aspirin/citric acid/sodium bicarbonate (OTC)

Antacid & Analgesic

Indicated for heartburn, acid indigestion, and sour stomach when accompanied with headache or body aches

2 tablets (dissolved in water) PO q4hr PRN; not to exceed 8 tablets/day (see Administration)

Age >60 years old: Do not exceed 4 tablets/day (see Cautions)

Antacid & Analgesia

<12 years old: Safety and efficacy not established

≥12 years: As adults; 2 tablets (dissolved in water) PO q4hr PRN; not to exceed 8 tablets/day (see Administration)

Contraindicated (1)

• mifepristone

  aspirin/citric acid/sodium bicarbonate, mifepristone. Other (see comment). Contraindicated. Comment: Aspirin induced antiplatelet activity may induce excessive bleeding after an abortion w/mifepristone (RU 486).

Serious - Use Alternative (14)

• atazanavir

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

• baloxavir marboxil

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• ibuprofen

  ibuprofen decreases effects of aspirin/citric acid/sodium bicarbonate by Other (see comment). Avoid or Use Alternate Drug. Comment: Ibuprofen decreases the antiplatelet effects of aspirin by blocking the active site of platelet cyclooxygenase. The effect of other NSAIDs on aspirin is not established.

• ibuprofen IV

  ibuprofen IV decreases effects of aspirin/citric acid/sodium bicarbonate by Other (see comment). Avoid or Use Alternate Drug. Comment: Ibuprofen decreases the antiplatelet effects of aspirin by blocking the active site of platelet cyclooxygenase. The effect of other NSAIDs on aspirin is not established.

• infigratinib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

• ketorolac

  aspirin/citric acid/sodium bicarbonate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• ketorolac intranasal

  aspirin/citric acid/sodium bicarbonate, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• measles, mumps, rubella and varicella vaccine, live

  aspirin/citric acid/sodium bicarbonate, measles, mumps, rubella and varicella vaccine, live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.

• methotrexate

  aspirin/citric acid/sodium bicarbonate increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. Caution should be exercised when salicylates are given in combination with methotrexate. Risk for drug interactions with methotrexate is greatest during high-dose methotrexate therapy, it has been recommended that any of these drugs be used cautiously with methotrexate even when methotrexate is used in low doses.

• pemetrexed

  aspirin/citric acid/sodium bicarbonate increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Interrupt dosing in all patients taking NSAIDs with long elimination half-lives for at least 5d before, the day of, and 2d following pemetrexed administration. If coadministration of an NSAID is necessary, closely monitor patients for toxicity, especially myelosuppression, renal toxicity, and GI toxicity.

• probenecid

  aspirin/citric acid/sodium bicarbonate decreases effects of probenecid by acidic (anionic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Aspirin decreases uricosuric action of probenecid.

• sotorasib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

• ticlopidine

  aspirin/citric acid/sodium bicarbonate increases effects of ticlopidine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• varicella virus vaccine live

  aspirin/citric acid/sodium bicarbonate, varicella virus vaccine live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.

Monitor Closely (252)

• abciximab

  aspirin/citric acid/sodium bicarbonate, abciximab. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  aspirin/citric acid/sodium bicarbonate, abciximab. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• acalabrutinib

  aspirin/citric acid/sodium bicarbonate decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

• acebutolol

  aspirin/citric acid/sodium bicarbonate decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  acebutolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• aceclofenac

  aceclofenac and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor.
  
  aceclofenac and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• acemetacin

  acemetacin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor.
  
  acemetacin and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• acetazolamide

  acetazolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
  
  acetazolamide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Use Caution/Monitor. Salicylate levels increased at moderate doses; risk of CNS toxicity. Salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• agrimony

  aspirin/citric acid/sodium bicarbonate and agrimony both increase anticoagulation. Use Caution/Monitor.

• albuterol

  aspirin/citric acid/sodium bicarbonate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfalfa

  aspirin/citric acid/sodium bicarbonate and alfalfa both increase anticoagulation. Use Caution/Monitor.

• alfuzosin

  aspirin/citric acid/sodium bicarbonate decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• alteplase

  aspirin/citric acid/sodium bicarbonate, alteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• American ginseng

  aspirin/citric acid/sodium bicarbonate and American ginseng both increase anticoagulation. Use Caution/Monitor.

• amiloride

  amiloride and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• amoxicillin

  amoxicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  amoxicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• ampicillin

  ampicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• anagrelide

  aspirin/citric acid/sodium bicarbonate, anagrelide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• antithrombin alfa

  aspirin/citric acid/sodium bicarbonate, antithrombin alfa. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  antithrombin alfa and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• antithrombin III

  aspirin/citric acid/sodium bicarbonate, antithrombin III. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  antithrombin III and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• arformoterol

  aspirin/citric acid/sodium bicarbonate increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• argatroban

  aspirin/citric acid/sodium bicarbonate, argatroban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  argatroban and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• asenapine

  aspirin/citric acid/sodium bicarbonate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• atenolol

  aspirin/citric acid/sodium bicarbonate decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  atenolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• azficel-T

  azficel-T, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking aspirin may experience increased bruising or bleeding at biopsy and/or injection sites. Concomitant use of aspirin is not recommended. .

• azilsartan

  aspirin/citric acid/sodium bicarbonate, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• bemiparin

  bemiparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• benazepril

  aspirin/citric acid/sodium bicarbonate decreases effects of benazepril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Potential for dangerous interaction. Use with caution and monitor closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  benazepril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• bendroflumethiazide

  aspirin/citric acid/sodium bicarbonate increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• betaxolol

  aspirin/citric acid/sodium bicarbonate decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  betaxolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• bisoprolol

  aspirin/citric acid/sodium bicarbonate decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  bisoprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• bivalirudin

  aspirin/citric acid/sodium bicarbonate, bivalirudin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  bivalirudin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• bosutinib

  aspirin/citric acid/sodium bicarbonate decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

• brinzolamide

  brinzolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.

• budesonide

  aspirin/citric acid/sodium bicarbonate decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

• bumetanide

  aspirin/citric acid/sodium bicarbonate increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• cabotegravir

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

• candesartan

  aspirin/citric acid/sodium bicarbonate decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  candesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  candesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• captopril

  aspirin/citric acid/sodium bicarbonate decreases effects of captopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  captopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• carbenoxolone

  aspirin/citric acid/sodium bicarbonate increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carvedilol

  aspirin/citric acid/sodium bicarbonate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  carvedilol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• celecoxib

  aspirin/citric acid/sodium bicarbonate and celecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and celecoxib both increase serum potassium. Use Caution/Monitor.

