How does ibuprofen reduce fever

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen is a Generic name for a drug containing the same name active ingredient. It is used as a pain reliever for various conditions such as: headaches, dental pain, muscle pain, tendinitis (inflammation or irritation of a tendon, a thick cord that attaches bone to muscle), menstrual cramps, and for the treatment of pain, swelling and joint stiffness caused by arthritis, osteoarthritis, juvenile arthritis, bursitis, ankylosing spondylitis, psoriatic arthritis and gout. It can also be used to temporarily reduce fever and for the treatment of common cold symptoms. Ibuprofen may be used intravascular with opiates for relieving moderate to severe pain. Ibuprofen lysine may be also used intravscular as a therapy for premature neonates with ductus arteriosus.

Ibuprofen is available in following dosage forms and strengths: capsule, capsule liquid filled, capsule coated (200, 220 and 400 mg), injection (100mg/ml), oral liquid (100 mg/5mL and 50 mg/1.25mL), solution (100 mg, 100 mg/5mL), suspension (100 mg, 200 mg/10mL, 100 mg/5mL) and tablet (200, 300, 400, 600 and 800 mg).

Common Brand names for ibuprofen are: Advil, Motrin, Brufen, Calprofen, Genpril, Ibu, Midol, Nuprin, Cuprofen, Nurofen, Ibuprofen 800 and PediaCare Children’s Pain Reliever/Fever Reducer IB.

What is Excedrin

Excedrin is a Brand name for a drug containing a combination of acetaminophen, aspirin, and caffeine. Acetaminophen works as fever reducer and weak pain reliever. Aspirin works by reducing body substances that can cause inflammation, pain and fever. Caffeine works as a stimulant of the central nervous system, and it can add analgesic effects of NSAID drugs when they are used together. In blood vessels, it relaxes muscle contractions improving blood flow.

Excedrin is used for the treatment of pain that can be caused by migraine headaches, tension headaches, menstrual cramps, muscle aches, arthritis and toothaches. It is also used as for a treatment of a common cold, or nasal congestion.

Other Brand names on the market for the drugs containing acetaminophen, aspirin, and caffeine are: Arthriten, Backaid IPF, Anacin Advanced Headache Formula, Goody’s Headache Powders, Pamprin Max and Pain Reliever Plus.

How does Ibuprofen and Excedrin work in the body

Ibuprofen inhibits synthesis of prostaglandins (substances in the body that play a key role in pain and inflammation processes in body tissues) by inhibiting at least 2 cyclooxygenase (COX) isoenzymes, COX-1 and COX-2. Inhibition of COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects while the inhibition of COX-1 may cause gastrointestinal bleeding and ulcers. Ibuprofen has the lowest risk of causing gastrointestinal bleeding of all NSAID, producing balanced inhibitory effects on both COX-1 and COX-2 isoenzymes. But, this advantage is lost at high doses. This drug may also inhibit chemotaxis, decrease proinflammatory cytokine activity, alter lymphocyte activity, and inhibit neutrophil aggregation – these effects may also contribute to anti-inflammatory activity.

Acetylsalicylic acid works by irreversibly inhibition of the activity of both types of cyclooxygenase COX-1 and COX-2 by decreasing the formation of precursors of prostaglandins and thromboxanes from arachidonic acid. This makes acetylsalicylic acid different from other NSAIDS drugs such as ibuprofen or diclofenac which are reversible inhibitors of COX enzymes. In platelets low-doses of aspirin (75-100 mg) can irreversibly blocks the production of thromboxane A₂, producing an inhibitory effect on platelet aggregation during the lifetime of the platelet which is 8–9 days. This property makes aspirin useful for reducing the incidence of heart attacks.

Acetaminophen is highly selective COX-2 inhibitor that inhibits prostaglandin synthesis. It can inhibit COX-2 in CNS. Acetaminophen also acts on the hypothalamic heat regulating centers to produce antipyresis. Acetaminophen’s reactive metabolite N-acetyl-p-benzoquinone imine (NAPQI) can cause a potentially fatal, hepatic necrosis through the process of lipid peroxidation if acetaminophen is overdosed (more than 4g daily).

Caffeine is commonly added to common analgesics such as ibuprofen, acetaminophen and aspirin, because many studies suggest that it accelerate absorption and enhances analgesic efficacy of this drugs.

Can patients take Ibuprofen and Excedrin together

Patient should not use Ibuprofen and Excedrin together at the same time. Excedrin contains acetaminophen, aspirin, and caffeine. Ibuprofen is very similar to aspirin, and both they have same effects. Co-administration of Ibuprofen and Excedrin will probably not be beneficial and may cause harm. If they are taken together, these medicines can increase the risk of side effects to happen by causing stomach upset and bleeding that may lead to a stomach ulcer. The best option is to choose one product, and if it is not sufficient for their pain, patients should talk with their pharmacist or health care provider who could suggest other therapy options, depending on the type of pain they are experiencing.

The table below shows side effects after Ibuprofen and Excedrin administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Frequency Not Defined

Dermatologic problems, Angioedema, CNS alteration, ulceration, GI pain, bleeding, Bronchospasm, Hearing loss, Platelet aggregation inhibition, Nausea, Vomiting, Rash, Renal damage, Tinnitus, Urticaria, Premature hemolysis, Hepatotoxicity, Pulmonary edema, Vomiting, Headache, Fluid retention, Dizziness, Heartburn, Constipation

Special precautions and warnings during Ibuprofen and Excedrin administration:

Patients should tell their doctor and pharmacist if they are allergic to ibuprofen, acetaminophen, aspirin or any other NSAIDs such as ketoprofen or naproxen, any other medicines, or any of the inactive ingredients that can be found in those products. Ask your pharmacist or check the label on the package for a list of the inactive ingredients.
Excedrin contain aspirin and it shouldn’t be given to a child or teenager with a flu symptoms, fever, or chicken pox. In these patients, Aspirin can cause a serious condition called Reye’s syndrome that can sometimes be fatal in children.
Patients should tell their doctor and pharmacist what prescription and nonprescription medications, nutritional supplements, vitamins, and herbal products they are taking or plan to take. Patients should tell their doctor if they are using any of the following drugs: acetazolamide, ACE inhibitors such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril quinapril, ramipril and trandolapril, diuretics, lithium and methotrexate. Doctor may need to change the doses of these medicines or monitor carefully for side effects.
Patients should tell their doctor or pharmacist if they have or ever had conditions such as: asthma, nasal polyps, frequent stuffed or runny nose or swelling of the feet, ankles, hands, arms, or lower legs; lupus, liver or kidney disease.
If Ibuprofen is given to a child, parents should tell the doctor if the child has not been drinking enough fluids or has lost a large amount of fluid after repeated diarrhea, vomiting.
Patients should tell their doctor if they are pregnant, especially if they are in the last few months of pregnancy. These drugs shouldn’t be used during pregnancy. Aspirin may harm the fetus and cause problems with delivery if it is taken during the last few months of pregnancy.
Patients with phenylketonuria should avoid these medicines.
Acetaminophen overdose can lead to acute liver failure. Acetaminophen administration shouldn’t exceed the doses of 4g per day.
Patients should tell their doctor if they have ever had a rash while taking acetaminophen.
Patients with phenylketonuria should avoid these medicines.
Patients should also know that combination acetaminophen products for cough and colds containing cough suppressants expectorants, nasal decongestants and antihistamines, should not be used in children younger than 2 years of age. In children 2 through 11 years of age such combinations should be used carefully and only according to the directions on the label.

“Can you take Metformin and Januvia together?“

What is Naproxen

Naproxen is a Generic name for the drug containing naproxen sodium as an active ingredient. This is nonsteroidal anti-inflammatory drug (NSAID) which is used as a pain reliever for various conditions such as: headaches, dental pain, muscle pain, tendinitis (inflammation or irritation of a tendon, a thick cord that attaches bone to muscle), menstrual cramps, and for the treatment of pain, swelling and joint stiffness caused by arthritis, osteoarthritis, juvenile arthritis, bursitis, ankylosing spondylitis and gout. This drug can also be used to temporarily reduce fever and for the treatment of common cold.

Naproxen products on the market are: Naproxen capsule, Naproxen tablet, Naproxen All Day Relief for Pain, Naproxen Liquid Gels, Naproxen Caplets All Day Relief for Pain, Naproxen Menstrual Pain Relief and Naproxen Sodium (nsaid) Fever Reducer / Pain Reliever.

Other Brand names for medications containing naproxen are: Anaprox, EC-Naprosyn, Flanax Pain Reliever, Leader Naproxen Sodium, Midol Extended Relief, Naprelan 375, Naprosyn.

What is Lortab

Lortab is a Brand name for a drug containing combination of hydrocodone and acetaminophen as active ingredients. Both drugs work as pain killers. Hydrocodone is potent opioid pain (narcotic) medicine while Acetaminophen is a less potent analgesic that can increase the effects of Hydrocodone. Lortab is used for the treatment of moderate to severe pain. Lortab is available in tablet form in following strengths: 5 mg/325 mg, 7.5/325 mg and 10/325 mg. Dosage is adjusted according to the severity of the pain and patient response. Tolerance to hydrocodone can be developed with continued use of Lortab and incidence of untoward effects is dose related.

Other Brand names for medications containing combination of hydrocodone and acetaminophen are: Lorcet, Hycet, Lortab, Verdrocet, Vicodin, Lortab Elixir, Norco, Xodol, and Zolvit.

How does Naproxen and Lortab work in the body

Naproxen inhibits synthesis of prostaglandins (substances in the body that play a key role in pain and inflammation processes in body tissues) by inhibiting at least 2 cyclooxygenase (COX) isoenzymes, COX-1 and COX-2. Inhibition of COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects while the inhibition of COX-1 may cause gastrointestinal bleeding and ulcers. COX-1-dependent prostaglandins play a crucial homeostatic role in physiological functions (gastrointestinal cytoprotection, aggregation of platelets and modulation of vascular muscle tone) while COX-2-dependent prostaglandins play dominant roles in pathophysiologic processes (inflammation and cancer, or physiological processes such as endothelial vasoprotection). If NSAID drug less inhibits the COX-1, less side effect would be caused. Studies showed that naproxen has a lowest risk of provoking heart attack compared to all other NSAIDs. This drug may also inhibit chemotaxis, decrease proinflammatory cytokine activity, alter lymphocyte activity, and inhibit neutrophil aggregation – these effects may also contribute to anti-inflammatory activity.

Hydrocodone is an opioid agonist of opioid receptors within the CNS. This morphinans structure substance blocks pain perception in the cerebral cortex of the brain. Hydrocodone decreases synaptic chemical transmission in the CNS, which in turn inhibits pain sensation into the higher centers of the brain. Agonist activities at the μ and kappa receptors can cause analgesia, miosis, and decreased body temperature. Agonist activity at the μ receptor can also cause the suppression of opiate withdrawal, while antagonist activity can result in precipitation of withdrawal. Hydrocodone acts at several locations within the CNS by involving several systems of neurotransmitters to produce analgesia, but the precise mechanism of action has not been fully understood. Opiate agonists don’t change the threshold or responsiveness of afferent nerve endings to noxious stimuli nor the conduction of impulses along peripheral nerves. Instead, they alter the perception of pain at the spinal cord and higher concentrations in the CNS and the person’s emotional response to pain. Hydrocodone can produce inhibition at the chemoreceptors through μ-opioid receptors and in the medulla through μ and δ receptors which can lead to dose-related respiratory depression.

Can patients take Naproxen and Lortab together

From a pharmacology standpoint, there is no harm if Naproxen is taken together with Lortab. So if Lortab isn’t controlling the pain well, patients can use Naproxen and Lortab together but only with physician instructions. Naproxen is a blood thinner and may cause bleeding in predisposed patients, so if patient is already taking Lortab for the treatment of post-surgical pain, in that case, these drugs shouldn’t be used together. There are also many other factors that can exclude the usage of Naproxen and Lortab combination such as: age, past medical history, pregnancy and breast-feeding, and possible interactions with other medications, food or alcohol. However, Naproxen is the safest NSAID for the patients with coronary disease. It has the lowest risk of provoking heart attack.

