Diclofenac-Misoprostol

Diclofenac decreases the amount of calcium lost in the urine, which may help prevent bone loss in postmenopausal women.

Indomethacin has been reported to decrease absorption of folic acid and vitamin C. Under certain circumstances, indomethacin may interfere with the actions of vitamin C.Calcium and phosphate levels may also be reduced with indomethacin therapy. It remains unclear whether people taking this drug need to supplement any of these nutrients.

NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss. Iron supplements can cause GI irritation. However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency. If both iron and nabumetone are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

Diclofenac causes complex changes to L-tryptophan levels in the blood, but the clinical implications of this are unknown. More research is needed to determine whether supplementation with L-tryptophan is a good idea for people taking diclofenac.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Elevated calcium and vitamin D blood levels are commonly found in people with sarcoidosis. In one individual with sarcoidosis, taking flubiprofen lowered elevated blood calcium levels, but did not alter the concentration of vitamin D. One controlled study showed that flurbiprofen reduced blood levels of vitamin D in people with frequent calcium kidney stones. Further research is needed to determine whether flurbiprofen reduces blood calcium and vitamin D levels in healthy people.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The flavonoids found in the extract of licorice (Glycyrrhiza glabra) known as DGL (deglycyrrhizinated licorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin. DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.

Nonsteroidal anti-inflammatory drugs commonly cause damage to stomach and intestinal tissue. Though the mechanism by which NSAIDs cause this side effect is unknown, some researchers believe that free-radical damage is involved. A test tube study showed that flurbiprofen increases free-radical activity in stomach cells, which is blocked by the antioxidant N-acetyl cysteine. Additional research is needed to determine whether people taking flurbiprofen together with N-acetyl cysteine might experience fewer gastrointestinal side effects.

Willow bark (Salix alba) contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of aspirin to individuals taking diclofenac results in a significant reduction in blood levels of diclofenac. Though there are no studies investigating interactions between willow bark and diclofenac, people taking the drug should avoid the herb until more information is available.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

A common side effect of misoprostol is diarrhea, which is aggravated by taking magnesium. Consequently, individuals who experience diarrhea while taking misoprostol should avoid magnesium supplementation.

White willow bark (Salix alba) contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs. Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

In a study of healthy volunteers, the rise in blood levels of diclofenac was significantly greater and the clearance of the drug was significantly slower when the volunteers were pretreated with 500 mg of resveratrol per day for 10 days than when they did not receive resveratrol. Thus, taking resveratrol could increase both the efficacy and the adverse effects of diclofenac. People interested in taking both diclofenac and resveratrol should consult a doctor.

Piroxicam may prevent inflammation by blocking the activity of enzymes that depend on folic acid. However, other studies show that people taking NSAIDs such as aspirin have lower than normal levels of folic acid in their red blood cells. Further research is needed to determine whether supplemental folic acid prevents a deficiency of the vitamin or indirectly reduces the beneficial effects of piroxicam.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.