aspirin rectal (OTC)

Antipyretic/Analgesic

300-600 mg PR q4-6hr PRN

Administration

Patient should lie on left side with knees bent

Remove protective wrap before inserting

Gently insert tip into rectum with slight side-to-side movement (tip of suppository pointing toward navel)

Antipyretic/Analgesic

<12 years: 10-15 mg/kg/dose PR q4-6hr; not to exceed 4 g/day

>12 years: As adults; 300-600 mg PR q4-6hr PRN

Renal Impairment

CrCl<10 mL: Not recommended

Hepatic Impairment

Not recommended

Administration

Patient should lie on left side with knees bent

Remove protective wrap before inserting

Gently insert tip into rectum with slight side-to-side movement (tip of suppository pointing toward navel)

Antipyretic/Analgesic

<12 years: 10-15 mg/kg/dose PR q4-6hr; not to exceed 4 g/day

>12 years: As adults; 300-600 mg PR q4-6hr PRN

Contraindicated (2)

• dichlorphenamide

  dichlorphenamide increases levels of aspirin rectal by unknown mechanism. Contraindicated. Coadministration of dichlorphenamide with high-dose aspirin may increase salicylate levels. Anorexia, tachypnea, lethargy, and coma reported.

• mifepristone

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

Serious - Use Alternative (26)

• abciximab

  aspirin rectal increases effects of abciximab by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• anagrelide

  aspirin rectal increases effects of anagrelide by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• benazepril

  aspirin rectal, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• captopril

  aspirin rectal, captopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• cilostazol

  aspirin rectal increases effects of cilostazol by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• clopidogrel

  aspirin rectal increases effects of clopidogrel by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• dipyridamole

  aspirin rectal increases effects of dipyridamole by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• enalapril

  aspirin rectal, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• eptifibatide

  aspirin rectal increases effects of eptifibatide by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• fosinopril

  aspirin rectal, fosinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• ibuprofen

  ibuprofen decreases effects of aspirin rectal 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 rectal 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.

• ketorolac

  aspirin rectal, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.

• lisinopril

  aspirin rectal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• measles, mumps, rubella and varicella vaccine, live

  aspirin rectal, 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 rectal increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. The relative risk of interaction of different NSAIDs w/methotrexate is not established. Selective COX 2 inhibitors are believed to have minimal interaction. Greater risk in pts. with renal impairment. Greater toxicity with high dose methotrexate (e.g., anti neoplastic regimen).

• moexipril

  aspirin rectal, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• pemetrexed

  aspirin rectal increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Especially in pts. w/mild moderate renal insufficiency. D/C NSAIDs 2 5 d before and 2 d after pemetrexed administration.

• perindopril

  aspirin rectal, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• probenecid

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

• quinapril

  aspirin rectal, quinapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• ramipril

  aspirin rectal, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• ticlopidine

  aspirin rectal increases effects of ticlopidine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• tirofiban

  aspirin rectal increases effects of tirofiban by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• trandolapril

  aspirin rectal, trandolapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• varicella virus vaccine live

  aspirin rectal, 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 (217)

• acebutolol

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

• aceclofenac

  aceclofenac and aspirin rectal both increase anticoagulation. Use Caution/Monitor.
  
  aceclofenac and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• acemetacin

  acemetacin and aspirin rectal both increase anticoagulation. Use Caution/Monitor.
  
  acemetacin and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• acetazolamide

  acetazolamide, aspirin rectal. 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 rectal. 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 rectal and agrimony both increase anticoagulation. Use Caution/Monitor.

• albuterol

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

• alfalfa

  aspirin rectal and alfalfa both increase anticoagulation. Use Caution/Monitor.

• alfuzosin

  aspirin rectal decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• aliskiren

  aspirin rectal will decrease the level or effect of aliskiren by Other (see comment). Use Caution/Monitor. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

• alteplase

  aspirin rectal and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• American ginseng

  aspirin rectal and American ginseng both increase anticoagulation. Use Caution/Monitor.

• amiloride

  amiloride and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• amoxicillin

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

• ampicillin

  ampicillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• antithrombin alfa

  antithrombin alfa and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• antithrombin III

  antithrombin III and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• arformoterol

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

• argatroban

  argatroban and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• asenapine

  aspirin rectal decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• atenolol

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

• azilsartan

  aspirin rectal, 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 rectal 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 rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• bendroflumethiazide

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

• betaxolol

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

• betrixaban

  aspirin rectal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

• bimatoprost

  bimatoprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• bisoprolol

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

• bivalirudin

  bivalirudin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• brinzolamide

  brinzolamide, aspirin rectal. 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 rectal, budesonide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

• bumetanide

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

• candesartan

  candesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• carbenoxolone

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

• carvedilol

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

• celecoxib

  aspirin rectal and celecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and celecoxib both increase serum potassium. Use Caution/Monitor.