The table below shows side effects after Naproxen and Lortab administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Common side effects 1-10%	Constipation (8-11%), Abdominal pain (3-9%), Drowsiness (3-9%), Dizziness (3-9%), Heartburn (3-9%), Headache (3-9%), Nausea (3-9%), Edema (3-9%), Fluid retention (3-9%), Dyspnea (3-9%), Lightneadedness (<3%), Hearing disturbances (<3%), GI perforation (1-4%), GI ulcers (1-4%), GI bleeding (1-4%), Diarrhea (1-3%), Stomatitis (<3%), Diverticulitis (1-3%)
Frequency Not Defined	Hepatotoxicity, Agranulocytosis, Hemolytic anemia, Respiratory depression, Biliary tract spasm, Hallucinations, Circulatory collapse, Bradycardia, Cardiac arrest, Confusion, Decreased urination, Fatigue, Hypotension, Coma, Dysphoria, Euphoria, Lethargy, Lightheadedness, Histamine release, Physical and psychological dependence, Urinary tract spasm
Rare Side Effects <1%	Elevation of serum alanine aminotransferase or aspartate aminotransferase (3 × upper limit of normal)

Special precautions and warnings during Naproxen and Lortab administration:

Information retrieved from:

Patients should tell their doctor and pharmacist if they are allergic to Lortab or Naproxen, or any other medicines, or any of the ingredients that are used in Lortab or Naproxen products.
Patients should tell their doctors or pharmacists what prescription and nonprescription medicines, vitamins or nutritional supplements they are taking or plan to take.
Patients should also tell their doctors if they are using any of the following medications: antihistamines, dronedarone, medications for irritable bowel disease, Parkinson’s disease and ulcers, haloperidol, azithromycin, amiodarone, butorphanol, chlorpromazine; citalopram, laxatives such as lactulose, nalbuphine or pentazocine, levofloxacin.
They should also tell their doctors if they are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), rasagiline (Azilect), or tranylcypromine (Parnate). Doctor may need to change the doses of medicines or monitor carefully for side effects.
Lortab shouldn’t be used if patient has blockage of stomach or intestines, or paralytic ileus.
Patients should tell their doctor if they have or have ever had hypotension, difficulties with urinating, seizure attacks, or any of the thyroid, liver, kidney, gall bladder or pancreas disease.
If patients are having surgery, including dental surgery, they should tell their doctor or dentist that they are taking Lortab.
Lortab may make patients drowsy. Patients taking Lortab should not drive a car or operate machinery.
Lortab may cause dizziness, fainting and lightheadedness, if patient get up too quickly from a lying position. This is more common when initial dose of Lortab is taken. To avoid this problem, patients should slowly get out of bed, resting their feet on the floor for a few minutes before standing up.
Lortab can cause constipation. Patients should talk with their doctor about changing diet and using other medications to treat or prevent constipation.
There aren’t also appropriate studies on the relationship of geriatric-specific problems with the effects of naproxen and hydrocodone combination. However, elderly patients are more likely to develop kidney or stomach problems which are age-related. Hydrocodone is more likely to cause breathing problems in older patients who are severely ill, malnourished, or if they have other risk factors
Pregnant patients should never use these medicines; because their babies could become drug dependent, so life-threatening withdrawal symptoms can be caused after baby is born. Those babies may need medical treatment for several weeks. Patients should tell doctor if they are pregnant or plan to become pregnant. Patients should tell their doctor if they are breastfeeding.
If patient should have surgery, including dental surgery, he/she should tell the doctor or dentist that he/she is taking naproxen
Patients should avoid alcohol while using these medications. Drinking alcohol can increase certain side effects of Lortab and Naproxen. Alcohol may increase the risk of liver damage while taking Lortab.
Acetaminophen overdose can lead to acute liver failure. Acetaminophen administration shouldn’t exceed the doses of 4g per day.
Patients should tell their doctor if they have ever had a rash while taking acetaminophen.
Patients with phenylketonuria should avoid these medicines.

“Can you take Ibuprofen and Excedrin together?“

What is Ibuprofen

Common Brand names for ibuprofen are: Advil, Motrin, Brufen, Calprofen, Genpril, Ibu, Midol, Nuprin, Cuprofen, Nurofen, Ibuprofen 800 and PediaCare Children’s Pain Reliever/Fever Reducer IB.

What is Cipro

Cipro is a Brand name for an antibiotic drug containing ciprofloxacin as an active ingredient. Ciprofloxacin belongs to the group of antibiotics called fluoroquinolones. This drug is used for the treatment of infections caused by susceptible bacteria such as: acute uncomplicated cystitis, urinary tract infections, lower respiratory tract infections, chronic bacterial prostatitis, acute sinusitis, bone and joint infections, skin infections, infectious diarrhea, complicated intra-abdominal infections in combination with metronidazole, typhoid fever, uncomplicated urethral and cervical gonorrhea, and for prevention and treatment of inhalational anthrax. It is available in the form of tablet in doses of 250, 500 and 750 mg, intravascular solution 2 mg and intravascular liquid in dose of 10 mg.

Other Brand names on the market containing ciprofloxacin as an active ingredient are: Cipro XR, Cipro I.V., Proquin XR Cipro Cystitis Pack, Ciloxan and Otiprio.

How does Ibuprofen and ciprofloxacin work in the body

Ciprofloxacin works by inhibiting the enzyme called topoisomerase II (also known as DNA gyrase) and topoisomerase IV. Both enzymes are required for DNA replication, transcription, repair and recombination in bacteria. Ciprofloxacin contain in vitro activity against most gram-positive and gram-negative microorganisms. The mode of action is different from other antimicrobial agents such as macrolides, beta-lactams, aminoglycosides, or tetracyclines, thus, bacteria resistant to these drugs may be susceptible to ciprofloxacin. There is also no known cross-resistance between other classes of antimicrobials and ciprofloxacin. Ciprofloxacin has 100 times higher affinity for bacterial DNA gyrase compared to mammalian.

Can patients take Ibuprofen and Cipro together

Patients can take Ibuprofen and Cipro together as long as their kidney function is all right. These drugs have different mechanisms of action in the body and have no significant interaction if recommendable doses are taken. However in patients with impaired renal function, concomitant administration of Ibuprofen and Cipro may worsen renal function ( creatinine clearance is lower than < 30ml/min). Taking these two drugs together may further decrease the renal elimination of ciprofloxacin, resulting in elevated levels of this drug in the blood that may increase the incidence of seizures. Patients with a history of seizure disorders, and those who are taking drugs that can lower seizure threshold in the brain or patients with significantly impaired renal function may be at increased risk of developing seizures while taking this combination.

The table below shows side effects after Ibuprofen and Cipro administration in recommendable doses. The incidence can be significantly increased if these drugs are overdosed or taken together.

Common side effects 1-10%	Nausea (3%), increased aminotransferase levels (2%), Abdominal pain (2%), Diarrhea (2% adults; 5% children), Vomiting (1% adults; 5% children), Headache (1%), Increased serum creatinine (1%), Rash (2%), Restlessness (1%)
Frequency Not Defined	Dermatologic problems, Angioedema, CNS alteration, ulceration, bleeding, Bronchospasm, Hearing loss, Platelet aggregation inhibition, Nausea, Renal damage, Tinnitus, Urticaria, Premature hemolysis, Hepatotoxicity, Pulmonary edema, Vomiting, Fluid retention, Dizziness, Heartburn, Constipation, Flushing, Photosensitivity, Dizziness, Ataxia, Diplopia

Special precautions and warnings during Ibuprofen and Cipro administration:

Patients should tell their doctor and pharmacist if they are allergic to ibuprofen, ciprofloxacin or any other antibiotic, aspirin or any other NSAIDs such as ketoprofen or naproxen, or any other medicines, or any of the inactive ingredients that can be found in those products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medications, nutritional supplements, vitamins, and herbal products they are taking or plan to take. Patients using ibuprofen should tell their doctor if they are using any of the following drugs: acetazolamide, ACE inhibitors such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril quinapril, ramipril and trandolapril, diuretics, lithium and methotrexate. Doctor may need to change the doses of these medicines or monitor carefully for side effects.
Patients should tell their doctor if they are using tizanidine (Zanaflex). Doctor will probably tell the patient not to take Cipro while they are taking this medication. Patients should also tell their doctor if they are using some of following drugs: warfarin , certain antidepressants, caffeine or medications that contain caffeine, clozapine, cyclosporine, diuretics, glyburide, amiodarone, disopyramide, procainamide, quinidine, and sotalol, methotrexate, metoclopramide, naproxen, ibuprofen, phenytoin, probenecid, ropinirole or theophylline. Doctor may need to change the doses of these medicines or monitor carefully for side effects.
Patients taking antacids that contain magnesium hydroxide or aluminum hydroxide or didanosine, iron, zinc, calcium,vitamin supplements or sucralfate need to allow some time to pass between when they take a dose of any of these medications and when they take a dose of Cipro.
Patients should tell their doctor if they have or ever had or if anyone in their family has or has ever had a prolonged QT interval or an irregular heartbeat, and if they have or have ever had nerve problems, a low amount of potassium in blood, cerebral arteriosclerosis seizures, or liver disease.
Cipro may cause confusion, dizziness, lightheadedness, and tiredness. Patients should not drive a car or operate machinery while using Cipro.
During Cipro administration, patients should avoid prolonged and unnecessary exposure to sunlight or UV light. Cipro may make skin sensitive to sunlight or UV light. Patients should call their doctor if their skin becomes reddened, blistered or swollen during Cipro administration.
Patients should tell their doctor or pharmacist if they have or ever had conditions such as: asthma, nasal polyps, frequent stuffed or runny nose or swelling of the feet, ankles, hands, arms, or lower legs; lupus, liver or kidney disease.
If Ibuprofen is given to a child, parents should tell the doctor if the child has not been drinking enough fluids or has lost a large amount of fluid after repeated diarrhea, vomiting.
Patients should tell their doctor if they are pregnant, especially if they are in the last few months of pregnancy. These drugs shouldn’t be used during pregnancy.

“Can Amoxicillin/Clarithromycin/Omeprazole be used in combination?”
“Can naproxen be taken with hydrocodone?“

How does Amoxicillin work

Amoxicillin is a beta lactam class of antibiotic that is primarily used for the treatment of a variety of bacterial infections. Besides bacterial infections, the drug is also prescribed for skin and urinary tract infections, pneumonia, and strep throat. The drug is commonly available under generic name Amoxicillin and marketed under the various brand names such as Amoxil, Tycil, Trimox, Amocla, Actimoxi, Moxatag, Larotid and Alphamox. The drug was first available in 1972 and was listed on the World Health Organization’s List of Essential Medicines. Amoxicillin chemically belongs to the Penicillins class of drugs and characterized by the presence of penam ring. The drug Amoxicillin is available in various forms such as capsule, tablets, oral solution and pediatric drops for oral uses. The recommended dose of Amoxicillin in adult is 500 mg thrice a day or 875 mg twice a day. However, the dose varies depending upon patient and diseased state.