• celiprolol

  aspirin/citric acid/sodium bicarbonate decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  celiprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• chloroquine

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

• chlorothiazide

  aspirin/citric acid/sodium bicarbonate increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorpropamide

  aspirin/citric acid/sodium bicarbonate increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• chlorthalidone

  aspirin/citric acid/sodium bicarbonate increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• choline magnesium trisalicylate

  aspirin/citric acid/sodium bicarbonate and choline magnesium trisalicylate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

• cilostazol

  aspirin/citric acid/sodium bicarbonate, cilostazol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• cinnamon

  aspirin/citric acid/sodium bicarbonate and cinnamon both increase anticoagulation. Use Caution/Monitor.

• ciprofloxacin

  aspirin/citric acid/sodium bicarbonate decreases levels of ciprofloxacin by Other (see comment). Use Caution/Monitor. Comment: Buffered aspirin may decrease absorption of quinolones. Consider administering 2 hr before or 6 hr after, buffered aspirin administration.

• citalopram

  citalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• clomipramine

  clomipramine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• clopidogrel

  aspirin/citric acid/sodium bicarbonate, clopidogrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• cordyceps

  aspirin/citric acid/sodium bicarbonate and cordyceps both increase anticoagulation. Use Caution/Monitor.

• cortisone

  aspirin/citric acid/sodium bicarbonate, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• cyclopenthiazide

  aspirin/citric acid/sodium bicarbonate increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclosporine

  aspirin/citric acid/sodium bicarbonate increases toxicity of cyclosporine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.

• dabigatran

  dabigatran and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

• dabrafenib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

• dalteparin

  aspirin/citric acid/sodium bicarbonate, dalteparin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  dalteparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• deferasirox

  deferasirox, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Combination may increase GI bleeding, ulceration and irritation. Use with caution.

• deferiprone

  aspirin/citric acid/sodium bicarbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• deflazacort

  aspirin/citric acid/sodium bicarbonate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• desirudin

  aspirin/citric acid/sodium bicarbonate, desirudin. Either increases levels of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• dexamethasone

  aspirin/citric acid/sodium bicarbonate, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• diclofenac

  aspirin/citric acid/sodium bicarbonate and diclofenac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and diclofenac both increase serum potassium. Use Caution/Monitor.

• dicloxacillin

  dicloxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  dicloxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• diflunisal

  aspirin/citric acid/sodium bicarbonate and diflunisal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and diflunisal both increase serum potassium. Use Caution/Monitor.

• digoxin

  aspirin/citric acid/sodium bicarbonate and digoxin both increase serum potassium. Use Caution/Monitor.

• dipyridamole

  aspirin/citric acid/sodium bicarbonate, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• dobutamine

  aspirin/citric acid/sodium bicarbonate increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dong quai

  aspirin/citric acid/sodium bicarbonate and dong quai both increase anticoagulation. Use Caution/Monitor.

• dopexamine

  aspirin/citric acid/sodium bicarbonate increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxazosin

  aspirin/citric acid/sodium bicarbonate decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• drospirenone

  drospirenone and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

  duloxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• eltrombopag

  eltrombopag increases levels of aspirin/citric acid/sodium bicarbonate by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

• elvitegravir

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  aspirin/citric acid/sodium bicarbonate decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

• enalapril

  aspirin/citric acid/sodium bicarbonate decreases effects of enalapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  enalapril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• enoxaparin

  aspirin/citric acid/sodium bicarbonate, enoxaparin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  enoxaparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor. Additive effects are intended when both drugs are prescribed as indicated for unstable angina, non-Q-wave MI, and STEMI

• ephedrine

  aspirin/citric acid/sodium bicarbonate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  aspirin/citric acid/sodium bicarbonate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  aspirin/citric acid/sodium bicarbonate increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epoprostenol

  aspirin/citric acid/sodium bicarbonate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

• eprosartan

  aspirin/citric acid/sodium bicarbonate decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  eprosartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  eprosartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• eptifibatide

  aspirin/citric acid/sodium bicarbonate, eptifibatide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• escitalopram

  escitalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• esmolol

  aspirin/citric acid/sodium bicarbonate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  esmolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• ethacrynic acid

  aspirin/citric acid/sodium bicarbonate increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• etodolac

  aspirin/citric acid/sodium bicarbonate and etodolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and etodolac both increase serum potassium. Use Caution/Monitor.

• fenbufen

  aspirin/citric acid/sodium bicarbonate and fenbufen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and fenbufen both increase serum potassium. Use Caution/Monitor.

• fennel

  aspirin/citric acid/sodium bicarbonate and fennel both increase anticoagulation. Use Caution/Monitor.

• fenoprofen

  aspirin/citric acid/sodium bicarbonate and fenoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and fenoprofen both increase serum potassium. Use Caution/Monitor.

• feverfew

  aspirin/citric acid/sodium bicarbonate and feverfew both increase anticoagulation. Use Caution/Monitor.

• fish oil

  fish oil, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• fludrocortisone

  aspirin/citric acid/sodium bicarbonate, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• fluoxetine

  fluoxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• flurbiprofen

  aspirin/citric acid/sodium bicarbonate and flurbiprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and flurbiprofen both increase serum potassium. Use Caution/Monitor.

• fondaparinux

  fondaparinux and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• formoterol

  aspirin/citric acid/sodium bicarbonate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• forskolin

  aspirin/citric acid/sodium bicarbonate and forskolin both increase anticoagulation. Use Caution/Monitor.

• fosinopril

  aspirin/citric acid/sodium bicarbonate decreases effects of fosinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  fosinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• furosemide

  aspirin/citric acid/sodium bicarbonate increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• garlic

  aspirin/citric acid/sodium bicarbonate and garlic both increase anticoagulation. Use Caution/Monitor.

• gefitinib

  aspirin/citric acid/sodium bicarbonate decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

• gentamicin

  aspirin/citric acid/sodium bicarbonate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ginger

  aspirin/citric acid/sodium bicarbonate and ginger both increase anticoagulation. Use Caution/Monitor.

• ginkgo biloba

  aspirin/citric acid/sodium bicarbonate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

• glimepiride

  aspirin/citric acid/sodium bicarbonate increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• glipizide

  aspirin/citric acid/sodium bicarbonate increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• glyburide

  aspirin/citric acid/sodium bicarbonate increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• green tea

  green tea increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical, due to caffeine content). Combination may increase risk of bleeding.

• griseofulvin

  griseofulvin decreases levels of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Use Caution/Monitor.

• heparin

  aspirin/citric acid/sodium bicarbonate, heparin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  heparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• horse chestnut seed

  aspirin/citric acid/sodium bicarbonate and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

• hyaluronidase

  aspirin/citric acid/sodium bicarbonate decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Salicylates, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect.