• celiprolol

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

• chlorothiazide

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

• chlorpropamide

  aspirin rectal increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• chlorthalidone

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

• cinnamon

  aspirin rectal and cinnamon both increase anticoagulation. Use Caution/Monitor.

• citalopram

  citalopram, aspirin rectal. 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 rectal. 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

  clopidogrel, aspirin rectal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.

• cordyceps

  aspirin rectal and cordyceps both increase anticoagulation. Use Caution/Monitor.

• cortisone

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

• cyclopenthiazide

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

• dabigatran

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

• dalteparin

  dalteparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• defibrotide

  defibrotide increases effects of aspirin rectal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.

• deflazacort

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

• dexamethasone

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

• diclofenac

  aspirin rectal and diclofenac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and diclofenac both increase serum potassium. Use Caution/Monitor.

• dicloxacillin

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

• diflunisal

  aspirin rectal and diflunisal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and diflunisal both increase serum potassium. Use Caution/Monitor.

• digoxin

  aspirin rectal and digoxin both increase serum potassium. Use Caution/Monitor.

• dobutamine

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

• dong quai

  aspirin rectal and dong quai both increase anticoagulation. Use Caution/Monitor.

• dopexamine

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

• doxazosin

  aspirin rectal decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• drospirenone

  drospirenone and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

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

• edoxaban

  edoxaban, aspirin rectal. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss.

• eltrombopag

  eltrombopag increases levels of aspirin rectal by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF, aspirin rectal. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.

• enoxaparin

  enoxaparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• ephedrine

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

• epinephrine

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

• epinephrine racemic

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

• epoprostenol

  aspirin rectal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

• eprosartan

  eprosartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• escitalopram

  escitalopram, aspirin rectal. 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

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

• ethacrynic acid

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

• etodolac

  aspirin rectal and etodolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and etodolac both increase serum potassium. Use Caution/Monitor.

• fenbufen

  aspirin rectal and fenbufen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and fenbufen both increase serum potassium. Use Caution/Monitor.

• fennel

  aspirin rectal and fennel both increase anticoagulation. Use Caution/Monitor.

• fenoprofen

  aspirin rectal and fenoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and fenoprofen both increase serum potassium. Use Caution/Monitor.

• feverfew

  aspirin rectal and feverfew both increase anticoagulation. Use Caution/Monitor.

• fish oil triglycerides

  fish oil triglycerides will increase the level or effect of aspirin rectal by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fludrocortisone

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

• fluoxetine

  fluoxetine, aspirin rectal. 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 rectal and flurbiprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and flurbiprofen both increase serum potassium. Use Caution/Monitor.

• fluvoxamine

  fluvoxamine, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

• fondaparinux

  fondaparinux and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• formoterol

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

• forskolin

  aspirin rectal and forskolin both increase anticoagulation. Use Caution/Monitor.

• furosemide

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

• garlic

  aspirin rectal and garlic both increase anticoagulation. Use Caution/Monitor.

• gentamicin

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

• ginger

  aspirin rectal and ginger both increase anticoagulation. Use Caution/Monitor.

• ginkgo biloba

  aspirin rectal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

• glimepiride

  aspirin rectal increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• glipizide

  aspirin rectal increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• glyburide

  aspirin rectal increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• green tea

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

• griseofulvin

  griseofulvin decreases levels of aspirin rectal by unknown mechanism. Use Caution/Monitor.

• heparin

  heparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• horse chestnut seed

  aspirin rectal and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

• hyaluronidase

  aspirin rectal 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 rectal decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• hydrochlorothiazide

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

• hydrocortisone

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

• ibrutinib

  ibrutinib will increase the level or effect of aspirin rectal by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  aspirin rectal and ibuprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and ibuprofen both increase serum potassium. Use Caution/Monitor.

• ibuprofen IV

  aspirin rectal will increase the level or effect of ibuprofen IV by acidic (anionic) drug competition for renal tubular clearance. Modify Therapy/Monitor Closely.
  
  aspirin rectal and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.
  
  aspirin rectal and ibuprofen IV both increase serum potassium. Modify Therapy/Monitor Closely.

• icosapent

  icosapent, aspirin rectal. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• imatinib

  imatinib, aspirin rectal. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.