What is Clarithromycin

Clarithromycin is an antibiotic drug that belongs to macrolide class of antibiotics i.e. antibiotics that inhibit the growth of bacteria and fight with a broad spectrum of gram-positive bacteria. The drug is available under generic name Clarithromycin and brand names such as Biaxin, Biaxin XL, Biaxin XL-Pak. The drug Clarithromycin was developed in the year 1980 and later recognized and classified in World Health Organization’s List of Essential Medicines that are needed in a basic health system. The drug is chemically derived from Erythromycin and known as 6-O-methylerythromycin. It is generally prescribed to treat bacterial infections such as bronchitis (infection of the tubes leading to the lungs), pneumonia or lung infection, ear infection, skin infection, throat infection and sinuses infection. The drug is also used to treat cat scratch disease and other infections caused by bartonella, Cryptosporidiosis and as second line agent in the treatment of Toxoplasmosis and Lyme disease. The drug is also used as an alternative to treat strep throat and bacterial endocarditis in those who cannot take penicillin. The drug Clarithromycin is also used to treat disseminated Mycobacterium avium complex (MAC) infection, a condition that usually affects patients with HIV (Human Immunodeficiency Virus). Besides this, Clarithromycin is also used in combination with other drugs to treat H. pylori mediated stomach ulcer. The drug is available as delayed or extended release tablet that lasts for a long time or as liquid suspension form to be taken orally by mouth. The drug is recommended with a dosing schedule of 7 to 14 days, with or without food in every 12 hours i.e. twice a day. The length and duration of the drug vary depending upon patients and the disease status.

How does omeprazole work

Omeprazole is a proton pump inhibitor that acts through blocking gastric acid secretion. The drug was approved by FDA in September, 1989 and grouped in World Health Organization’s List of the essential medications required in a basic health system. Chemically, Omeprazole is a pro drug, which means normally it is biologically inactive agent that produces a drug only upon metabolization inside the body. The generic name of the drug is Omeprazole, Omeprazole/Sodium bicarbonate and is available under several brand names such as Prilosec, Omesec, Prilosec OTC, Zegerid, Zegerid OTC etc. Chemically, Omeprazole belongs to a class of organic compounds known as sulfinylbenzimidazoles (containing a sulfinyl group attached at the position 2 of a benzimidazole moiety). Prescription Omeprazole is available as a delayed-release capsule (10, 20 and 40 mg), and packets of delayed-release granules (20 and 40 mg) for suspension, whereas nonprescription (over-the-counter) Omeprazole comes in the form of a delayed-release capsule or tablet (20 mg) to be taken by mouth. The dose of the drug depends upon the disease, age and weight. The active ingredient in the delayed-release capsule and delayed-release granule (oral suspension) are Omeprazole and Omeprazole magnesium respectively.

How Amoxicillin, Clarithromycin and Omeprazole work

Similar to penicillin and other beta lactam class of drugs Amoxicillin acts against susceptible bacteria during the stage of active multiplication. It acts on the bacteria through blocking or inhibiting the biosynthesis of cell wall mucopeptide (protein polysaccharide component of bacterial cell wall) during bacterial cell multiplication. In bacterial cell wall Amoxicillin interacts with penicillin-binding protein 1A (PBP-1A) and inactivate it through acylation. PBP-1A enzyme is involved in crosslinking of two linear peptidoglycan strands or polymer chain. Inactivation of PBP-1 results in complete loss of development of cross-link formation and inhibition of cell wall biosynthesis that leads to the death of the bacteria. Amoxicillin is primarily used for the treatment of bacterial infections such as bronchitis, pneumonia, gonorrhoea etc. Besides, this the drug is also recommended to treat the infections of Salmonella and Chlamydia, Lyme disease, Streptococcal pharyngitis and Tonsillitis.

Clarithromycin is a semisynthetic macrolide antibiotic that was originally derived from Erythromycin. The drug acts against a wide range of bacteria including gram-positive (Staphylococcus aureus, S. pneumoniae, and S. pyogenes) and gram-negative aerobic bacteria (Haemophilus influenzae, H. parainfluenzae, and Moraxella catarrhalis), many anaerobic bacteria, and some Mycobacteria. The drug also shows significant activity against other organisms including Mycoplasma, Toxoplasma, Ureaplasma, Chlamydia, and Borrelia. Clarithromycin is usually bacteriostatic antibiotic that means it stops bacteria from reproducing, while not necessarily killing them otherwise. However, depending upon the organism and concentration, Clarithromycin may also show bactericidal effects. Chemically, Clarithromycin belongs to the class of organic compounds known as macrolides and analogues, which are characterized by a lactone ring of at least twelve members. Clarithromycin acts in a manner similar to that of its parent compound Erythromycin. Clarithromycin, is first metabolized into active compound 14-OH Clarithromycin, which works synergistically with the parent compound. Clarithromycin active metabolites inhibit bacterial protein synthesis through its interaction with bacterial 50S ribosomal subunit. Within 50S ribosomal subunit, Clarithromycin specifically and reversibly binds with domain V of 23S ribosomal RNA. This results in inhibition or blocking of aminoacyl t-RNA translocation and ultimately polypeptide synthesis. Besides this, it has also been suggested that Clarithromycin also acts and inhibits microsomal CYP3A4 isozyme and P-glycoprotein.

The Omeprazole drug is a benzimidazole, which is a selective and irreversible proton pump inhibitor. The proton pumps are integral membrane proteins that are capable of moving protons across a biological membrane. In stomach, proton pumps (such as hydrogen-potassium (H+/ K+) ATPase enzyme system) are present at the secretory surface of parietal cells in the stomach and involved in pronounced and long-lasting production of gastric acid or gastric juice. The gastric acid is composed of hydrochloric acid (HCl), potassium chloride (KCl) and sodium chloride (NaCl). Omeprazole results in the suppression of gastric acid secretion by formation of a stable disulfide bond with the sulfhydryl group of the hydrogen-potassium (H+/ K+) ATPase enzyme system, thus inhibiting the final step in the acid production i.e., transport of hydrogen ions (via exchange with potassium ions) into the gastric lumen. Due to its mode of action the Omeprazole is generally prescribed to be taken atleast one hour before meals. The drug (prescription) is prescribed either alone or in combination with other medications in therapy of acid-induced inflammation, gastroesophageal reflux disease (GERD), stomach and duodenum ulcers, erosive esophagitis, Zollinger-Ellison Syndrome (gastrin-producing tumour), and heartburn.

Can Amoxicillin, Clarithromycin and Omeprazole be taken together in combination

Yes, Amoxicillin, Clarithromycin and Omeprazole medications can be used in combination. Amoxicillin (penicillin antibiotic) and Clarithromycin (macrolide antibiotic) are antibiotics that act against a broad spectrum of bacteria, where as Omeprazole acts as a proton pump inhibitor thus reduces the formation of gastric juice. Amoxicillin, Clarithromycin, and Omeprazole are together used in combination as a triple therapy to treat gastric or stomach ulcer caused by infection with Helicobacter pylori (H. pylori). In triple therapy, Omeprazole inhibits transport of hydrogen ions into the gastric lumen and suppresses gastric acid secretion, while Amoxicillin and Clarithromycin interrupt the bacterial cell wall and protein synthesis, thus causing weakening of the bacterial cell wall and cell lysis, as well as inhibition of bacterial reproduction. Amoxicillin shows several advantages over other antibiotics such as high tolerability and digestibility, lack of resistance to H.pylori and potent activity and efficacy in eradicating H.pylori. Each dosing regimen contains 4 pills (3 capsules and 1 tablet). Amoxicillin, Clarithromycin, and Omeprazole dosing schedule consists of an initial dose of 1000 mg Amoxicillin, 500 mg Clarithromycin and 20 mg Omeprazole, twice a day (12 h interval) in the morning and evening before eating a meal. The triple combination is available under brand name Omeclamox-Pak, which contains all three Amoxicillin, Clarithromycin and Omeprazole in prescribed dose. The triple therapy is usually recommended for a period of 10 days, however in case of an active gastric ulcer an additional dosing for 18 days of Omeprazole 20 mg once a day is also recommended. The pill or tablet should not be crushed or chewed rather it is recommended to swallow pill/tablet as a whole.

Clinical research and current scenario of Amxicillin/Clarithromycin/Omeprazole triple therapy

Double blind, multicentre United States trials have revealed that 10 days of twice-daily triple therapy with Amoxicillin, Clarithromycin and Omeprazole achieves per-protocol Helicobacter pylori eradication rates of approximately 80% to 90% in duodenal ulcer disease.
Similarly in China, one-week triple therapy of Amoxicillin, Clarithromycin and Omeprazole showed significant efficacy for the eradication of pylori infection. This therapeutic regimen suggested a low cost, good compliance and mild adverse events that offer a good choice for the treatment of peptic ulcers associated with H. pylori infection.
In children and adolescents, triple combination therapy with Amoxicillin, Clarithromycin and Omeprazole have shown a moderate efficacy. The data had shown that 10 days therapy achieves a better eradication rate (73%) than 7 days course (50%) to treat pylori infection.
It has been observed that addition of vitamin C along with Amoxicillin, Clarithromycin and Omeprazole 7 day therapy can reduce the dosage of Clarithromycin with higher eradication efficiency in pylori infection.
In a pilot study, it has been observed that a four-day, twice daily, quadruple therapy with Amoxicillin, Clarithromycin, Tinidazole and Omeprazole showed acceptably high cure rate of peptic ulcers associated with pylori infection.
Another pilot study performed in Japanese population has shown the efficacy and safety of Helicobacter pylori eradication therapy with Amoxicillin, Omeprazole and high and low dosage of Clarithromycin. In this study it has been demonstrated that triple-therapy regimen with Clarithromycin 400 mg/day was as effective as that with Clarithromycin 800 mg/day.
Currently, Amoxicillin is also used as triple therapy forHelicobacter pylori infection and duodenal ulcer disease in combination with Clarithromycin and Lansoprazole.

Amoxicillin Clarithromycin Omeprazole side effects

Safety and precautions while taking Omeprazole-Amoxicillin combination

The usual dosing of the drug in combination may vary depending upon the efficiency and side effects of the drug in a particular individual. Therefore, it is advisable to discuss all the health related issues with your doctor before taking Clarithromycin in combination with Amoxicillin and Omeprazole.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis or Stevens-Johnson syndrome) to Amoxicillin or any other penicillin antibiotic (such as Ampicillin, Dicloxacillin and Oxacillin) or to any macrolide antibiotic (e.g., erythromycin) or substituted benzimidazoles or to any ingredient of the drug formulation.
The Clarithromycin, Omeprazole and Amoxicillin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
It has been observed that Omeprazole may cause a serious type of allergic reaction when used in combination with antibiotics. In case of allergic hypersensitive reactions such as itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth, it is advisable to call your doctor right away.
The triple combination is not recommended if you have infectious mononucleosis or any previous kidney or liver problems, or low blood potassium or magnesium level, certain types of irregular heartbeat such as ventricular arrhythmias, long QT syndrome and QT prolongation.
Before taking Clarithromycin- Omeprazole-Amoxicillin, tell your doctor about your medical history if you have kidney disease, liver disease, asthma, mononucleosis (also called “mono”), a bleeding or blood clotting disorder, or any type of allergy, hay fever or hives. Do not stop taking Amoxicillin until you do not finish the prescription. If you do not follow the prescription or stop taking aAmoxicillin too early, it may lead to the development of antibiotic resistance in bacteria.
The use of Clarithromycin and Amoxicillin may sometimes increase the risk of Clostridium difficile-associateddiarrhea (CDAD). If you experience symptom of diarrhea that does not seem to improve seek immediate medical attention.
Antibiotic therapy of Amoxicillin and Clarithromycin in the absence of suspected bacterial infection and discontinuation of therapy before time or too early increases the risk of the development of drug-resistant bacteria.
It has been observed that colitis is occasionally caused by taking antibiotics (antibiotic associated colitis). Antibiotic therapy is usually associated with reduced gut microbial flora, permits overgrowth of some of the harmful bacteria over normal gut flora. Clostridium difficile is one of such bacterial species that flourish well under antibiotic therapy. Its toxin is supposed to be a primary cause of antibiotic-associated colitis. Thus, antibiotic therapy with Amoxicillin and other broad-spectrum antibiotics agents should be managed cautiously in patients with a history of gastrointestinal diseases, particularly colitis.