• hydralazine

  aspirin/citric acid/sodium bicarbonate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• hydrochlorothiazide

  aspirin/citric acid/sodium bicarbonate increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• hydrocortisone

  aspirin/citric acid/sodium bicarbonate, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• ibuprofen

  aspirin/citric acid/sodium bicarbonate and ibuprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen both increase serum potassium. Use Caution/Monitor.

• ibuprofen IV

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ibuprofen IV by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen IV both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

• icosapent

  icosapent, aspirin/citric acid/sodium bicarbonate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

• indapamide

  aspirin/citric acid/sodium bicarbonate increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indomethacin

  aspirin/citric acid/sodium bicarbonate and indomethacin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and indomethacin both increase serum potassium. Use Caution/Monitor.

• irbesartan

  aspirin/citric acid/sodium bicarbonate decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  irbesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  irbesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• isoproterenol

  aspirin/citric acid/sodium bicarbonate increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketoprofen

  aspirin/citric acid/sodium bicarbonate and ketoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketoprofen both increase serum potassium. Use Caution/Monitor.

• ketorolac

  aspirin/citric acid/sodium bicarbonate and ketorolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketorolac both increase serum potassium. Use Caution/Monitor.

• ketorolac intranasal

  aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

• labetalol

  aspirin/citric acid/sodium bicarbonate decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  labetalol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• ledipasvir/sofosbuvir

  aspirin/citric acid/sodium bicarbonate decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

• levalbuterol

  aspirin/citric acid/sodium bicarbonate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levomilnacipran

  levomilnacipran, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.

• lisdexamfetamine

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• lisinopril

  aspirin/citric acid/sodium bicarbonate decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  lisinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• lithium

  aspirin/citric acid/sodium bicarbonate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

• lornoxicam

  aspirin/citric acid/sodium bicarbonate and lornoxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and lornoxicam both increase serum potassium. Use Caution/Monitor.

• losartan

  aspirin/citric acid/sodium bicarbonate decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  losartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  losartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• meclofenamate

  aspirin/citric acid/sodium bicarbonate and meclofenamate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and meclofenamate both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  aspirin/citric acid/sodium bicarbonate and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and mefenamic acid both increase serum potassium. Use Caution/Monitor.

• meloxicam

  aspirin/citric acid/sodium bicarbonate and meloxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and meloxicam both increase serum potassium. Use Caution/Monitor.

• mesalamine

  mesalamine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.

• metaproterenol

  aspirin/citric acid/sodium bicarbonate increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methazolamide

  methazolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.

• methotrexate

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of methotrexate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

• methyclothiazide

  aspirin/citric acid/sodium bicarbonate increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• methylphenidate

  aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

• methylprednisolone

  aspirin/citric acid/sodium bicarbonate, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• metolazone

  aspirin/citric acid/sodium bicarbonate increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metoprolol

  aspirin/citric acid/sodium bicarbonate decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  metoprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• milnacipran

  milnacipran, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mistletoe

  aspirin/citric acid/sodium bicarbonate increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• moexipril

  aspirin/citric acid/sodium bicarbonate decreases effects of moexipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  moexipril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• moxisylyte

  aspirin/citric acid/sodium bicarbonate decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• mycophenolate

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

• nabumetone

  aspirin/citric acid/sodium bicarbonate and nabumetone both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and nabumetone both increase serum potassium. Use Caution/Monitor.

• nadolol

  aspirin/citric acid/sodium bicarbonate decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nadolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• nafcillin

  nafcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  nafcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• naproxen

  aspirin/citric acid/sodium bicarbonate and naproxen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and naproxen both increase serum potassium. Use Caution/Monitor.

• nebivolol

  aspirin/citric acid/sodium bicarbonate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• nefazodone

  nefazodone, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• neratinib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

• nettle

  aspirin/citric acid/sodium bicarbonate increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nilotinib

  aspirin/citric acid/sodium bicarbonate decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

• nitroglycerin rectal

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of nitroglycerin rectal by Other (see comment). Use Caution/Monitor. The pharmacological effects of nitroglycerin may be enhanced by concomitant administration of aspirin.

• norepinephrine

  aspirin/citric acid/sodium bicarbonate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• olmesartan

  aspirin/citric acid/sodium bicarbonate decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  olmesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  olmesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• omadacycline

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• omega 3 carboxylic acids

  omega 3 carboxylic acids, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• omega 3 fatty acids

  omega 3 fatty acids, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• oxacillin

  oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• oxaprozin

  aspirin/citric acid/sodium bicarbonate and oxaprozin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and oxaprozin both increase serum potassium. Use Caution/Monitor.

• panax ginseng

  aspirin/citric acid/sodium bicarbonate and panax ginseng both increase anticoagulation. Use Caution/Monitor.

• parecoxib

  aspirin/citric acid/sodium bicarbonate and parecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and parecoxib both increase serum potassium. Use Caution/Monitor.

• paroxetine

  paroxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pau d'arco

  aspirin/citric acid/sodium bicarbonate and pau d'arco both increase anticoagulation. Use Caution/Monitor.

• pegaspargase

  pegaspargase increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

• penbutolol

  aspirin/citric acid/sodium bicarbonate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  penbutolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• penicillin G aqueous

  penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• perindopril

  aspirin/citric acid/sodium bicarbonate decreases effects of perindopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  perindopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• pexidartinib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

• phenindione

  phenindione and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• phenoxybenzamine

  aspirin/citric acid/sodium bicarbonate decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phentolamine

  aspirin/citric acid/sodium bicarbonate decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phytoestrogens

  aspirin/citric acid/sodium bicarbonate and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

• pindolol

  aspirin/citric acid/sodium bicarbonate decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  pindolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• pirbuterol

  aspirin/citric acid/sodium bicarbonate increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  aspirin/citric acid/sodium bicarbonate and piroxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and piroxicam both increase serum potassium. Use Caution/Monitor.

• pivmecillinam

  pivmecillinam, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  pivmecillinam, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• potassium acid phosphate

  aspirin/citric acid/sodium bicarbonate and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  aspirin/citric acid/sodium bicarbonate and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium citrate

  aspirin/citric acid/sodium bicarbonate and potassium citrate both increase serum potassium. Use Caution/Monitor.

• pralatrexate

  aspirin/citric acid/sodium bicarbonate increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor.

• prasugrel

  aspirin/citric acid/sodium bicarbonate, prasugrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• prazosin

  aspirin/citric acid/sodium bicarbonate decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• prednisolone

  aspirin/citric acid/sodium bicarbonate, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• prednisone

  aspirin/citric acid/sodium bicarbonate, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• probenecid

  aspirin/citric acid/sodium bicarbonate decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.