• indapamide

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

• indomethacin

  aspirin rectal and indomethacin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and indomethacin both increase serum potassium. Use Caution/Monitor.

• irbesartan

  irbesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• isoproterenol

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

• ketoprofen

  aspirin rectal and ketoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and ketoprofen both increase serum potassium. Use Caution/Monitor.

• ketorolac

  aspirin rectal and ketorolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and ketorolac both increase serum potassium. Use Caution/Monitor.

• labetalol

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

• latanoprost

  latanoprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• latanoprostene bunod ophthalmic

  latanoprostene bunod ophthalmic, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• levalbuterol

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

• levomilnacipran

  levomilnacipran, aspirin rectal. 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.

• lithium

  aspirin rectal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

• lornoxicam

  aspirin rectal and lornoxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and lornoxicam both increase serum potassium. Use Caution/Monitor.

• losartan

  losartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• meclofenamate

  aspirin rectal and meclofenamate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and meclofenamate both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  aspirin rectal and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and mefenamic acid both increase serum potassium. Use Caution/Monitor.

• meloxicam

  aspirin rectal and meloxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and meloxicam both increase serum potassium. Use Caution/Monitor.

• mesalamine

  mesalamine, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.

• metaproterenol

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

• methazolamide

  methazolamide, aspirin rectal. 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 rectal will increase the level or effect of methotrexate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

• methylprednisolone

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

• metolazone

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

• metoprolol

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

• milnacipran

  milnacipran, aspirin rectal. 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 rectal increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• moxisylyte

  aspirin rectal decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• mycophenolate

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

• nabumetone

  aspirin rectal and nabumetone both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and nabumetone both increase serum potassium. Use Caution/Monitor.

• nadolol

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

• nafcillin

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

• naproxen

  aspirin rectal and naproxen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and naproxen both increase serum potassium. Use Caution/Monitor.

• nebivolol

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

• nefazodone

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

• nettle

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

• norepinephrine

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

• olmesartan

  olmesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• oxacillin

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

• oxaprozin

  aspirin rectal and oxaprozin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and oxaprozin both increase serum potassium. Use Caution/Monitor.

• panax ginseng

  aspirin rectal and panax ginseng both increase anticoagulation. Use Caution/Monitor.

• parecoxib

  aspirin rectal and parecoxib both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and parecoxib both increase serum potassium. Use Caution/Monitor.

• paroxetine

  paroxetine, aspirin rectal. 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 rectal and pau d'arco both increase anticoagulation. Use Caution/Monitor.

• penbutolol

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

• penicillin G aqueous

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

• phenindione

  phenindione and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• phenoxybenzamine

  aspirin rectal decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phentolamine

  aspirin rectal decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• phytoestrogens

  aspirin rectal and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

• pindolol

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

• pirbuterol

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

• piroxicam

  aspirin rectal and piroxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and piroxicam both increase serum potassium. Use Caution/Monitor.

• pivmecillinam

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

• potassium acid phosphate

  aspirin rectal and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  aspirin rectal and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium citrate

  aspirin rectal and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium iodide

  potassium iodide and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• pralatrexate

  aspirin rectal increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor.

• prasugrel

  aspirin rectal, prasugrel. 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 rectal decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• prednisolone

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

• prednisone

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

• propranolol

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

• protamine

  protamine and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• reishi

  aspirin rectal and reishi both increase anticoagulation. Use Caution/Monitor.

• reteplase

  aspirin rectal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• sacubitril/valsartan

  sacubitril/valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  aspirin rectal and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

• salmeterol

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

• salsalate

  aspirin rectal and salsalate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and salsalate both increase serum potassium. Use Caution/Monitor.

• saw palmetto

  saw palmetto increases toxicity of aspirin rectal by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

• sertraline

  sertraline, aspirin rectal. 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 rectal and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

• silodosin

  aspirin rectal decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  aspirin rectal, 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 rectal 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 rectal 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.

• sotalol

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

• sparsentan

  aspirin rectal and sparsentan both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Coadministration of NSAIDS, including selective COX-2 inhibitors, may result in deterioration of kidney function (eg, possible kidney failure). Monitor for signs of worsening renal function with concomitant use with NSAIDs.

• spironolactone

  spironolactone and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.
  
  aspirin rectal 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 rectal and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfasalazine

  aspirin rectal and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and sulfasalazine both increase serum potassium. Use Caution/Monitor.

• sulindac

  aspirin rectal and sulindac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and sulindac both increase serum potassium. Use Caution/Monitor.