“What is Pregabalin?“
“Can you take Ibuprofen and Excedrin together?“

What is Pregabalin

Pregabalin is a gamma-aminobutyric acid (GABA) derivative, a synthetic medication that is used for the treatment of neuropathic pain (pain arising due to damaged nerves), epilepsy (brain disorder characterized by recurring seizures), fibromyalgia (condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body), and generalized anxiety disorder. The drug is marketed under generic name Pregabalin and brand name Lyrica. Besides this, the drug is also available under several brand names worldwide, such as Galinerve, Gabamax, Gabafit, Maxgalin, Gabasafe, Peganex, Nuramed, Pevesca, pregab, Progab, Proage and Pregaba. Pregabalin chemically belongs to the class of organic compounds which are known as Gamma amino acids and derivatives (Gamma-aminobutyric acid derivative, GABA). Pregabalin is chemically known as (S)-3-(aminomethyl)-5-methylhexanoic acid. The drug Pregabalin is commercially available in the form of capsule and oral suspension or solution for administration through mouth. The capsules are available in different dosages or strength of 25 to 300 mg, while oral solution is available in strength of 20 mg/mL.

**Pregabalin: Structure and chemical information.**

What is Oxycodone

Oxycodone is a semisynthetic molecule that is used to treat moderate to severe pain. The drug is an opioid medication that is synthesized from plant alkaloid thebaine. The alkaloid is extracted from Persian poppy. It is one of the many opioid alkaloids found in the opium poppy. Chemically, the drug is a narcotic (addictive drugs that affect mood and behaviour) and analgesic. The drug was first developed and became available for clinical use since 1917. The drug is available under generic name Oxycodone and marketed under brand names Roxicodone, OxyContin, OxyIR, and Oxaydo. Oxycodone is chemically known as (1S,5R,13R,17S)-17-hydroxy-10-methoxy-4-methyl-12-oxa-4-azapentacyclo[9.6.1.0¹,¹³.0⁵,¹⁷.0⁷,¹⁸]octadeca-7(18),8,10-trien-14-one and belongs to the class of morphinans. Oxycodone is available as single-ingredient medication for immediate release and controlled release. The drug Oxycodone is available as tablet in the form of hydrochloride salt (Oxycodone hydrochloride), which is white, odourless crystalline powder in appearance. The tablets for oral administration is available under various dosage or strength such 5 mg, 10 mg, 15 mg, 20 mg or 30 mg, which contain an equivalent amount of Oxycodone hydrochloride USP. Parental formulations of Oxycodone is also available as 10 mg/mL and 50 mg/mL for intravenous (IV) or intramuscular (IM) administration.

**Oxycodone: Structure and chemical information.**

oxycodone-hydrochloride tablets — **Oxycodone-hydrochloride tablets**

Oxycodone15/30mg tablets — **Oxycodone 15/30mg tablets**

How Pregabalin and Oxycodone works

Pregabalin is a synthetic, gamma-aminobutyric acid (GABA) derivative that blocks calcium channels and functions as anti-convulsant, anti-epileptic, anxiolytic, and analgesic agent. The exact mode of action of Pregabalin remains unclear and the proposed mechanism is based upon results involving genetically modified mice and compounds that are structurally related to the drug such as gabapentin. The drug causes a decrease in the excitability of the neurons in the central nervous system by binding to the auxiliary subunit (α2-δ protein) of a voltage-gated calcium channel present on the neurons of the central nervous system. Pregabalin causes a decrease of pro-nociceptive neurotransmitters (a calcium dependent process) in the spinal cord either by reduction of calcium currents or disruption of alpha2-delta containing-calcium channel trafficking. These neurotransmitters are involved in the noradrenergic and serotonergic pathways that cause modulation of pain transmission in the spinal cord. Besides this, Pregabalin also lowers the release of several other neurotransmitters, including glutamate, noradrenaline, and substance P possibly by modulation of calcium channel function. However, the significance of this effect remains unclear. Although Pregabalin is a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), it does not bind directly to GABA or benzodiazepine receptors. The sodium channels, opiate receptors, and cyclooxygenase enzymes do not play a role in the mechanism of action of Pregabalin. The drug is also inactive at serotonin and dopamine receptors and does not inhibit reuptake of the serotonin, dopamine, or noradrenaline.

Pharmacodynamically Oxycodone is similar in action to that of hydrocodone and morphine. The most prominent sites of action of Oxycodone involve central nervous system and smooth muscle organs. It acts directly on mu, kappa, and delta opioid receptors as agonist. The opioid receptors are a group of inhibitory G protein-coupled receptors and present within the central nervous system (CNS) of the brain. Oxycodone is mainly affected by mu-type opioid receptors, which act as a positive and negative modulators of synaptic transmission via G-proteins. Interaction or binding of the Oxycodone opiate stimulates the exchange of GTP for GDP and decreases intracellular cAMP by inhibiting adenylate cyclase. This results in inhibition of release of nociceptive neurotransmitters such as dopamine, substance P, acetylcholine, GABA, and noradrenaline. Besides this, Oxycodone also inhibits the release of glucagon, insulin, vasopression etc. Oxycodone treatment results in opening of calcium dependent potassium channel (mu and delta receptor agonists), inhibition of voltage operated calcium channel (kappa receptor agonists). All these events result in hyperpolarisation (i.e. such a change in a cell’s membrane potential that makes it more negative) and decrease neuronal excitability.

Can both Pregabalin and Oxycodone be taken together in combination

Yes, Pregabalin in combination with Oxycodone represents a valuable addition to the existing monotherapy with either Oxycodone or Pregabalin alone in patients with neuropathic pain. It has been observed that Pregabalin is safe and effective in patients with postherpetic neuralgia, trigeminal neuralgia, painful diabetic neuropathy and fibromyalgia. However, the drug is less effective in monotherapy in treatment of pain associated with HIV neuropathy and other neuropathic pain. For this purpose Pregabalin is occasionally recommended in combination with other analgesic agents such as Oxycodone. Similarly, single analgesic drug like Oxycodone has less perfect therapeutic/adverse effect profile for every pain condition. To improve the compliance, Oxycodone in combination of Pregabalin, Gabapentin, Acetaminophen, Paracetamol, NSAIDs and Morphine offers greater pain relief and/or reduced adverse effects than the constituent drugs when used individually. Clinical studies have suggested that the combination of Pregabalin and Oxycodone are safe and effective and may offer certain advantages. Recent open-label study of neuropathic pain patients suggests that Pregabalin may provide greater analgesia and opioidsparing effects. Combination therapy of Pregabalin with Oxycodone is significantly more effective for pain relief and significantly improves quality of life compared to monotherapy.

Safety and precautions while taking Pregabalin: Oxycodone combination

It is always recommended that analgesia should be dose–limited when used in combination due to their increased side effects. Caution should be taken before using Pregabalin in combination with Oxycodone.
Oxycodone and Pregabalin can be taken together at the same time to treat neuropathic pain. However, the dose should be adjusted by professional healthcare, if needed.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis or Stevens-Johnson syndrome) to Oxycodone or any other opioid drug or -aminobutyric acid (GABA) derivative or to any ingredient of the drug formulation.
The Oxycodone and Pregabalin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
Before taking Oxycodone-Pregabalin, tell your doctor about your medical history if you have kidney disease, liver disease, asthma, liver disease, mononucleosis (also called “mono”), a bleeding or blood clotting disorder, or any type of allergy, hay fever or hives.
Oxycodones in combination with Pregabalin exacerbate the side effects such as drowsiness, dizziness, confusion, difficulty to focus properly, impairment in thinking, judgment, and motor coordination. These side effects are more in elderly population therefore it is recommended to avoid the activities which require alertness such as operating dangerous equipment or machinery, driving etc.
It has been observed that opioids such as Oxycodone are narcotic and therefore have the strong potential for dependence and withdrawal. Furthermore, misuse, overdose and diversion can lead to severe consequence including death. It is therefore suggested that treatment should be taken under professional guidance and supervision.

“Can I take Amoxicillin Clarithromycin Omeprazole for h-pylori“

what is levothyroxine

Levothyroxine is basically an human made or synthetic hormone for treatment of endocrine disorder and replacement therapy of principle thyroid hormone thyroxine (T4) that is made and released by thyroid gland located in the neck region. In newborn and fetus it is important for the growth and development of cells including bones and brain and in adult, thyroid hormone helps to maintain brain functions , utilization of food and body temperature . The drug is presribed for the treatment of hypothyroidism (low thyroid hormone release) and also used for the diseases treatment called goiter ( enlarged thyroid gland) which is caused by the hormone imbalances in the body. The drug is marketed and available under the brand name of synthroid, levothroid, levoxyl, tirosint and unithroid. The drug was first isolated in the pure form in 1914 at the mayo clinic by edward calwin kendall from extracts of hog thyroid gland and the hormone was synthesized by british chemist in 1927. levothyroxine is the second most prescribed drug in United States. The drug levothyroxine sodium is available in various dosage from i.e tablet, an intramuscular injection and as a solution for intravenous infusion. Drug levothyroxine is available in different strenghts they are 12.5mcg, 25mcg,50mcg, 75mcg, 100mcg, 125mcg, 150mcg, 175mcg, 200mcg, 300mcg, 500mcg, 112mcg, 137mcg and 13mcg. The recomended dose of drug is 12.5mcg to 25mcg with gradual dose increment at 4 to 6 weeks intervals untill the patient achieves clinically euthyroid and normalized serum TSH levels. However, the dose varies from the type and severity of the conditions.

what is calcium

calcium is a mineral and is present in more amount than any other mineral. About 99% of the calcium is stored in teeths and bones, although it is present in the muscles,blood and the fluid present between the cells. Calcium is essential mineral for building and maintaining bones and is also necessary for various other functions such as contraction and relaxation of blood vessels and muscles, the secretion of hormones and enzyme and nerve impulse transmission throughout the nervous system. Normally few calcium compounds have been used as a source of supplement i.e calcium carbonate, calcium citrate, calcium chloride and calcium citrate malate.The brand name of calcium carbonate are caltrate, tums regular strenght this belongs to class of antacids, minerals and electrolytes. The brand name of other compund calcium citrate are calcitrate and citracal belongs to class of minerals and electrolytes. The calcium compounds are available in various dosage forms such as oral tablets, oral powder, oral capsule, oral suspension, chewable and compounding powder. The recomended dose for calcium is 900 to 2500mg/day and it varies from the type and condition of patient.

How does levothyroxine and calcium works in the body

The drug levothyroxine mimic’s the function of endogenous thyroxine hormone which is the principle hormone for major endocrine disorders. The principle hormone thyroxine is released after proteolysis of thyroglobulin and subsequently secreted into the blood. The released thyroxine is Tetra iodinated tyrosine (T4) and in kidney and liver it is converted into (T3) triodotyrosine which is the active form. In order to increase the solubility of thyroxine hormone it binds to thyroid hormone binding proteins i.e. Thyroxine binding globulin and thyroxine binding prealbumin and thus the transport and binding of major thyroid hormone takes place in the nucleus and cytoplasm in the body. Thus it acts as an hormone replacement therapy and normalize the deficiency symptoms.

calcium and calcium compounds are used for the calcium supplementation when calcium deficiency is observed in an individual . Calcium plays vital role in formation and maintanance of the bones. It is also useful as it binds with other minerals like phosphate, etc and aid their excretion or removal from the body. Acting as an antacid is its secondary action neutralizing stomach acids. Simply it acts as an external calcium supplement for the body deficient to calcium.

Can pateints take levothyroxine and calcium together

levothyroxine absorption is primarily affected by taking calcium together . Therefore the drug levothyroxine and calcium are adviced to take at a difference of 4 hours or more and if taken together the dose of the drug should be adjusted appropriately as sometimes the dose required to compensate the thyroxine hormone required for the body is lesser but it increases significantly due to decrease in the absorption of the drug levothyroxine because of calcium. Most importantly doctor should be informed of all the medication an patient is taking such that any further drug-drug interaction could be avoided and pateint gets proper relief from symtoms.