• propranolol

  aspirin/citric acid/sodium bicarbonate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  propranolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• protamine

  protamine and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• quinapril

  aspirin/citric acid/sodium bicarbonate decreases effects of quinapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  quinapril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• ramipril

  aspirin/citric acid/sodium bicarbonate decreases effects of ramipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  ramipril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• reishi

  aspirin/citric acid/sodium bicarbonate and reishi both increase anticoagulation. Use Caution/Monitor.

• reteplase

  aspirin/citric acid/sodium bicarbonate, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• rilpivirine

  aspirin/citric acid/sodium bicarbonate decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

• riociguat

  aspirin/citric acid/sodium bicarbonate decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

• rivaroxaban

  aspirin/citric acid/sodium bicarbonate, rivaroxaban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  rivaroxaban, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Aspirin are known to increase bleeding. Bleeding risk may be increased when aspirin is used concomitantly with rivaroxaban. Monitor for signs/symptoms of blood loss.

• sacubitril/valsartan

  sacubitril/valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  sacubitril/valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• salicylates (non-asa)

  aspirin/citric acid/sodium bicarbonate and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

• salmeterol

  aspirin/citric acid/sodium bicarbonate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  aspirin/citric acid/sodium bicarbonate and salsalate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and salsalate both increase serum potassium. Use Caution/Monitor.

• sarecycline

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sertraline

  sertraline, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• Siberian ginseng

  aspirin/citric acid/sodium bicarbonate and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

• silodosin

  aspirin/citric acid/sodium bicarbonate decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  aspirin/citric acid/sodium bicarbonate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of aspirin/citric acid/sodium bicarbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of aspirin/citric acid/sodium bicarbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

• sotalol

  aspirin/citric acid/sodium bicarbonate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  sotalol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• sparsentan

  aspirin/citric acid/sodium bicarbonate decreases effects of sparsentan by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer sparsentan 2 hours before or after administration of antacids. Antacids may decrease sparsentan exposure which may reduce efficacy of sparsentan.

• spironolactone

  spironolactone and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. When used concomitantly, spironolactone dose may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained.

• succinylcholine

  aspirin/citric acid/sodium bicarbonate and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfamethoxazole

  aspirin/citric acid/sodium bicarbonate, sulfamethoxazole. Either increases effects of the other by plasma protein binding competition. Use Caution/Monitor. Due to high protein binding capacity of both drugs, one may displace the other when coadministered leading to an enhanced effect of the displaced drug; risk is low with low dose aspirin.

• sulfasalazine

  aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase serum potassium. Use Caution/Monitor.

• sulindac

  aspirin/citric acid/sodium bicarbonate and sulindac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and sulindac both increase serum potassium. Use Caution/Monitor.

• telmisartan

  aspirin/citric acid/sodium bicarbonate decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  telmisartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  telmisartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• temocillin

  temocillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  temocillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• tenecteplase

  aspirin/citric acid/sodium bicarbonate, tenecteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• terazosin

  aspirin/citric acid/sodium bicarbonate decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• terbutaline

  aspirin/citric acid/sodium bicarbonate increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ticagrelor

  aspirin/citric acid/sodium bicarbonate, ticagrelor. Other (see comment). Use Caution/Monitor. Comment: Maintenance doses of aspirin above 100 mg decreases effectiveness of ticagrelor. Therefore, after the initial loading dose of aspirin (usually 325 mg), use ticagrelor with a maintenance dose of aspirin of 75-100 mg.

• ticarcillin

  ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• timolol

  aspirin/citric acid/sodium bicarbonate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  timolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• tirofiban

  aspirin/citric acid/sodium bicarbonate, tirofiban. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• tobramycin inhaled

  tobramycin inhaled and aspirin/citric acid/sodium bicarbonate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• tolazamide

  aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• tolbutamide

  aspirin/citric acid/sodium bicarbonate increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• tolfenamic acid

  aspirin/citric acid/sodium bicarbonate and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

• tolmetin

  aspirin/citric acid/sodium bicarbonate and tolmetin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and tolmetin both increase serum potassium. Use Caution/Monitor.

• tolvaptan

  aspirin/citric acid/sodium bicarbonate and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

  aspirin/citric acid/sodium bicarbonate increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trazodone

  trazodone, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• triamcinolone acetonide injectable suspension

  aspirin/citric acid/sodium bicarbonate, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• triamterene

  triamterene and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• valproic acid

  aspirin/citric acid/sodium bicarbonate increases levels of valproic acid by plasma protein binding competition. Use Caution/Monitor.

• valsartan

  aspirin/citric acid/sodium bicarbonate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• venlafaxine

  venlafaxine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• vismodegib

  aspirin/citric acid/sodium bicarbonate will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

• vitamin K1 (phytonadione)

  aspirin/citric acid/sodium bicarbonate increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• vorapaxar

  aspirin/citric acid/sodium bicarbonate, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• zotepine

  aspirin/citric acid/sodium bicarbonate decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

Minor (124)

• aceclofenac

  aceclofenac will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• acemetacin

  acemetacin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• acyclovir

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• alendronate

  aspirin/citric acid/sodium bicarbonate, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.

• aluminum hydroxide

  aluminum hydroxide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• amikacin

  aspirin/citric acid/sodium bicarbonate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• aminohippurate sodium

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• anamu

  aspirin/citric acid/sodium bicarbonate and anamu both increase anticoagulation. Minor/Significance Unknown.

• ascorbic acid

  aspirin/citric acid/sodium bicarbonate decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.
  
  ascorbic acid will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  ascorbic acid increases levels of aspirin/citric acid/sodium bicarbonate by decreasing renal clearance. Minor/Significance Unknown.

• balsalazide

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• bendroflumethiazide

  bendroflumethiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• bismuth subsalicylate

  bismuth subsalicylate increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown.

• bumetanide

  aspirin/citric acid/sodium bicarbonate, bumetanide. Other (see comment). Minor/Significance Unknown. Comment: Salicylates are less likely than other NSAIDs to interact w/bumetanide.

• calcium carbonate

  calcium carbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• cefadroxil

  cefadroxil will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefamandole

  cefamandole will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefazolin

  cefazolin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefepime

  cefepime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefixime

  cefixime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefpirome

  cefpirome will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefprozil

  cefprozil will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ceftazidime

  ceftazidime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ceftibuten

  ceftibuten will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• celecoxib

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of celecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cephalexin

  cephalexin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chlorothiazide

  chlorothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chlorpropamide

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  aspirin/citric acid/sodium bicarbonate increases effects of chlorpropamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• chlorthalidone

  chlorthalidone will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• choline magnesium trisalicylate

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chromium

  aspirin/citric acid/sodium bicarbonate increases levels of chromium by unspecified interaction mechanism. Minor/Significance Unknown.