• tafluprost

  tafluprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• telmisartan

  telmisartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• temocillin

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

• tenecteplase

  aspirin rectal and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• terazosin

  aspirin rectal decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• terbutaline

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

• ticarcillin

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

• timolol

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

• tolazamide

  aspirin rectal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• tolbutamide

  aspirin rectal increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

• tolfenamic acid

  aspirin rectal and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

• tolmetin

  aspirin rectal and tolmetin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and tolmetin both increase serum potassium. Use Caution/Monitor.

• tolvaptan

  aspirin rectal and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

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

• travoprost ophthalmic

  travoprost ophthalmic, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• trazodone

  trazodone, aspirin rectal. 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 rectal, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Aspirin in conjunction with corticosteroids in hypoprothrombinemia should used with caution. Clearance of salicylates may increase with concurrent use of corticosteroids.

• triamterene

  triamterene and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• valproic acid

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

• valsartan

  valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• venlafaxine

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

• vitamin K1 (phytonadione)

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

• voclosporin

  voclosporin, aspirin rectal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

• vorapaxar

  aspirin rectal, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur.

• vortioxetine

  aspirin rectal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Risk minimal with low-dose aspirin.

• zanubrutinib

  aspirin rectal, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• zotepine

  aspirin rectal decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

Minor (118)

• aceclofenac

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

• acemetacin

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

• acyclovir

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

• alendronate

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

• aluminum hydroxide

  aluminum hydroxide, aspirin rectal. 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 rectal increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• aminohippurate sodium

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

• anamu

  aspirin rectal and anamu both increase anticoagulation. Minor/Significance Unknown.

• ascorbic acid

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

• balsalazide

  aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• bismuth subsalicylate

  bismuth subsalicylate increases effects of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown.

• budesonide

  budesonide decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• bumetanide

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

• calcium carbonate

  calcium carbonate, aspirin rectal. 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• cefamandole

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

• cefepime

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

• cefixime

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

• cefpirome

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

• cefprozil

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

• ceftazidime

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

• ceftibuten

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

• celecoxib

  aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chlorothiazide

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

• chlorpropamide

  aspirin rectal will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
  
  aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chromium

  aspirin rectal increases levels of chromium by unspecified interaction mechanism. Minor/Significance Unknown.

• clopidogrel

  clopidogrel increases levels of aspirin rectal by decreasing metabolism. Minor/Significance Unknown.

• cortisone

  cortisone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• creatine

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

• cyanocobalamin

  aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• danshen

  aspirin rectal and danshen both increase anticoagulation. Minor/Significance Unknown.

• deflazacort

  deflazacort decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• devil's claw

  aspirin rectal and devil's claw both increase anticoagulation. Minor/Significance Unknown.

• dexamethasone

  dexamethasone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• dexrazoxane

  aspirin rectal increases levels of dexrazoxane by unspecified interaction mechanism. Minor/Significance Unknown.

• diclofenac

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

• diflunisal

  aspirin rectal 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 rectal by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• eplerenone

  aspirin rectal decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• ethanol

  ethanol increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• etodolac

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

• fenbufen

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

• fenoprofen

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

• feverfew

  aspirin rectal decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• flurbiprofen

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

• folic acid

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

• furosemide

  aspirin rectal decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• ganciclovir

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

• gentamicin

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

• glimepiride

  aspirin rectal increases effects of glimepiride by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glipizide

  aspirin rectal increases effects of glipizide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• glyburide

  aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• ibuprofen

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

• imidapril

  aspirin rectal decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

• indapamide

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

• indomethacin

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

• insulin aspart

  aspirin rectal increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin lispro

  aspirin rectal increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• insulin regular human

  aspirin rectal increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.

• ketoprofen

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

• ketorolac

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

• L-methylfolate

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

• lornoxicam

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

• meclofenamate

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

• mefenamic acid

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

• meloxicam

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

• mesalamine

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

• methylprednisolone

  methylprednisolone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• metolazone

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

• nabumetone

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

• naproxen

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

• neomycin PO

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

• noni juice

  aspirin rectal and noni juice both increase serum potassium. Minor/Significance Unknown.

• ofloxacin

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

• oxaprozin

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

• parecoxib

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

• paromomycin

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

• pegaspargase

  pegaspargase increases effects of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of bleeding events.

• penicillin VK

  penicillin VK, aspirin rectal. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown.