Different activity profile of levothyroxine when co-administered with other drugs:

Decrease in the activity of levothyroxine is seen when taken with some minerals or multivitamins supplements, the absorption of levothyroxine is reduced such that the dose required by the body increases.
Increased rate of elimination of levothyroxine from the body which leads into decreased levels of levothyroxine in the blood. Enzyme inducers stimulate the production of enzymes, which in turn increase levothyroxine from the body where in normal patient is maintained by normal feedback mechanism, increasing levothyroxine levels in the body.
Some drugs when taken together causes changes in levothyroxine binding in blood. The binding protein Thyroxine-binding globulin(TBG) acts as an carrier of thyroid hormone when TBG levels are high in blood they trap the hormone and to compensate if secrets more thyroid hormone for normal functioning.
The drug levothyroxine may increase or decrease the safety or effectiveness of the other drug by increasing or decreasing the level of other drug in the blood.

Adverse effects of levothyroxine

levothyroxine as an active ingredient has broad category of adverse reaction. They are:

General adverse reactions: These reactions are normal like fatigue, weight loss, heat intolerance, increased appetite, etc
cardiovascular adverse effects: Those effects which is driven my brain like anxiety, insomia, hypersensitivity, irritability,etc.
Gastrointestinal effects: diarrhoe, abdominal cramps, vomiting, elevation in liver function test.
cardiovascular adverse effects: they are palpitations, tachycardia, cardiac arrest, increased heart pulse, increased bllod pressure, arrhythmias,etc
Endocrine adverse effects: some times it causes decrese in bone density either by decreasing calcium absorption or increasing decalcification of bones.

Adverse effects of calcium

Calcium is a mineral supplement to compensate the deficiency of calcium in the body. But this mineral supplement may prove to be very dangerous with its side effects.
Common side effects of calcium are nausea, vomiting, hypersensitivity reactions, consitipation, decreased appetite, dry mouth is one major side effect seen in most patient, more frequency of urination.
emergency call for doctor if adverse reactions are swelling of lips, face, tounge or throat, difficulty in breathing, high levels of calcium in blood causing joint pain,stonach pain and kther general reactions.

“Can you take Oxycontin with Lyrica?“

What is Oxycodone

Oxycodone is a semisynthetic molecule that is used to treat moderate to severe pain. The drug is an opioid medication that is synthesized from plant alkaloid thebaine. It is one of the many opioid alkaloids found in the opium poppy. The alkaloid is primarily extracted from Persian poppy. The drug was first developed and became available for clinical use since 1917. The drug is available under generic name Oxycodone and marketed under brand names Roxicodone, OxyContin, OxyIR, and Oxaydo. Chemically, the drug is a narcotic (addictive drugs that affect mood and behaviour) and analgesic. Oxycodone is known chemically as (1S,5R,13R,17S)-17-hydroxy-10-methoxy-4-methyl-12-oxa-4-azapentacyclo[9.6.1.0¹,¹³.0⁵,¹⁷.0⁷,¹⁸] octadeca-7(18),8,10-trien-14-one and belongs to the class of morphinans. Oxycodone is available as single-ingredient medication for immediate release and controlled release. The drug Oxycodone is available as tablet in the form of hydrochloride salt (Oxycodone hydrochloride), which is white, odourless crystalline powder in appearance. The tablets for oral administration are available under various dosage or strength such as 5 mg, 10 mg, 15 mg, 20 mg or 30 mg, which contain an equivalent amount of Oxycodone hydrochloride USP. Parental formulations of Oxycodone are also available as 10 mg/mL and 50 mg/mL for intravenous (IV) or intramuscular (IM) administration.

What is Aspirin

Aspirinis an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain. Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack. Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time). This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin. The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897. Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

How Oxycodone and Aspirin works

Aspirin is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase (COX) enzyme therefore known as COX inhibitor agent. The action of both acetyl and salicylate component of the acetylsalicylic acid (ASA or Aspirin) and its active metabolite salicylate are liable for the anti-inflammatory and analgesic properties through inhibition of cyclooxygenases. ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly. Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid. Antipyretic effect of ASA is resulted from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibit the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

Can both Oxycodone and Aspirin be taken together in combination

Yes, Oxycodone in combination with Aspirin represents a valuable, safe, and effective therapeutic regimen to provide relieve from moderate to moderately severe pain. In this dual combination , Oxycodone acts as a narcotic pain reliever that acts on central nervous system of brain, whereas Aspirin acts as nonsteroidal anti-inflammatory drug (NSAID) that works through inhibition of cyclooxygenase (COX). Both these medications together reduce the pain and swelling thus offers greater pain relief and/or reduced adverse effects than the constituent drugs when used individually. Both the medications are prescribed to be taken orally through mouth. It is usually recommended to take drug with food or milk to avoid stomach disturbance. Clinical studies have suggested that the combination of Oxycodone with Aspirin are safe and effective and may offer certain advantages. Oxycodone: Aspirin combination is marketed by Endo Pharmaceuticals under trade name Percodan. Each tablet of Percodan contains a mixture of 4.8355 mg of Oxycodone HCl which is comparable to 4.3 mg Oxycodone (as free base) and 325 mg of Aspirin.

Safety and precautions while taking Oxycodone: Aspirin combination

It is always recommended that analgesia should be dose–limited when used in combination due to their increased side effects. Caution should be taken before using Aspirin in combination with Oxycodone.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Oxycodone or any other opioid narcotic drug (i.e. hydrocodone, codeine, and oxymorphone) or nonsteroidal anti-inflammatory drugs (i.e. ibuprofen, naproxen, celecoxib) or salicylates (such as salsalate), or to any ingredient of the drug formulation.
The drugs are also not recommended if you have any blood clotting or bleeding disorder (i.e. haemophilia), asthma or breathing problem, kidney disease, liver disease, vitamin K deficiency, low platelet count etc.
The Oxycodone and Aspirin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
It has been observed that opioids such as Oxycodone are narcotic and therefore have the strong potential for dependence and withdrawal. Furthermore, misuse, overdose and diversion can lead to severe consequences including death. It is therefore suggested that treatment should be taken under professional guidance and supervision.

“Propranolol- drug class, uses, strength, side effects, mechanism of action“
“Can you take Levothyroxine with Calcium“

What is Propranolol

Propranolol is a synthetic pharmaceutical drug that is used to treat hypertension, tremors, and prophylaxis of migraine and heart attacks. The drug is available under generic name Propranolol and various brand names such as Inderal, Inderal LA, Avlocardyl, Deralin, Dociton, Inderalici, InnoPran XL, Sumial, Anaprilinum and Bedranol SR. The drug is useful in the treatment of complications related to the high blood pressure, hypertension, myocardial infarction and irregular heart rhythms. Propranolol is also prescribed for the treatment of pheochromocytoma (tumor of adrenal glands), proliferating infantile hemangioma and hypertrophic subaortic stenosis. The drug is recommended for the prevention of angina (chest pain), migraine headaches, ascites (accumulation of fluid in the abdominal cavity) and esophageal variceal bleedings. Chemically, Propranolol belongs to the class of organic compounds which are known as Naphthalenes, available as a monohydrochloride salt and named as 1-(naphthalen-1-yloxy)-3-[(propan-2-yl) amino] propan-2-ol. The drug Propranolol is commercially available as tablet, extended-release capsule for oral administration and solution form for oral as well as IV administration. The tablets are available in different dosage or strengths of 10, 20, 40, 60 and 80 mg; capsules in strengths of 60, 80, 120 and 160 mg whereas solution is available in two different dosages of 20mg and 40mg/5mL.

What is Losartan

Losartan belongs to a class of drugs known as angiotensin receptor blockers (ARBs). Losartan is available as a potassium salt of losartan, a non-peptide angiotensin II antagonist. The drug was the first angiotensin II antagonist to be marketed. Losartan is a prescription medication that is used for treating hypertension either alone or with other blood pressure medicines; reducing the chance of stroke in patients suffering with high blood pressure and left ventricular hypertrophy (an enlargement of the walls of the left chamber of the heart) and delaying the progression of diabetic kidney disease (diabetic nephropathy) in patients suffering with type 2 diabetes who have or had high blood pressure. Besides, the drug also finds implication in the treatment of myocardial infarction, systolic dysfunction, congestive heart failure, and coronary artery disease in patients who cannot tolerate ACE (angiotensin-converting enzyme) inhibitors.The drug is marketed under generic name Losartan and brand name Cozaar. Losartan chemically belongs to the class of organic compounds which are known as biphenyltetrazoles and derivatives. Losartan (potassium) is chemically known as 2-butyl-4-chloro-1[p-(o-1H-tetrazol-5-ylphenyl)benzyl]imidazole-5-methanol monopotassium salt. The drug Losartan is commercially available in the form of tablet for oral administration. The tablets are available in different dosages or strength of 25, 50 and 100 mg which respectively contain potassium in following amounts: 2.12 mg, 4.24 mg and 8.48 mg.

How Propranolol and Losartan works

Propranolol is a non-selective, competitive blocker of beta (1)-adrenergic receptors. The drug competes with sympathomimetic neurotransmitters such as catecholamines. Catecholamines including Dopamine, Norepinephrin and Epinephrine are released by adrenal gland under physical and emotional stress. Propranolol competitively binds with beta-adrenergic receptor and inhibits the sympathetic stimulation which results in reduction in resting heart rate, systolic and diastolic blood pressure, cardiac output and reflex orthostatic hypotension.

Losartan, an antihypertensive agent brings about competitive and selective inhibition of binding of angiotensin II to angiotensin I (AT1) receptor present in a variety of tissues including vascular smooth muscle and the adrenal glands. Angiotensin II (acts as a vasoconstrictor in vascular smooth muscle) is synthesized from angiotensin I via angiotensin-converting enzyme (ACE) and is responsible for stimulating the adrenal cortex to synthesize and secrete aldosterone. Alsosterone in turn brings about a decrease in the excretion of sodium and water while increases the excretion of potassium. Losartan, by blocking the binding of angiotensin II to the AT 1 receptor, results in vasodilatation and decrease in the effects of aldosterone thereby causing decreased vascular resistance and blood pressure.

Can both Propranolol and Losartan be taken together in combination

Yes, Propranolol in combination with Losartan represents a valuable addition to the existing monotherapy with either Propranolol or Losartan alone in patients with hypertension. The combination is very safe and no extra side effects occur from taking the drugs individually. Propranolol is a beta blocker and its pharmacological action results in reduced cardiac output and sympathetic activity which complements the effects of renin–angiotensin–aldosterone system (RAAS) associated with Losartan mechanism of action in reducing the blood pressure. Studies indicate a significant reduction in blood pressure in patients (approximately 36%) with type 2 diabetes when a beta blocker (Propranolol) is added to ARB therapy. Randomized, open-label, active controlled trials mainly in pediatric population also indicated for the first time about the safety and efficacy of Losartan add-on BB (beta-blockade) therapy in decreasing the progression of aortic root dilation in comparison to BB treatment alone in patients suffering with Marfan syndrome (MFS, a genetic disorder of connective tissue).

Safety and precautions while taking Propranolol: Losartan combination

The Propranolol and Losartan may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
Propranolol and Losartan can be taken together at the same time to treat hypertension. However, the dose should be adjusted by professional healthcare, if needed.
Do not use the medicine if you are hypersensitive or allergic to Propranolol or Losartan and any of its ingredients.
ARBs (angiotensin receptor blockers) including Losartan are usually the preferred choices for patients in reducing the blood pressure in patients with diabetes as these drugs lower the rate of kidney disease. Other antihypertensive drugs such as beta blockers (e.g., Propranolol) can be dangerous for such patients as it might mask the symptoms of hypoglycemia.
The combination of Propranolol and Losartan is not recommended in patients with high cholesterol as beta blockers (such as Propranolol) can increase the level of triglyceride and reduce beneficial HDL.
Before taking Propranolol-Losartan combination, tell your doctor about your medical history or any coexisting diseased state.
Propranolol-Losartan combination is also effective especially in old people due to high incidence of diabetes and also in African Americans who have severe hypertension which cannot be controlled by the use of single antihypertensive agent.