• cortisone

  cortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• creatine

  creatine, aspirin/citric acid/sodium bicarbonate. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

• cyanocobalamin

  aspirin/citric acid/sodium bicarbonate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• cyclopenthiazide

  cyclopenthiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• danshen

  aspirin/citric acid/sodium bicarbonate and danshen both increase anticoagulation. Minor/Significance Unknown.

• deflazacort

  deflazacort decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• devil's claw

  aspirin/citric acid/sodium bicarbonate and devil's claw both increase anticoagulation. Minor/Significance Unknown.

• dexamethasone

  dexamethasone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• diclofenac

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of diclofenac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• diclofenac topical

  diclofenac topical, aspirin/citric acid/sodium bicarbonate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Although low, there is systemic exposure to diclofenac topical; theoretically, concomitant administration with systemic NSAIDS or aspirin may result in increased NSAID adverse effects.

• diflunisal

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of diflunisal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• diltiazem

  diltiazem increases effects of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• eplerenone

  aspirin/citric acid/sodium bicarbonate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• ethanol

  ethanol increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• etodolac

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of etodolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• fenbufen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of fenbufen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• fenoprofen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of fenoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• feverfew

  aspirin/citric acid/sodium bicarbonate decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• flurbiprofen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of flurbiprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• folic acid

  aspirin/citric acid/sodium bicarbonate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• furosemide

  aspirin/citric acid/sodium bicarbonate decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• ganciclovir

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• gentamicin

  aspirin/citric acid/sodium bicarbonate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• glimepiride

  aspirin/citric acid/sodium bicarbonate increases effects of glimepiride by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glipizide

  aspirin/citric acid/sodium bicarbonate increases effects of glipizide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glyburide

  aspirin/citric acid/sodium bicarbonate increases effects of glyburide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• hydrochlorothiazide

  hydrochlorothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• ibuprofen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ibuprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• imidapril

  aspirin/citric acid/sodium bicarbonate decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• indapamide

  indapamide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• indomethacin

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• insulin aspart

  aspirin/citric acid/sodium bicarbonate increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin detemir

  aspirin/citric acid/sodium bicarbonate increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin glargine

  aspirin/citric acid/sodium bicarbonate increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin glulisine

  aspirin/citric acid/sodium bicarbonate increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin lispro

  aspirin/citric acid/sodium bicarbonate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin NPH

  aspirin/citric acid/sodium bicarbonate increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin regular human

  aspirin/citric acid/sodium bicarbonate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• ketoprofen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ketorolac

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ketorolac intranasal

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• L-methylfolate

  aspirin/citric acid/sodium bicarbonate decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• lornoxicam

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of lornoxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• meclofenamate

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of meclofenamate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• mefenamic acid

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• meloxicam

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• mesalamine

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methyclothiazide

  methyclothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• metolazone

  metolazone will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• nabumetone

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• naproxen

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• neomycin PO

  aspirin/citric acid/sodium bicarbonate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• noni juice

  aspirin/citric acid/sodium bicarbonate and noni juice both increase serum potassium. Minor/Significance Unknown.

• ofloxacin

  ofloxacin, aspirin/citric acid/sodium bicarbonate. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

• oxaprozin

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• parecoxib

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• paromomycin

  aspirin/citric acid/sodium bicarbonate increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• penicillin VK

  penicillin VK, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown.

• pentazocine

  aspirin/citric acid/sodium bicarbonate, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• piperacillin

  piperacillin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by plasma protein binding competition. Minor/Significance Unknown. Salicylic acid could be displaced from protein binding sites or it could itself displace other protein-bound drugs and result in an enhanced effect of the displaced drug

• piroxicam

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of piroxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• prednisolone

  prednisolone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• prednisone

  prednisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• rivastigmine

  rivastigmine increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

• rose hips

  aspirin/citric acid/sodium bicarbonate decreases levels of rose hips by increasing renal clearance. Minor/Significance Unknown.
  
  rose hips will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  rose hips increases levels of aspirin/citric acid/sodium bicarbonate by decreasing renal clearance. Minor/Significance Unknown.

• salicylates (non-asa)

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• salsalate

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of salsalate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• sodium bicarbonate

  sodium bicarbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• sodium citrate/citric acid

  sodium citrate/citric acid, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• streptomycin

  aspirin/citric acid/sodium bicarbonate increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• sulfadiazine

  aspirin/citric acid/sodium bicarbonate increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfamethoxazole

  aspirin/citric acid/sodium bicarbonate increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfasalazine

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• sulfisoxazole

  aspirin/citric acid/sodium bicarbonate increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulindac

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• teniposide

  aspirin/citric acid/sodium bicarbonate increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.

• tiludronate

  aspirin/citric acid/sodium bicarbonate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• tobramycin

  aspirin/citric acid/sodium bicarbonate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• tolazamide

  aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolbutamide

  aspirin/citric acid/sodium bicarbonate increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolfenamic acid

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• tolmetin

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• trandolapril

  aspirin/citric acid/sodium bicarbonate decreases effects of trandolapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• triamcinolone acetonide injectable suspension

  triamcinolone acetonide injectable suspension decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  aspirin/citric acid/sodium bicarbonate increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.
  
  triamterene, aspirin/citric acid/sodium bicarbonate. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.

• valganciclovir

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• vancomycin

  aspirin/citric acid/sodium bicarbonate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.

• verapamil

  verapamil increases effects of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• willow bark

  aspirin/citric acid/sodium bicarbonate will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  willow bark increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Willow bark contains salicylic acid, which may have additive effects/toxicity with salicylate drugs.

• zafirlukast

  aspirin/citric acid/sodium bicarbonate increases levels of zafirlukast by unknown mechanism. Minor/Significance Unknown.

• zoledronic acid

  aspirin/citric acid/sodium bicarbonate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• abciximab

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, abciximab. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  aspirin/citric acid/sodium bicarbonate, abciximab. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• acalabrutinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

• acebutolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  acebutolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• aceclofenac

  Monitor Closely (2)aceclofenac and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor.
  
  aceclofenac and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.Minor (1)aceclofenac will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• acemetacin

  Monitor Closely (2)acemetacin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor.
  
  acemetacin and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.Minor (1)acemetacin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• acetazolamide

  Monitor Closely (2)acetazolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
  
  acetazolamide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Use Caution/Monitor. Salicylate levels increased at moderate doses; risk of CNS toxicity. Salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• acyclovir

  Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• agrimony

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and agrimony both increase anticoagulation. Use Caution/Monitor.

• albuterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alendronate

  Minor (1)aspirin/citric acid/sodium bicarbonate, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.

• alfalfa

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and alfalfa both increase anticoagulation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• alteplase

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, alteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• aluminum hydroxide

  Minor (1)aluminum hydroxide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• American ginseng

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and American ginseng both increase anticoagulation. Use Caution/Monitor.

• amikacin

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• amiloride

  Monitor Closely (1)amiloride and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• aminohippurate sodium

  Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• amoxicillin

  Monitor Closely (2)amoxicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  amoxicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• ampicillin

  Monitor Closely (1)ampicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• anagrelide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, anagrelide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• anamu

  Minor (1)aspirin/citric acid/sodium bicarbonate and anamu both increase anticoagulation. Minor/Significance Unknown.

• antithrombin alfa

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, antithrombin alfa. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  antithrombin alfa and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• antithrombin III

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, antithrombin III. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  antithrombin III and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• arformoterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• argatroban

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, argatroban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  argatroban and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• ascorbic acid

  Minor (3)aspirin/citric acid/sodium bicarbonate decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.
  
  ascorbic acid will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  ascorbic acid increases levels of aspirin/citric acid/sodium bicarbonate by decreasing renal clearance. Minor/Significance Unknown.

• asenapine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• atazanavir

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

• atenolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  atenolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• azficel-T

  Monitor Closely (1)azficel-T, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking aspirin may experience increased bruising or bleeding at biopsy and/or injection sites. Concomitant use of aspirin is not recommended. .

• azilsartan

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• baloxavir marboxil

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• balsalazide

  Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• bemiparin

  Monitor Closely (1)bemiparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• benazepril

  Monitor Closely (2)benazepril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of benazepril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Potential for dangerous interaction. Use with caution and monitor closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• bendroflumethiazide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)bendroflumethiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• betaxolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  betaxolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• bismuth subsalicylate

  Minor (1)bismuth subsalicylate increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown.

• bisoprolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  bisoprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• bivalirudin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, bivalirudin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  bivalirudin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• bosutinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

• brinzolamide

  Monitor Closely (1)brinzolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.

• budesonide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

• bumetanide

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
  
  aspirin/citric acid/sodium bicarbonate increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate, bumetanide. Other (see comment). Minor/Significance Unknown. Comment: Salicylates are less likely than other NSAIDs to interact w/bumetanide.

• cabotegravir

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

• calcium carbonate

  Minor (1)calcium carbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• candesartan

  Monitor Closely (3)candesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  candesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• captopril

  Monitor Closely (2)captopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of captopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• carbenoxolone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carvedilol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  carvedilol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• cefadroxil

  Minor (1)cefadroxil will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefamandole

  Minor (1)cefamandole will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefazolin

  Minor (1)cefazolin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefepime

  Minor (1)cefepime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefixime

  Minor (1)cefixime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefpirome

  Minor (1)cefpirome will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefprozil

  Minor (1)cefprozil will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ceftazidime

  Minor (1)ceftazidime will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ceftibuten

  Minor (1)ceftibuten will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• celecoxib

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and celecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and celecoxib both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of celecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• celiprolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  celiprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• cephalexin

  Minor (1)cephalexin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chloroquine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

• chlorothiazide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)chlorothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chlorpropamide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (2)aspirin/citric acid/sodium bicarbonate will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  aspirin/citric acid/sodium bicarbonate increases effects of chlorpropamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• chlorthalidone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)chlorthalidone will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• choline magnesium trisalicylate

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and choline magnesium trisalicylate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chromium

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of chromium by unspecified interaction mechanism. Minor/Significance Unknown.

• cilostazol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, cilostazol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• cinnamon

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and cinnamon both increase anticoagulation. Use Caution/Monitor.

• ciprofloxacin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of ciprofloxacin by Other (see comment). Use Caution/Monitor. Comment: Buffered aspirin may decrease absorption of quinolones. Consider administering 2 hr before or 6 hr after, buffered aspirin administration.

• citalopram

  Monitor Closely (1)citalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.

• clomipramine

  Monitor Closely (1)clomipramine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.

• clopidogrel

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, clopidogrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• cordyceps

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and cordyceps both increase anticoagulation. Use Caution/Monitor.

• cortisone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)cortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• creatine

  Minor (1)creatine, aspirin/citric acid/sodium bicarbonate. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

• cyanocobalamin

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• cyclopenthiazide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)cyclopenthiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cyclosporine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases toxicity of cyclosporine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.

• dabigatran

  Monitor Closely (1)dabigatran and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

• dabrafenib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

• dalteparin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, dalteparin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  dalteparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• danshen

  Minor (1)aspirin/citric acid/sodium bicarbonate and danshen both increase anticoagulation. Minor/Significance Unknown.

• deferasirox

  Monitor Closely (1)deferasirox, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Combination may increase GI bleeding, ulceration and irritation. Use with caution.

• deferiprone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• deflazacort

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)deflazacort decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• desirudin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, desirudin. Either increases levels of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• devil's claw

  Minor (1)aspirin/citric acid/sodium bicarbonate and devil's claw both increase anticoagulation. Minor/Significance Unknown.

• dexamethasone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)dexamethasone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• diclofenac

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and diclofenac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and diclofenac both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of diclofenac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• diclofenac topical

  Minor (1)diclofenac topical, aspirin/citric acid/sodium bicarbonate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Although low, there is systemic exposure to diclofenac topical; theoretically, concomitant administration with systemic NSAIDS or aspirin may result in increased NSAID adverse effects.

• dicloxacillin

  Monitor Closely (2)dicloxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  dicloxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• diflunisal

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and diflunisal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and diflunisal both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of diflunisal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• digoxin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and digoxin both increase serum potassium. Use Caution/Monitor.

• diltiazem

  Minor (1)diltiazem increases effects of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• dipyridamole

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• dobutamine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dong quai

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and dong quai both increase anticoagulation. Use Caution/Monitor.

• dopexamine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxazosin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• drospirenone

  Monitor Closely (1)drospirenone and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

  Monitor Closely (1)duloxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• eltrombopag

  Monitor Closely (1)eltrombopag increases levels of aspirin/citric acid/sodium bicarbonate by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

• elvitegravir

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

• enalapril

  Monitor Closely (2)enalapril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of enalapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• enoxaparin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, enoxaparin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  enoxaparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Use Caution/Monitor. Additive effects are intended when both drugs are prescribed as indicated for unstable angina, non-Q-wave MI, and STEMI

• ephedrine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• eplerenone

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• epoprostenol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and epoprostenol both increase anticoagulation. Use Caution/Monitor.