• pentazocine

  aspirin rectal, 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 rectal 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 rectal 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• prednisone

  prednisone decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• rivastigmine

  rivastigmine increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

• rose hips

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

• salicylates (non-asa)

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

• salsalate

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

• sulfadiazine

  aspirin rectal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfamethoxazole

  aspirin rectal increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfasalazine

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

• sulfisoxazole

  aspirin rectal increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulindac

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

• teniposide

  aspirin rectal increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.

• tiludronate

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

• tobramycin

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

• tolazamide

  aspirin rectal increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolbutamide

  aspirin rectal increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

• tolfenamic acid

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

• tolmetin

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

• triamcinolone acetonide injectable suspension

  triamcinolone acetonide injectable suspension decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• triamterene

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

• valganciclovir

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

• vancomycin

  aspirin rectal increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.

• verapamil

  verapamil increases effects of aspirin rectal by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• willow bark

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

• zafirlukast

  aspirin rectal increases levels of zafirlukast by unknown mechanism. Minor/Significance Unknown.

• zoledronic acid

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

• abciximab

  Serious - Use Alternative (1)aspirin rectal increases effects of abciximab by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• acebutolol

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

• aceclofenac

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

• acemetacin

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

• acetazolamide

  Monitor Closely (2)acetazolamide, aspirin rectal. 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 rectal. 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 rectal 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 rectal and agrimony both increase anticoagulation. Use Caution/Monitor.

• albuterol

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

• alendronate

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

• alfalfa

  Monitor Closely (1)aspirin rectal and alfalfa both increase anticoagulation. Use Caution/Monitor.

• alfuzosin

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

• aliskiren

  Monitor Closely (1)aspirin rectal will decrease the level or effect of aliskiren by Other (see comment). Use Caution/Monitor. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

• alteplase

  Monitor Closely (1)aspirin rectal and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• aluminum hydroxide

  Minor (1)aluminum hydroxide, aspirin rectal. 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 rectal and American ginseng both increase anticoagulation. Use Caution/Monitor.

• amikacin

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

• amiloride

  Monitor Closely (1)amiloride and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• aminohippurate sodium

  Minor (1)aspirin rectal 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 rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  amoxicillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• ampicillin

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

• anagrelide

  Serious - Use Alternative (1)aspirin rectal increases effects of anagrelide by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• anamu

  Minor (1)aspirin rectal and anamu both increase anticoagulation. Minor/Significance Unknown.

• antithrombin alfa

  Monitor Closely (1)antithrombin alfa and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• antithrombin III

  Monitor Closely (1)antithrombin III and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• arformoterol

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

• argatroban

  Monitor Closely (1)argatroban and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• ascorbic acid

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

• asenapine

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

• atenolol

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

• azilsartan

  Monitor Closely (2)aspirin rectal, 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 rectal 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.

• balsalazide

  Minor (1)aspirin rectal 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 rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• benazepril

  Serious - Use Alternative (1)aspirin rectal, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• bendroflumethiazide

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• betaxolol

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

• betrixaban

  Monitor Closely (1)aspirin rectal, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

• bimatoprost

  Monitor Closely (1)bimatoprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• bismuth subsalicylate

  Minor (1)bismuth subsalicylate increases effects of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown.

• bisoprolol

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

• bivalirudin

  Monitor Closely (1)bivalirudin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• brinzolamide

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

• bumetanide

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

• calcium carbonate

  Minor (1)calcium carbonate, aspirin rectal. 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 (1)candesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• captopril

  Serious - Use Alternative (1)aspirin rectal, captopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• carbenoxolone

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

• carvedilol

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

• cefadroxil

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

• cefamandole

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

• cefepime

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

• cefixime

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

• cefpirome

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

• cefprozil

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

• ceftazidime

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

• ceftibuten

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

• celecoxib

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

• cephalexin

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

• chlorothiazide

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chlorpropamide

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

• chlorthalidone

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• chromium

  Minor (1)aspirin rectal increases levels of chromium by unspecified interaction mechanism. Minor/Significance Unknown.

• cilostazol

  Serious - Use Alternative (1)aspirin rectal increases effects of cilostazol by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• cinnamon

  Monitor Closely (1)aspirin rectal and cinnamon both increase anticoagulation. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)citalopram, aspirin rectal. 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 rectal. 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)clopidogrel, aspirin rectal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.Serious - Use Alternative (1)aspirin rectal increases effects of clopidogrel by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.Minor (1)clopidogrel increases levels of aspirin rectal by decreasing metabolism. Minor/Significance Unknown.