“Interaction between Aspirin and Oxycodone“

What is Coumadin

Coumadin is a Brand name for an anticoagulant (or blood thinner) drug that contains warfarin as an active ingredient. Warfarin prevents the formation of blood clots as well as their migration by inhibiting vitamin K-dependent coagulation factors. Coumadin is indicated for: treatment and prophylaxis of venous thrombosis and pulmonary embolism as its extension, treatment and prophylaxis of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, reduction of recurrent myocardial infarction and thromboembolic events (such as stroke or systemic embolization) after myocardial infarction and therefore the reduction the risk of death.

Coumadin has no effects on an established thrombus, and can’t reverse ischemic tissue damage. The main targets of anticoagulant therapy are to prevent further extension of the formed blood clot and to prevent the risk of secondary thromboembolic complications that may result in serious and possibly fatal outcomes. Despite its effectiveness, warfarin therapy has several issues. Many drugs interact with warfarin, as well as some foods (such as leaf vegetable foods because they typically contain large amounts of vitamin K1) and its activity has to be monitored by blood testing for parameter INR – International Normalized Ratio to be ensured that adequate safe dose is taken. If INR value is high, patients are predisposed to an increased risk of bleeding, while low INR values indicates that the dose of warfarin is uneffective to protect against thromboembolic events.

Other Brand names for warfarin products on the market are: Jantoven, Marevan, Waran and Warfant.

What is Synthroid

Synthroid is a Brand name for drug containing Levothyroxine (also known as L-thyroxine), a synthetic form of thyroid hormone, as an active ingredient. Chemically it is a chiral molecule in the L-form which is identical to natural thyroid prohormone thyroxine – T4. Thyroxine is naturally secreted by the follicular cells of the thyroid gland. Levothyroxine is used for the treatment of thyroid hormone deficiency, and rarely for the prevention of thyroid cancer recurrence. In the past, its related compound Dextrothyroxine was used for the treatment of hypercholesterolemia but it was withdrawn due to cardiac side effects. Synthroids indication are: Hypothyroidism, Pituitary TSH Suppression and Adjunct therapy for surgery and radioiodine therapy in the treatment of thyrotropin-dependent well-differentiated thyroid cancer. It is also used for the treatment of decompensated hypothyroidism or myxedema coma and stupor.

Other Brand names on the market are: Most common Brand names are: Euthyrox, Levothroid, Levoxyl, Levoxine, Levothyrox, Letrox, Tirosint, and Unithroid.

How does Coumadin and Synthroid work in the body

Warfarin works by inhibiting the enzyme activity of vitamin K reductase, which results in depletion of vitamin KH2 – the reduced form of vitamin K. Vitamin K is a cofactor for the carboxylation reactions of glutamate residues of vitamin K-dependent proteins, so this inhibition limits the gamma-carboxylation reactions and activation of the vitamin K-dependent coagulant proteins. Therefore, the synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X and anticoagulant proteins S and C is inhibited. Decreased levels of 3 of the 4 vitamin K-dependent coagulation factors (II, VII, and X) results in decreased prothrombin levels in blood and a decrease in the amount of thrombin generated and bound to fibrin. This reduces the thrombogenicity of clots.

Levothyroxine acts by imitating the effects of body thyroid hormone thyroxine – T4, (tetra-iodinated tyrosine derivative). T4 is converted to T3 (the active metabolite) in the liver and kidney. Thyroid hormones attach to thyroid hormone binding proteins, thyroxin-binding globulin, and thyroxin-binding prealbumin in order to increase solubility. After that, protein complex is transported to cytoplasm and nucleus of the cell where complex is binding to the thyroid hormone receptors. So by levothyroxine acting as a replacement for natural thyroxine, deficiency symptoms are relieved.

Can patients take Coumadin and Synthroid together

Coumadin and Synthroid Drug Interactions: If patients are currently being treated with Coumadin, they should let their doctor know before they are start taking Synthroid. Increased thyroid hormone levels can sensitize effects of warfarin, which may increase the risk of bleeding. Patients may need a dose adjustment or more frequent monitoring by their doctor or specialist to safely use both medicines. However, no special precautions are necessary if patients have been stable on levothyroxine therapy and are currently starting therapy with warfarin. It is very important to tell doctor about all other medications administration, including vitamins and herbs.

Prothrombin time or INR should be monitored closely when initiating, discontinuing, or changing the dosage of thyroid hormone therapy in patients stabilized on their oral anticoagulant regimen. Patients should be advised to contact their doctor if they develop signs and symptoms of excessive anticoagulation, such as: bruising, vomiting, unusual or prolonged bleeding, headache, dizziness, change in stool or urine color, or weakness.

The table below shows the incidence of side effects after Coumadin and Synthroid administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Frequency not defined

Angina pectoris, Myocardial infarction, Palpitations, Abdominal pain, Congestive heart failure, Flushing, Increased pulse, Choking sensation, Emotional lability, Headache, Heat intolerance, Arrhythmias, Arthralgia, Alopecia, Weight loss, Infertility, Dyspnea, Tremor, Fever, Tachycardia, Nervousness, Anxiety, Myasthenia, Pseudomotor cerebri, Cramps, Diarrhea, Insomnia, Decreased bone mineral density, Cholesterol embolus syndrome, Intraocular hemorrhage, Flatulence, Pruritus, Rash, Dizziness, Hematuria, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, Blood dyscrasias, Taste disturbance, Tissue necrosis, Anemia, Fever, “Purple toe” syndrome

Special precautions and warnings during Coumadin and Synthroid administration:

Patients should tell their doctor and pharmacist if they are allergic to Coumadine or Synthroid, or any other medications, or any of the ingredients that can be found in these products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interaction with warfarin and those interactions can cause serious side effects.
Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: diabetes; atherosclerosis, some liver or kidney disease; bleeding problems; porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
Patients using Coumadin should tell thir doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve. Coumadin may harm the fetus.
If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking Coumadin before the surgery or procedure or change your dosage of Coumadin before the surgery or procedure.
Cigarette smoking may decrease the effectiveness of Coumadin

What is Aniracetam

Aniracetam is a synthetic pharmaceutical drug that is used to improve or enhance the mental performance such as memory, learning capacity, attention and alertness. The drug is known as ampakinenootropic drug that is principally used for the treatment of Central Nervous System disorders. The drug Aniracetam is commercially available under generic name Aniracetam and marketed under several brand names such as Ampamet, Aniracetam-Sanhome, Memodrin, Referan, Pergamid, Draganon, Sarpul and many others worldwide. The drug is useful in the treatment of depression, schizophrenia, social problems, stress and sleep disorder, autism, chronic fatigue syndrome, emotional disturbances, and behavioural problems and urinary incontinence. The drug Aniracetam is also recommended for the treatment of behavioral and psychological symptoms of dementia, Alzheimer’s disease and Parkinson’s disease. Chemically, Aniracetam is belongs to a class of compound known as benzamides and named as N-anisoyl-2-pyrrolidinone or 1-(4-methoxybenzoyl) pyrrolidin-2-one.The Aniracetam is available as tablet or granules and powder form for oral administration through mouth. The tablet is swallowed as a whole and granules mixed in water and then swallowed. The drug is usually recommended two to three times a day and at least 15 minutes after meals.

What is Piracetum

Piracetam is a nootropic drug or smart drug i.e. Substances that primarily acts on the brain or nervous system. The drug is used to improve cognitive functions such as perception, reasoning, attention, learning, memory and intelligence. Besides this the drug is also used in combination with other medications to treat dementia or cognitive problems, depression , anxiety and movement disorder known as Cortical Myocolonus, a medical condition characterized by jerky muscles movements. The drug Piracetam is supposed to protect cerebral cortex (area of brain that is responsible for thought, perception, movement and recognition) against a lack of oxygen. Chemically the drug is belonging to racetams group and known as 2-oxo-1-pyrrolidine acetamide. It is a cyclic derivative of GABA and shares the 2-oxo-pyrrolidone base structure with pyroglutamic acid. In United States, Piracetam is allowed to be sold for medical purpose only and not as dietary supplements. The drug was originally discovered in 1964 by Belgian pharmaceutical company USB laboratories. Piracetam is available under generic name Piracetam and various brand names such as Avigilen, Cetam, Cerebrospan, Cerebroforte, Dinagen, Encetrop, Encefalux, Euvifor, Genogris, Gabacet, Nootrop, Nootron, Nootropil, Norzetam, Normabrain, Psycotron, Pirroxil, and Stimucortex. The medication is supplied as a tablet or granules/powder form for oral administration. The tablet is swallowed as a whole and granules mixed in water and then swallowed. The drug is usually recommended two to three times a day and at least 15 minutes after meals.

How Aniracetam and Piracetam works

Taking Piracetam vs Aniracetam:

The mode of action of Aniracetam is not fully understood but several theories have been put forth regarding the mechanism of action of the drug. These include glutamatergic, serotonergic, dopaminergic, cholinergic, and indirect adrenergic effects etc.

Nicotinic Cholinergic Receptors: Like other racetams, Aniracetam acts as a positive modulator of Nicotinic receptors involved in interaction with neurotransmitter acetylcholine. The drug also increases the release of acetylcholine from the brain hippocampus resulting in elevating the cholinergic neurotransmission.

AMPA Glutamatergic Receptors: Aniracetam is a positive modulator of AMPA (alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid) receptors responsible for the neurotransmission of glutamate (most common neurotransmitter in the brain). Aniracetam acts by binding to the non-active site of the AMPA receptor and modifies it resulting in reduced rate of desensitization thereby causing enhanced activation in presence of positive stimuli including glutamate. These receptors play important role in memory and are responsible for fast transmission at the synapses in the central nervous system.

GABAergic Receptors: Aniracetam increases the effects of GABAergic inhibition. GABA is responsible for the cognition (thinking) and emotional wellbeing, and improvement in the GABA function may serve in treating anxiety and cognitive disease.

Serotonergic Receptors: Aniracetam acts on serotonin receptors thereby inhibiting the breakdown of serotonin (involved in mood and behaviour regulation) and restoring its optimum level. Increased serotonin levels results in mood improvement, boosting energy, and decreasing anxiety.

Dopaminergic Receptors: Aniracetam causes reduction in anxiety and enhances socialization via interaction with dopamine receptors. The drug results in an increase in the release of dopamine and acts to improve mood and judgement.

Adrenergic Receptors: Binding of Aniracetam to AMPA receptors causes enhanced release of noradrenaline from neurons. This brings about slight stimulatory effect on the central nervous system.

Similar to Aniracetam, the mode of action of Piracetam is still under investigation/debate. Several theories have been put forward regarding the mode of Piracetam action. However, among the proposed mechanisms of action Piracetam is thought to exert its effect on central nervous system efficiency of cholinergic neurotransmission. Piracetam acts as a positive allosteric modulator of the AMPA receptor. Piracetam primarily act through muscarinic cholinergic (ACh) receptors (implicated in memory processes), NMDA glutamate receptors (implicated in learning and memory processes), but did not act on GABA receptors. It is suggested that Piracetam activate neuronal and vascular functions and influences cognitive function. Besides this it is also suggested that Piracetam also act on ion channels or ion carriers; therefore potentiate the neuron excitability. Piracetam has been observed to increase blood flow and oxygen consumption and increased brain activity.