• eprosartan

  Monitor Closely (3)aspirin/citric acid/sodium bicarbonate decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  eprosartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  eprosartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• eptifibatide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, eptifibatide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• escitalopram

  Monitor Closely (1)escitalopram, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• esmolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  esmolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• ethacrynic acid

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ethanol

  Minor (1)ethanol increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• etodolac

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and etodolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and etodolac both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of etodolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• fenbufen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and fenbufen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and fenbufen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of fenbufen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• fennel

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and fennel both increase anticoagulation. Use Caution/Monitor.

• fenoprofen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and fenoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and fenoprofen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of fenoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• feverfew

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and feverfew both increase anticoagulation. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

• fish oil

  Monitor Closely (1)fish oil, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• fludrocortisone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)fludrocortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• fluoxetine

  Monitor Closely (1)fluoxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• flurbiprofen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and flurbiprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and flurbiprofen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of flurbiprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• folic acid

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• fondaparinux

  Monitor Closely (1)fondaparinux and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• formoterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• forskolin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and forskolin both increase anticoagulation. Use Caution/Monitor.

• fosinopril

  Monitor Closely (2)fosinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of fosinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• furosemide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• ganciclovir

  Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• garlic

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and garlic both increase anticoagulation. Use Caution/Monitor.

• gefitinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

• gentamicin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• ginger

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and ginger both increase anticoagulation. Use Caution/Monitor.

• ginkgo biloba

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

• glimepiride

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of glimepiride by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glipizide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of glipizide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glyburide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of glyburide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• green tea

  Monitor Closely (1)green tea increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical, due to caffeine content). Combination may increase risk of bleeding.

• griseofulvin

  Monitor Closely (1)griseofulvin decreases levels of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Use Caution/Monitor.

• heparin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, heparin. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  heparin and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• horse chestnut seed

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

• hyaluronidase

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of hyaluronidase by Other (see comment). Use Caution/Monitor. Comment: Salicylates, when given in large systemic doses, may render tissues partially resistant to the action of hyaluronidase. Patients may require larger amounts of hyaluronidase for equivalent dispersing effect.

• hydralazine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• hydrochlorothiazide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)hydrochlorothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)hydrocortisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• ibuprofen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and ibuprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)ibuprofen decreases effects of aspirin/citric acid/sodium bicarbonate by Other (see comment). Avoid or Use Alternate Drug. Comment: Ibuprofen decreases the antiplatelet effects of aspirin by blocking the active site of platelet cyclooxygenase. The effect of other NSAIDs on aspirin is not established.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ibuprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ibuprofen IV

  Monitor Closely (3)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ibuprofen IV by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen IV both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ibuprofen IV both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)ibuprofen IV decreases effects of aspirin/citric acid/sodium bicarbonate by Other (see comment). Avoid or Use Alternate Drug. Comment: Ibuprofen decreases the antiplatelet effects of aspirin by blocking the active site of platelet cyclooxygenase. The effect of other NSAIDs on aspirin is not established.

• icosapent

  Monitor Closely (1)icosapent, aspirin/citric acid/sodium bicarbonate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

• imidapril

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• indapamide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)indapamide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• indomethacin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and indomethacin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and indomethacin both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• infigratinib

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

• insulin aspart

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin detemir

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin glargine

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin glulisine

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin lispro

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin NPH

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin regular human

  Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• irbesartan

  Monitor Closely (3)irbesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  irbesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• isoproterenol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketoprofen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and ketoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketoprofen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ketorolac

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and ketorolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketorolac both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• ketorolac intranasal

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• L-methylfolate

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• labetalol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  labetalol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• ledipasvir/sofosbuvir

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

• levalbuterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levomilnacipran

  Monitor Closely (1)levomilnacipran, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.

• lisdexamfetamine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• lisinopril

  Monitor Closely (2)lisinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• lithium

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and lornoxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and lornoxicam both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of lornoxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• losartan

  Monitor Closely (3)losartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  losartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• measles, mumps, rubella and varicella vaccine, live

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate, measles, mumps, rubella and varicella vaccine, live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.

• meclofenamate

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and meclofenamate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and meclofenamate both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of meclofenamate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• mefenamic acid

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and mefenamic acid both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• meloxicam

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and meloxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and meloxicam both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• mesalamine

  Monitor Closely (1)mesalamine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• metaproterenol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methazolamide

  Monitor Closely (1)methazolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.

• methotrexate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of methotrexate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. Caution should be exercised when salicylates are given in combination with methotrexate. Risk for drug interactions with methotrexate is greatest during high-dose methotrexate therapy, it has been recommended that any of these drugs be used cautiously with methotrexate even when methotrexate is used in low doses.

• methyclothiazide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Minor (1)methyclothiazide will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• methylphenidate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

• methylprednisolone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)methylprednisolone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• metolazone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)metolazone will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• metoprolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  metoprolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• mifepristone

  Contraindicated (1)aspirin/citric acid/sodium bicarbonate, mifepristone. Other (see comment). Contraindicated. Comment: Aspirin induced antiplatelet activity may induce excessive bleeding after an abortion w/mifepristone (RU 486).

• milnacipran

  Monitor Closely (1)milnacipran, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mistletoe

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• moexipril

  Monitor Closely (2)moexipril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of moexipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• moxisylyte

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• mycophenolate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

• nabumetone

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and nabumetone both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and nabumetone both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• nadolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nadolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• nafcillin

  Monitor Closely (2)nafcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  nafcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• naproxen

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and naproxen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and naproxen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• nebivolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• nefazodone

  Monitor Closely (1)nefazodone, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• neomycin PO

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• neratinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

• nettle

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nilotinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

• nitroglycerin rectal

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of nitroglycerin rectal by Other (see comment). Use Caution/Monitor. The pharmacological effects of nitroglycerin may be enhanced by concomitant administration of aspirin.

• noni juice

  Minor (1)aspirin/citric acid/sodium bicarbonate and noni juice both increase serum potassium. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ofloxacin

  Minor (1)ofloxacin, aspirin/citric acid/sodium bicarbonate. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

• olmesartan

  Monitor Closely (3)olmesartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  olmesartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• omadacycline

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• omega 3 carboxylic acids

  Monitor Closely (1)omega 3 carboxylic acids, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• omega 3 fatty acids

  Monitor Closely (1)omega 3 fatty acids, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• oxacillin

  Monitor Closely (2)oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  oxacillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• oxaprozin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and oxaprozin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and oxaprozin both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• panax ginseng

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and panax ginseng both increase anticoagulation. Use Caution/Monitor.

• parecoxib

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and parecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and parecoxib both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• paromomycin

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• paroxetine

  Monitor Closely (1)paroxetine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pau d'arco

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and pau d'arco both increase anticoagulation. Use Caution/Monitor.