• cordyceps

  Monitor Closely (1)aspirin rectal and cordyceps both increase anticoagulation. Use Caution/Monitor.

• cortisone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• creatine

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

• cyanocobalamin

  Minor (1)aspirin rectal 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 rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• dabigatran

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

• dalteparin

  Monitor Closely (1)dalteparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• danshen

  Minor (1)aspirin rectal and danshen both increase anticoagulation. Minor/Significance Unknown.

• defibrotide

  Monitor Closely (1)defibrotide increases effects of aspirin rectal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.

• deflazacort

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• devil's claw

  Minor (1)aspirin rectal and devil's claw both increase anticoagulation. Minor/Significance Unknown.

• dexamethasone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• dexrazoxane

  Minor (1)aspirin rectal increases levels of dexrazoxane by unspecified interaction mechanism. Minor/Significance Unknown.

• dichlorphenamide

  Contraindicated (1)dichlorphenamide increases levels of aspirin rectal by unknown mechanism. Contraindicated. Coadministration of dichlorphenamide with high-dose aspirin may increase salicylate levels. Anorexia, tachypnea, lethargy, and coma reported.

• diclofenac

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

• dicloxacillin

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

• diflunisal

  Monitor Closely (2)aspirin rectal and diflunisal both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and diflunisal both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and digoxin both increase serum potassium. Use Caution/Monitor.

• diltiazem

  Minor (1)diltiazem increases effects of aspirin rectal by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• dipyridamole

  Serious - Use Alternative (1)aspirin rectal increases effects of dipyridamole by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• dobutamine

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

• dong quai

  Monitor Closely (1)aspirin rectal and dong quai both increase anticoagulation. Use Caution/Monitor.

• dopexamine

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

• doxazosin

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

• drospirenone

  Monitor Closely (1)drospirenone and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

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

• edoxaban

  Monitor Closely (1)edoxaban, aspirin rectal. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss.

• eltrombopag

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

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF, aspirin rectal. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.

• enalapril

  Serious - Use Alternative (1)aspirin rectal, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• enoxaparin

  Monitor Closely (1)enoxaparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• ephedrine

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

• epinephrine

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

• epinephrine racemic

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

• eplerenone

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

• epoprostenol

  Monitor Closely (1)aspirin rectal and epoprostenol both increase anticoagulation. Use Caution/Monitor.

• eprosartan

  Monitor Closely (1)eprosartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• eptifibatide

  Serious - Use Alternative (1)aspirin rectal increases effects of eptifibatide by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• escitalopram

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

• ethacrynic acid

  Monitor Closely (1)aspirin rectal 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 rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• etodolac

  Monitor Closely (2)aspirin rectal and etodolac both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and etodolac both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and fenbufen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and fenbufen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and fennel both increase anticoagulation. Use Caution/Monitor.

• fenoprofen

  Monitor Closely (2)aspirin rectal and fenoprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and fenoprofen both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and feverfew both increase anticoagulation. Use Caution/Monitor.Minor (1)aspirin rectal decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

• fish oil triglycerides

  Monitor Closely (1)fish oil triglycerides will increase the level or effect of aspirin rectal by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fludrocortisone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• fluoxetine

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

• fluvoxamine

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

• folic acid

  Minor (1)aspirin rectal 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 rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• formoterol

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

• forskolin

  Monitor Closely (1)aspirin rectal and forskolin both increase anticoagulation. Use Caution/Monitor.

• fosinopril

  Serious - Use Alternative (1)aspirin rectal, fosinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• furosemide

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

• ganciclovir

  Minor (1)aspirin rectal 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 rectal and garlic both increase anticoagulation. Use Caution/Monitor.

• gentamicin

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

• ginger

  Monitor Closely (1)aspirin rectal and ginger both increase anticoagulation. Use Caution/Monitor.

• ginkgo biloba

  Monitor Closely (1)aspirin rectal and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.

• glimepiride

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

• glipizide

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

• glyburide

  Monitor Closely (1)aspirin rectal increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)aspirin rectal 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 rectal 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 rectal by unknown mechanism. Use Caution/Monitor.

• heparin

  Monitor Closely (1)heparin and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• horse chestnut seed

  Monitor Closely (1)aspirin rectal and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.