Can both Aniracetam and Piracetam be taken together in combination

Mixing Piracetam and Aniracetam: Yes, both the drugs can be taken together in combination. Aniracetam and Piracetam are routinely used to treat medical conditions related to dementia, Alzheimer’s, and other trauma to the brain with great efficacy.Aniracetam Piracetam can be taken as stack that provides additional benefits as compared to taking Aniracetam Piracetam individually. Literature studies with racetam class of drugs have suggested that these drugs were routinely used in combination to increase their impact on cognitive enhancement. In clinical studies, it has been observed that Aniracetam Piracetam combination increase the potent ability of each other. However, combination therapy required professional supervision and dose adjustment for better and desired results. Both Aniracetam and Piracetam acts on brain and improve memory, perception, reasoning, attention, learning and intelligence. Despite this, when comparing Aniracetam vs. Piracetam, it has been observed that Aniracetam is more potent then Piracetam in improving concentration, anxiety, fear, depression and attentiveness. The recommended dose of Aniracetam (750-4500 mg) is usually less then Piracetam (1.5 – 6.5 gm).

Safety and precautions while taking Aniractam: Piracetam combination

It is generally recommended to continue with the normal diet unless and until asked by your doctor.
Aniracetam should be taken with a fat source (fish oil or fat rich food such as almonds, yogurt, eggs white/yolk, whole milk, salmon, etc.) due to its fat soluble nature. While Piracetam is highly soluble in water then fat or oil, therefore it is recommended to take with a glass of water.
Aniracetam must be taken in combination with a choline source including eggs, butter, beef.
Aniracetam and Piracetam should never be taken as a self-medication practice for treatment of physiological problems.
Consult your physician prior to use of Aniracetam Piracetam and never self prescribe the drug.
Aniracetam and Piracetam both are generally not recommended to be taken in case of pregnancy and breastfeeding.
Aniracetam should be used with caution in patients suffering from mild to moderate renal impairment (dose adjustment may be needed).
Dosage adjustments (reduction of the daily dosage by half) are necessary in case of patients with serious renal failure (creatinine clearance < 10 mL/min).
Sudden withdrawal of Aniracetam and Piracetam should be avoided. Aniracetam and Piracetam combination should not be taken very late in the day as it may cause sleep delay.
Do not use the medicine if you are hypersensitive or allergic to racetam class of drug or any of its ingredients. Before taking Aniracetam, tell your doctor about your medical history.
Consult with your doctor and pharmacist if you are taking any prescription and nonprescription medications, nutritional supplements, vitamins and herbal products.
Do not share this medication with other persons having the similar kind of problems. Consult your doctor for more details.

What is amoxicillin used to treat

Amoxicillin is a semi-synthetic antibiotic, an analog of ampicillin. It has broad spectrum bactericidal activity against both gram negative and gram positive strains of microorganisms. It was first discovered by Beecham Research Laboratories and was available in 1972. It is in the World Health Organization’s list of Essential Medicines and was approved by FDA in 1980’s. Amoxicillin is sold under the brand names like Amoxil, Tycil, Trimox, etc. as well as generic is available for this drug. The drug is available in different dosage form i.e tablets, capsules and suspensions and can be taken with or without food. Common dose for the amoxicillin varies with the age group for adult mild to moderate ear, nose or throat infection is 500 mg per 12 hours or 250 mg per 8 hours in divided doses, for severe infections is 850 mg per 12 hours and 500 mg per 8 hours and finish all. For children, in mild to moderate nose, throat or ear is 40 mg per kg at interval of 8 hours and for severe the dose is as high as 48 mg per kg at an interval of 12 hours. In case of overdose immediately call doctor or call 9-1-1.

Mechanism of action in the body “How does amoxicillin work”

Amoxicillin is a class of Beta-lactam antibiotics which is active against wide range of gram positive and gram negative bacteria. It is a drug of choice within the class because it is well absorbed when orally administered. Amoxicillin is prone to degradation by beta lacatmase enzyme produced by bacteria therefore, to decrease degradation is sometimes given in combination with clavulanic acid. As amoxicillin is an analog of penicillin, it acts by binding to penicillin binding sites called penicillin binding protien 1A(PBP-1A) in the cell wall binding to sensitive part of bacteria making it inactive. This inactivation of the enzyme prevents the cross-linking of two peptidoglycan strands, inhibiting the cell wall synthesis in the body. Further process is mediated with the help of autolysins, this amoxicillin interfers with the autolysins inhibitor.

Side effects of amoxicillin

Hypersensitivity: Hypersensitivity is the most common reaction in patients with history of allergy, hay fever , asthma or urticaira.
Dermatological: Dermatological side effects majorly include skin rash, fixed dose eruption, and bullous pemphigoid.
Gastrointestinal: The side effects that are seen may be even normal malfunctioning of the body but nausea, diarrhea, cramps, vomiting and abdominal pain is also reported.
Heamatologic: Patients receiving anticoagulant treatment have been reported with increased bleeding time and decreased hemoglobin and hematocrit.
Nervous system: Central system also gets kick from amoxcillin and rarely include headache, dizziness, reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions,etc.

Amoxicillin use in pregnant women

It is advisable to take amoxicillin in pregnancy but in controlled and prescribed doses as over dose and self medication of antibiotics is not advisable in any conditions. The studies reveals that their are no evidences of teratogenicity in infants after the use of amoxicillin. The benefits of amoxicillin always over weighs the side effects. This antibiotics always come with caution may interfere with birth control pills.

Amoxicillin and lactating women

The use of amoxicillin is controlled in lactating women, as it is known that amoxicillin is eliminated in the milk. Amoxicillin milk concentration can reach its peak level within 5 hours of intake. The amoxicillin milk concentration may cause sensitization to infants. However, the American Academy of Pediatrics considers it compatible for its use in lactation and breast feeding. This kind of cautions can been seen or read on labels in pharmacy for the medicine and even on the manufactures label, caution use in nursing patient.

What does levothyroxine do to your body

Pharmacokinetics of levothyroxine is required to understand the nature of the drug and what our body does to it . Lets understand the ADME of levothyroxine in detail:

Absorption: As the drug is administered orally, the absorption is in the range of 40 – 80% from the intestine . Levothyroxine is taken empty stomach for it best efficiency as the dietary fibers may interfere with the absorption of the drug. The absorption is increased by fasting and decreased by certain malabsorption, by certain foods and even age factor plays an important role.

Distribution: About 99% of it is bounded to proteins and is circulated in plasma along with thyroxine binding albumin, thyroxine binding globulin and prealbumin.

Metabolism: The site of metabolsim is usually liver and kidney. The major pathway for metabolism is sequential deiodination and along with kidney they are responsible for 80% of the circulating T3. It is excreted in bile, from kidney by glucuronidation and conjugation.

Elimination: It is majorly eliminated through urine i.e about 80% and remaning T4 is eliminated in stool. Half life elimination is 6-7days for euthyroid patients, about 9-10 days for hypothyroid patients and 3-4 days for hyperthyroid patients.

Can you take levothyroxine with coffee

It is not advisable to take medication with coffee but YES, many patients take their medication with coffee or those medication which is mostly prescribed in the morning at breakfast time. Coffee contains caffeine as active ingredient which interferes with the absorption of levothyroxine which was practically performed and published at “Clinical Thyroidology for Patients”. If levothyroxine and coffee are consumed together or taken at same time or slightly after swallowing levothyroxine, it interferes with the proper absorption of levothyroxine or may be called as malabsorption of levothyroxine. This may lead to decrease in the absorption of levothyroxine which is not compensated by the bodies of patients. Dose adjustments is required for effective levothyroxine action in the body.

Is it advisable to take levothyroxine and amoxicillin together

Amoxicillin and Synthroid drug interactions: Yes, you can take levothyroxine and amoxcillin together if prescribed by physician . As physician is the one who knows their profile very keenly and care about patients health. If we talk about the direction of use for levothyroxine and amoxcillin, both are directed to be ingested empty stomach to avoid interaction with food and to avoid decreased efficacy of the drug, to potently resist the infectious bacteria and to with stand the normal function of thyroid hormone replacement therapy. Secondly the two drugs are from different branches of therapy amoxcillin is an antibiotic where as levothyroxine is an aid for hormone replacement therapy.

“Lorcaserin oral : Uses, Dosage Side Effects, Interactions, Pictures, Reviews“
“Levothyroxine and calcium deficiency“

What is Aspirin?

Aspirin is an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain. Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack. Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time). This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin. The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897. Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

What is Clopidogrel?

Clopidogrel is an oral, thienopyridine-class drug that is used to inhibit blood clots formation. The drug is available under generic name Clopidogrel and brand name Plavix worldwide. Clopidogrel is an antiplatelet agent that is primarily used to prevent or inhibit the formation of blood clots in a variety of medical conditions including coronary artery disease, peripheral vascular disease, and cerebrovascular disease. The drug is recommended to reduce the risk of stroke and myocardial infarction (heart attack) in people who have already had a history of myocardial infarction, other forms of acute coronary syndrome, unstable angina, stroke, and peripheral artery disease. Clopidogrel is also used in combination with acetylsalicylic acid (ASA, aspirin), to prevent thrombosis (blood clotting) following placement of a coronary stent (a tube shaped appliance that is used to keep the arteries open in the treatment of coronary heart disease). Clopidogrel is also used in combination with acetylsalicylic acid as an alternative antiplatelet drug in people with a history of gastric ulceration or when aspirin cannot be used. Clopidogrel or a related drug is also recommended for patients with myocardial infarction with ST-elevation, percutaneous coronary intervention (PCI), fibrinolytic therapy, non-ST elevation myocardial infarction or unstable angina and stable ischemic heart disease. Clopidogrel is available as a bisulfate salt and is a synthetic pharmaceutical organic compound with molecular formula C₁₆H₁₆ClNO₂S. The drug is chemically known as methyl (2S)-2-(2-chlorophenyl)-2-{4H,5H,6H,7H-thieno[3,2-c]pyridin-5-yl}acetate. The medication is supplied as either pink, round, biconvex, or pink, oblong film-coated tablets for oral administration by mouth.

How Aspirin and Clopidogrel work?

Aspirin is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase (COX) enzyme therefore known as COX inhibitor agent. The action of both acetyl and salicylate component of the acetylsalicylic acid (ASA or Aspirin) and its active metabolite salicylate are liable for the anti-inflammatory and analgesic properties through inhibition of cyclooxygenases. ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly. Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid. Antipyretic effect of ASA results from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibits the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

Clopidogrel is an antiplatelet agent that prevents the formation of blood clots. When metabolized by the body, the active metabolite of the drug binds irreversibly to the P2Y12 subtype of adenosine diphosphate (ADP) receptor on the platelets. The occupancy of the platelet receptor (involved in the aggregation of platelets and cross-linking by fibrin protein) by the drug impairs the binding of ADP to the receptor and thus, the activation of the glycoprotein GPIIb/IIIa complex. GPIIb/IIIa complex is the major receptor for fibrinogen whose impaired activation prevents binding of fibrinogen to platelets and inhibits platelets from sticking to each other. Clopidogrel interference with the platelet functions and prevents blot clots formation inside the blood vessels.

Can both Aspirin and Clopidogrel be taken together in combination?

Yes, both the drugs can be taken together in combination. Clinical studies indicate the safety and efficacy of using the combination of the drugs for a variety of purposes. The fixed dose combination of Aspirin and Clopidogrel is available commercially under brand name Clopivas-AP 75/150 (containing 75 mg or 150 mg each of Clopidogrel and Aspirin).The other brand names of Clopidogrel-Aspirin combination are Antiban-ASP, Asicom PLUS, Antiplar Plus , Asogrel-A etc. most suitable indications for the use of combined Clopidogrel and Aspirin therapy includes the treatment of acute coronary syndromes and the prevention of coronary events after placement of a stent. Current clinical data supports short-term use of combination therapy (approximately 1 to 2 weeks) for patients with an ST-segment elevation myocardial infarction and who do not receive stent placement in the course of treatment. However, long term combination therapy is more beneficial in case of patients with unstable angina or non-ST-segment elevation myocardial infarction. Dual combination therapy (for an average duration of 9 months) also offers advantage in reducing the incidence of cardiovascular death, myocardial infarction (MI), and stroke at 12 months over monotherapy involving Aspirin alone. Clopidogrel in combination with Aspirin is also prescribed for treatment of non-ST segment elevation acute coronary syndrome in patients at moderate to high risk of MI or death. Clopidogrel in combination with Aspirin is advised for 12 months after the most recent acute episode of non-ST elevation acute coronary syndrome. This is followed by standard care, including treatment with low-dose aspirin. Dual combination involving Clopidogrel and Aspirin is also recommended before a percutaneous coronary intervention (PCI) so as to reduce the risk of major ischaemic events (cardiovascular death, MI or urgent target vessel revascularisation within 1 month of PCI. Combination therapy for a minimum of 28 days is also highly useful in the patient receiving coronary stents to decrease the incidence of acute and subacute stent thrombosis. Clinical data indicates the effectiveness and safety of Clopidogrel use in combination with Aspirin for different durations depending on the type of stent deployed e.g., duration of 4 weeks in case where a bare metal stent has been deployed and 12 months where a drug-eluting stent has been deployed. Shorter or longer use of combination therapy is usually recommended as required for specific individual circumstances.