• pegaspargase

  Monitor Closely (1)pegaspargase increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

• pemetrexed

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Interrupt dosing in all patients taking NSAIDs with long elimination half-lives for at least 5d before, the day of, and 2d following pemetrexed administration. If coadministration of an NSAID is necessary, closely monitor patients for toxicity, especially myelosuppression, renal toxicity, and GI toxicity.

• penbutolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  penbutolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• penicillin G aqueous

  Monitor Closely (2)penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  penicillin G aqueous, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• penicillin VK

  Minor (1)penicillin VK, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown.

• pentazocine

  Minor (1)aspirin/citric acid/sodium bicarbonate, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• perindopril

  Monitor Closely (2)perindopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of perindopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• pexidartinib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

• phenindione

  Monitor Closely (1)phenindione and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• phenoxybenzamine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phentolamine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phytoestrogens

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

• pindolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  pindolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• piperacillin

  Minor (1)piperacillin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by plasma protein binding competition. Minor/Significance Unknown. Salicylic acid could be displaced from protein binding sites or it could itself displace other protein-bound drugs and result in an enhanced effect of the displaced drug

• pirbuterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and piroxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and piroxicam both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of piroxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• pivmecillinam

  Monitor Closely (2)pivmecillinam, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  pivmecillinam, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• potassium acid phosphate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium citrate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and potassium citrate both increase serum potassium. Use Caution/Monitor.

• pralatrexate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor.

• prasugrel

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, prasugrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• prazosin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• prednisolone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)prednisolone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• prednisone

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)prednisone decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• probenecid

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate decreases effects of probenecid by acidic (anionic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Aspirin decreases uricosuric action of probenecid.

• propranolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  propranolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• protamine

  Monitor Closely (1)protamine and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

• quinapril

  Monitor Closely (2)quinapril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of quinapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ramipril

  Monitor Closely (2)ramipril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of ramipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• reishi

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and reishi both increase anticoagulation. Use Caution/Monitor.

• reteplase

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• rilpivirine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

• riociguat

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

• rivaroxaban

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate, rivaroxaban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
  
  rivaroxaban, aspirin/citric acid/sodium bicarbonate. Other (see comment). Use Caution/Monitor. Comment: Aspirin are known to increase bleeding. Bleeding risk may be increased when aspirin is used concomitantly with rivaroxaban. Monitor for signs/symptoms of blood loss.

• rivastigmine

  Minor (1)rivastigmine increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

• rose hips

  Minor (3)aspirin/citric acid/sodium bicarbonate decreases levels of rose hips by increasing renal clearance. Minor/Significance Unknown.
  
  rose hips will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  rose hips increases levels of aspirin/citric acid/sodium bicarbonate by decreasing renal clearance. Minor/Significance Unknown.

• sacubitril/valsartan

  Monitor Closely (3)sacubitril/valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  sacubitril/valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and salsalate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and salsalate both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of salsalate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• sarecycline

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sertraline

  Monitor Closely (1)sertraline, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• Siberian ginseng

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

• silodosin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• sodium bicarbonate

  Minor (1)sodium bicarbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• sodium citrate/citric acid

  Minor (1)sodium citrate/citric acid, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of aspirin/citric acid/sodium bicarbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of aspirin/citric acid/sodium bicarbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

• sotalol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  sotalol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• sotorasib

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

• sparsentan

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of sparsentan by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer sparsentan 2 hours before or after administration of antacids. Antacids may decrease sparsentan exposure which may reduce efficacy of sparsentan.

• spironolactone

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. When used concomitantly, spironolactone dose may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained.
  
  spironolactone and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

• streptomycin

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• succinylcholine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfadiazine

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfamethoxazole

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, sulfamethoxazole. Either increases effects of the other by plasma protein binding competition. Use Caution/Monitor. Due to high protein binding capacity of both drugs, one may displace the other when coadministered leading to an enhanced effect of the displaced drug; risk is low with low dose aspirin.Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfasalazine

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• sulfisoxazole

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulindac

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and sulindac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and sulindac both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• telmisartan

  Monitor Closely (3)telmisartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  telmisartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• temocillin

  Monitor Closely (2)temocillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  temocillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• tenecteplase

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, tenecteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• teniposide

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.

• terazosin

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• terbutaline

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ticagrelor

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, ticagrelor. Other (see comment). Use Caution/Monitor. Comment: Maintenance doses of aspirin above 100 mg decreases effectiveness of ticagrelor. Therefore, after the initial loading dose of aspirin (usually 325 mg), use ticagrelor with a maintenance dose of aspirin of 75-100 mg.

• ticarcillin

  Monitor Closely (2)ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• ticlopidine

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate increases effects of ticlopidine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• tiludronate

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• timolol

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  timolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• tirofiban

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, tirofiban. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• tobramycin

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• tobramycin inhaled

  Monitor Closely (1)tobramycin inhaled and aspirin/citric acid/sodium bicarbonate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• tolazamide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolbutamide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin/citric acid/sodium bicarbonate increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolfenamic acid

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and tolfenamic acid both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• tolmetin

  Monitor Closely (2)aspirin/citric acid/sodium bicarbonate and tolmetin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate and tolmetin both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• tolvaptan

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trandolapril

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases effects of trandolapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• trazodone

  Monitor Closely (1)trazodone, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• triamcinolone acetonide injectable suspension

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)triamcinolone acetonide injectable suspension decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  Monitor Closely (1)triamterene and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.Minor (2)aspirin/citric acid/sodium bicarbonate increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.
  
  triamterene, aspirin/citric acid/sodium bicarbonate. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.

• valganciclovir

  Minor (1)aspirin/citric acid/sodium bicarbonate will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• valproic acid

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases levels of valproic acid by plasma protein binding competition. Use Caution/Monitor.

• valsartan

  Monitor Closely (3)valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

• vancomycin

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.

• varicella virus vaccine live

  Serious - Use Alternative (1)aspirin/citric acid/sodium bicarbonate, varicella virus vaccine live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.

• venlafaxine

  Monitor Closely (1)venlafaxine, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• verapamil

  Minor (1)verapamil increases effects of aspirin/citric acid/sodium bicarbonate by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• vismodegib

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

• vitamin K1 (phytonadione)

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• vorapaxar

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• willow bark

  Minor (2)aspirin/citric acid/sodium bicarbonate will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  willow bark increases effects of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Willow bark contains salicylic acid, which may have additive effects/toxicity with salicylate drugs.

• zafirlukast

  Minor (1)aspirin/citric acid/sodium bicarbonate increases levels of zafirlukast by unknown mechanism. Minor/Significance Unknown.

• zoledronic acid

  Minor (1)aspirin/citric acid/sodium bicarbonate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• zotepine

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.