• hyaluronidase

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

• hydrochlorothiazide

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• hydrocortisone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• ibrutinib

  Monitor Closely (1)ibrutinib will increase the level or effect of aspirin rectal by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  Monitor Closely (2)aspirin rectal and ibuprofen both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and ibuprofen both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)ibuprofen decreases effects of aspirin rectal 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 rectal 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 rectal will increase the level or effect of ibuprofen IV by acidic (anionic) drug competition for renal tubular clearance. Modify Therapy/Monitor Closely.
  
  aspirin rectal and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.
  
  aspirin rectal and ibuprofen IV both increase serum potassium. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)ibuprofen IV decreases effects of aspirin rectal 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 rectal. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.

• imatinib

  Monitor Closely (1)imatinib, aspirin rectal. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.

• imidapril

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

• indapamide

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• indomethacin

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

• insulin aspart

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

• insulin lispro

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

• insulin regular human

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

• irbesartan

  Monitor Closely (1)irbesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• isoproterenol

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

• ketoprofen

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

• L-methylfolate

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

• latanoprost

  Monitor Closely (1)latanoprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• latanoprostene bunod ophthalmic

  Monitor Closely (1)latanoprostene bunod ophthalmic, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• levalbuterol

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

• levomilnacipran

  Monitor Closely (1)levomilnacipran, aspirin rectal. 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.

• lisinopril

  Serious - Use Alternative (1)aspirin rectal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• lithium

  Monitor Closely (1)aspirin rectal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

• lornoxicam

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

• losartan

  Monitor Closely (1)losartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• measles, mumps, rubella and varicella vaccine, live

  Serious - Use Alternative (1)aspirin rectal, 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 rectal and meclofenamate both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and meclofenamate both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and mefenamic acid both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and meloxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and meloxicam both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.Minor (1)aspirin rectal 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 rectal increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• methazolamide

  Monitor Closely (1)methazolamide, aspirin rectal. 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 rectal 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 rectal increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. The relative risk of interaction of different NSAIDs w/methotrexate is not established. Selective COX 2 inhibitors are believed to have minimal interaction. Greater risk in pts. with renal impairment. Greater toxicity with high dose methotrexate (e.g., anti neoplastic regimen).

• methylprednisolone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• metolazone

  Monitor Closely (1)aspirin rectal 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 rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

• metoprolol

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

• mifepristone

  Contraindicated (1)aspirin rectal, 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 rectal. 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 rectal increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• moexipril

  Serious - Use Alternative (1)aspirin rectal, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• moxisylyte

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

• mycophenolate

  Monitor Closely (1)aspirin rectal 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 rectal and nabumetone both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and nabumetone both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nadolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• nafcillin

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

• naproxen

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

• nefazodone

  Monitor Closely (1)nefazodone, aspirin rectal. 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 rectal increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

• nettle

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

• noni juice

  Minor (1)aspirin rectal and noni juice both increase serum potassium. Minor/Significance Unknown.

• norepinephrine

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

• ofloxacin

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

• olmesartan

  Monitor Closely (1)olmesartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• oxacillin

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

• oxaprozin

  Monitor Closely (2)aspirin rectal and oxaprozin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and oxaprozin both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and panax ginseng both increase anticoagulation. Use Caution/Monitor.

• parecoxib

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

• paromomycin

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

• paroxetine

  Monitor Closely (1)paroxetine, aspirin rectal. 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 rectal and pau d'arco both increase anticoagulation. Use Caution/Monitor.

• pegaspargase

  Minor (1)pegaspargase increases effects of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of bleeding events.

• pemetrexed

  Serious - Use Alternative (1)aspirin rectal increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Especially in pts. w/mild moderate renal insufficiency. D/C NSAIDs 2 5 d before and 2 d after pemetrexed administration.

• penbutolol

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

• penicillin G aqueous

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

• penicillin VK

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

• pentazocine

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

• perindopril

  Serious - Use Alternative (1)aspirin rectal, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• phenindione

  Monitor Closely (1)phenindione and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• phenoxybenzamine

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

• phentolamine

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

• phytoestrogens

  Monitor Closely (1)aspirin rectal and phytoestrogens both increase anticoagulation. Use Caution/Monitor.

• pindolol

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

• piperacillin

  Minor (1)piperacillin will increase the level or effect of aspirin rectal 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 rectal increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• piroxicam

  Monitor Closely (2)aspirin rectal and piroxicam both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and piroxicam both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
  
  pivmecillinam, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

• potassium acid phosphate

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

• potassium chloride

  Monitor Closely (1)aspirin rectal and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium citrate

  Monitor Closely (1)aspirin rectal and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium iodide

  Monitor Closely (1)potassium iodide and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• pralatrexate

  Monitor Closely (1)aspirin rectal increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor.

• prasugrel

  Monitor Closely (1)aspirin rectal, prasugrel. 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 rectal decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.

