)fluoxetine will increase the level or effect of metoclopramide intranasal by affecting hepatic enzyme CYP2D6 metabolism. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Avoid or Use Alternate Drug. Content is reviewed before publication and upon substantial updates.