• prednisolone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• prednisone

  Monitor Closely (1)aspirin rectal, 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 rectal by increasing renal clearance. Minor/Significance Unknown.

• probenecid

  Serious - Use Alternative (1)aspirin rectal 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 rectal decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  propranolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• protamine

  Monitor Closely (1)protamine and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

• quinapril

  Serious - Use Alternative (1)aspirin rectal, quinapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• ramipril

  Serious - Use Alternative (1)aspirin rectal, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• reishi

  Monitor Closely (1)aspirin rectal and reishi both increase anticoagulation. Use Caution/Monitor.

• reteplase

  Monitor Closely (1)aspirin rectal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• rivastigmine

  Minor (1)rivastigmine increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased GI symptoms.

• rose hips

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

• sacubitril/valsartan

  Monitor Closely (1)sacubitril/valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  Monitor Closely (2)aspirin rectal and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• salsalate

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

• saw palmetto

  Monitor Closely (1)saw palmetto increases toxicity of aspirin rectal by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

• sertraline

  Monitor Closely (1)sertraline, aspirin rectal. 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 rectal and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.

• silodosin

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

• sodium bicarbonate

  Minor (1)sodium bicarbonate, aspirin rectal. 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 rectal. 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 rectal, 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 rectal 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 rectal 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.

• sotalol

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

• sparsentan

  Monitor Closely (1)aspirin rectal and sparsentan both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Coadministration of NSAIDS, including selective COX-2 inhibitors, may result in deterioration of kidney function (eg, possible kidney failure). Monitor for signs of worsening renal function with concomitant use with NSAIDs.

• spironolactone

  Monitor Closely (2)aspirin rectal 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 rectal both increase serum potassium. Modify Therapy/Monitor Closely.

• streptomycin

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

• succinylcholine

  Monitor Closely (1)aspirin rectal and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfadiazine

  Minor (1)aspirin rectal increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfamethoxazole

  Minor (1)aspirin rectal increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulfasalazine

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

• sulfisoxazole

  Minor (1)aspirin rectal increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

• sulindac

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

• tafluprost

  Monitor Closely (1)tafluprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• telmisartan

  Monitor Closely (1)telmisartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• temocillin

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

• tenecteplase

  Monitor Closely (1)aspirin rectal and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

• teniposide

  Minor (1)aspirin rectal increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.

• terazosin

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

• terbutaline

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

• ticarcillin

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

• ticlopidine

  Serious - Use Alternative (1)aspirin rectal increases effects of ticlopidine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• tiludronate

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

• tirofiban

  Serious - Use Alternative (1)aspirin rectal increases effects of tirofiban by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• tobramycin

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

• tolazamide

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

• tolbutamide

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

• tolfenamic acid

  Monitor Closely (2)aspirin rectal and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and tolfenamic acid both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and tolmetin both increase anticoagulation. Use Caution/Monitor.
  
  aspirin rectal and tolmetin both increase serum potassium. Use Caution/Monitor.Minor (1)aspirin rectal 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 rectal and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

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

• trandolapril

  Serious - Use Alternative (1)aspirin rectal, trandolapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

• travoprost ophthalmic

  Monitor Closely (1)travoprost ophthalmic, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

• trazodone

  Monitor Closely (1)trazodone, aspirin rectal. 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 rectal, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Aspirin in conjunction with corticosteroids in hypoprothrombinemia should used with caution. Clearance of salicylates may increase with concurrent use of corticosteroids.Minor (1)triamcinolone acetonide injectable suspension decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

• triamterene

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

• valganciclovir

  Minor (1)aspirin rectal 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 rectal increases levels of valproic acid by plasma protein binding competition. Use Caution/Monitor.

• valsartan

  Monitor Closely (1)valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• vancomycin

  Minor (1)aspirin rectal 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 rectal, 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 rectal. 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 rectal by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.

• vitamin K1 (phytonadione)

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

• voclosporin

  Monitor Closely (1)voclosporin, aspirin rectal. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

• vorapaxar

  Monitor Closely (1)aspirin rectal, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur.

• vortioxetine

  Monitor Closely (1)aspirin rectal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Risk minimal with low-dose aspirin.

• willow bark

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

• zafirlukast

  Minor (1)aspirin rectal increases levels of zafirlukast by unknown mechanism. Minor/Significance Unknown.

• zanubrutinib

  Monitor Closely (1)aspirin rectal, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• zoledronic acid

  Minor (1)aspirin rectal 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 rectal decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.