Safety and precautions while taking Aspirin: Clopidogrel combination

In patients with recent TIA (transient ischemic attack) or stroke and highly prone for recurrent ischemic events, the dual therapy of Aspirin and Clopidogrel is not very effective than that of Clopidogrel alone, but the combination increases major bleeding.
Clopidogrel extends the duration of the bleeding time and therefore should be used with caution in patients at risk of increased bleeding from trauma, surgery, or other pathological conditions especially gastrointestinal and intraocular.
The Aspirin and Clopidogrel may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Clopidogrel, any of its constituents or any other antiplatelet drug and Aspirin or any of its ingredients.
Aspirin and Clopidogrel both are generally not recommended to be taken in case of pregnancy and breastfeeding.
Administration of the drugs (Aspirin and Clopidogrel) is usually not recommended in patients with bleeding disorders or hemorrhagic disorders.
Do not share this medication with other persons having the similar kind of problems. Consult your doctor for more details.

“How does Lorcaserin work“
“Amoxicillin levothyroxine interaction“

What is folic acid

Folic acid is synthetic form of folate.It is also sometimes known as B vitamin. Folic acid is water soluble vitamin and chemically it is 5′-methlytetrahydrofolate. International Union of Pure and Applied Chemistry state that folic acid and folate are preferred synonyms for pteroylgliutamate and pteroylglutamic acid. Folate is important for the body as it helpe in synthesizing and repair of DNA. It is also required to synthesize methylated DNA which is involved as a cofactor in many biological reactions. Folic acid is synthetically produced and have an fortified theory that it is converted into folate. Folic acid is oxidized form not significatly found in natural fruits and vegetables. Folic acid is available as supplement in solid dosage form i.e tablets in both the typs OTC and prescription based. The Folic acid is available in varied doses from 400mcg, 800mcg and 1mg( need prescription). Folic acid is also available in combination with other vitamins and minerals over the counter.

Where can folic acid be found

Folic acid can be obtained from a lot of sources like green leafy vegetables, fruits, meat and also in deficient world it is now added to foods such as breads, bagels, etc to meet the daily requirements in this challenging world.

Vegetables: Brocolli, spinach, lettuce are rich in folic acid. Other vegetables that also contains good amount of folic acid are Brussels Sprouts, asparagus, okra,etc.

Fruits and fruit juices: Orange and orange juices are rich in this vitamin.

Meat: Beef liver and kidney have high amount of folate.

Grains: whole grains, fortified cereals and beans are other folate rich foods.

Yeast and mushrooms also have an considerable amount of folae in them.

What is the normal folate levels for an healthy individual

The folate levels are generally categorized at two different levels . First is plasma(or serum) folate concentration and secondly RBC folate concentration. This concentrations are dependent on intakes, the serum folate concentrations shows the short term folate intake whereas the RBC folate concentration reflects the long term folate concentration.

The deficiency of folate in an adult can be defined as <3.0 ng/dl for serum folate concentration and <140ng/dl in regards with RBC folate concentration. However, hogh levels of serum folate levels and RBC folate levels are thought to be fine when vitamin B12 is in normal range. Body cells require Vitamin B12 to use folic acid in the body, but when theirs low levels of vitamin B12, cells cannot use folic acid and its level builds up in the body which is a concern and require medical attention.

Folic acid deficiency

What happens if our body does not get considerable amount of folate?

Deficiency of folate is not so common in United States of America due the availability of the folate contained food in diet. However, the underlying causes of deficiency may be low folate in diet , some genetic impariment or underlying diseases.

Meganoblastic anaemia: This is a kind of aneamia that results from the inhibition of DNA synthesis during RBC production. The function of folic acid is to mediate the production of RBC and repair and synthesis of DNA . Meganoblastic anemia is due to hypovitaminosis, specifically a deficiency of vitamon b12 and/or folic acid.

The common symptoms of megnoblastic anemia are: Weakness, fatigue, irritability, concentration problem, headache, shortness of breath and heart palpitation. Red blood cells are responsible for transport of oxygen and less oxygen may lead to above problems.

Other folic acid deficiency causes: Sore in mouth and inside the tongue and change in the colour of hair, finger nails and skin.

The population that mostly affected by the deficiency of folic acid is the pregnant ladies. Deficiency of folic acid in pregnant women may cause spina bifida, which is a neural tube defecr(spine does not close during the first month of pregnancy). Premature birth and low birth weight are also complications that can occur during low level of folic acid.

Folic acid as supplement

Folic acid is a synthetic form of naturally occuring folate and hence is used when there is deficiency of folate in blood. Folic acid is also used in conditions associated with folate deficiencies like ulcerative colitis, liver diseases, and kidney dialysis.

Folic acid is also used in the prevention of heart diseases and strokee. Folic acid decreases the levels of homocysteine which is an amino acid. Folic acid is alone cannot lower the risk of heart diseases, but combination of other vitamins can help.

IT can also be used in conditions like memory loss, alzheimer’s disease, age related hearing loss, osteoporosis, sleep problems, depression, nerve pain, muscle pain and inherited disease Fragile X-syndrome.

Can patients take levothyroxine and folic acid together

Yes you can take levothyroxine and folic acid together at the same time their is no interaction between this medication but follow as per prescribed and finish all. If is women is planing to get pregnant and she is suffering from hypothyroidism she will be prescribed with an prenatal tablets or prenatal supplement which contains vitamins and folic acid even. So their is no prominent adverse event reported till date with combination therapy.

Changes in homocysteine level with the combination therapy

Homocyteine is a homologue of amino acid cysteine, differing by an additional methylene bridge. The normal range of homocysteine in western population is 10-12 micro mol/L and levels of 20micro mol/L in populations with low intakes of vitamin B or in older age group. Homocysteine levels are usually higher in men than women as per the studies conducted, and generally the levels increases with the increase of age.

An study was conducted volunterally where the effects of folic acid plus lebvothyroxine on serum homocysteine level in hypothyroidism were studied. Levels of homocysteine are higher in untreated hypothyroidim. Therefore proper treatment of hypothyroidism may decrease the risk of arttherosclerosis and heart diseases by reducing the homocysteine levels. Folate and vitamin B12, which are involved actively in the metabolism of homocysteine and convert it to cysteine and in turn causing reduction in serum homocysteine levels.

Therefore, it was concluded that the combination of levpthyroxine and folic acid had an better control on controlling and reducing the homocysteine levels and causing further reduction generating heart diseases.

“Is is safe to take both Levothyroxine and Amoxicillin together”
“Aspirin and clopidogrel dual therapy for stroke”

What does Aspirin treat?

Aspirin is an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain. Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack. Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time). This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin. The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897. Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

What is Ticagrelor?

Ticagrelor (trade name Brilinta in the US, Brilique and Possia in the EU) belongs to a class of drugs called antiplatelets. It is a P2Y₁₂ platelet aggregation inhibitor. The drug is produced by AstraZeneca. Ticagrelor is a prescription drug that is available only as a brand name drug called Brilinta and not available as a generic drug. Ticagrelor is indicated for reducing the risk of stroke, heart attack, or death in case of patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI). Ticagrelor is also recommended to prevent blood clots formation in people with coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) who have had a heart attack or severe chest pain. Ticagrelor is a nucleoside analogue and has a molecular formula C₂₃H₂₈F₂N₆O₄S. The drug is a synthetic pharmaceutical compound and belongs to the class of organic compounds known as triazolopyrimidines which are polycyclic aromatic compounds containing triazole ring fused to a pyrimidine ring. Chemically it is known as (1S,2S,3R,5S)-3-[7-{[(1R,2S)-2-(3,4-difluorophenyl)cyclopropyl]amino}-5(propylthio)-3H-[1,2,3]-triazolo[4,5-d]pyrimidin-3-yl]-5-(2-hydroxyethoxy)cyclopentane-1,2-diol. The active component of the drug is Ticagrelor besides other inactive ingredients. The drug is supplied in the form of tablets in two varying doses of 90 mg and 60 mg to be taken orally with or without food two times a day.

How does Aspirin and Ticagrelor work in the body?

ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly. Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid. Antipyretic effect of ASA is resulted from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibit the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

The mode of action of Ticagrelor is similar to those of other thienopyridines including clopidogrel, prasugrel and ticlopidine. Ticagrelor and its major metabolite bind reversibly with adenosine diphosphate (ADP) receptors of subtype P2Y12 thereby preventing signal transduction and platelet activation. However, the binding site of Ticagrelor in contrast to the other antiplatelet drugs is different from ADP, which makes it an allosteric antagonist. The blockage is reversible. Besides, the drug does not need to be metabolized by the hepatic system to become active which is beneficial for the patients with genetic variants regarding the enzyme CYP2C19.

Can both Aspirin and Ticagrelor be taken together in combination?

Aspirin and Ticagrelor interaction: Yes, Ticagrelor in combination with Aspirin represents a valuable, safe, and effective therapeutic regimen for the treatment of acute coronary syndrome (MI or unstable angina). Ticagrelor, a potent P2Y12 inhibitor together with Aspirin provides a standard therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI). For the treatment of ACS, the recommended initial loading dose of Aspirin is 325 mg, which is to be followed by the maintenance dose of 75-100 mg/day. It is recommended not to exceed the Aspirin dose above 100 mg per day as it causes a reduction in the effectiveness of Ticagrelor.

Safety and precautions while taking Aspirin:Ticagrelor combination

It is always recommended that analgesia should be dose–limited when used in combination due to their increased side effects. Caution should be taken before using Aspirin in combination with Ticagrelor.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Ticagrelor or nonsteroidal anti-inflammatory drugs (i.e. ibuprofen, naproxen, celecoxib) or salicylates, or to any ingredient of the drug formulation.
The drugs are also not recommended in case of patients with a history of bleeding problems or a history of stomach or intestinal bleeding and should be used with caustion in patients with a history of asthma.
Ticagrelor and Aspirin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements.
It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult as it may increase the chance of having a heart attack, blood clotting problems, or other serious conditions.
The uptake of drugs should be hold or stopped in case a patient is undergoing any test, procedure or surgery and then should be restarted later.
Do not share the medications with other persons having the similar kind of problems. Consult your doctor for more details.
Aspirin and Ticagrelor are generally not recommended to be taken in case of pregnancy and breastfeeding.
The drugs are usually not recommended to be taken along with alcohol.

“Can I take Niacin and Aspirin together?”
“Belviq (Lorcaserin) dosing, indications, interactions, adverse effects”

How Coumadin works in the body

Coumadin is a Brand name for an anticoagulant (or blood thinner) drug that contains warfarin as an active ingredient. Warfarin prevents the formation of blood clots as well as their migration by inhibiting vitamin K-dependent coagulation factors. Coumadin is indicated for: treatment and prophylaxis of venous thrombosis and pulmonary embolism as its extension, treatment and prophylaxis of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, reduction of recurrent myocardial infarction and thromboembolic events (such as stroke or systemic embolization) after myocardial infarction and therefore the reduction the risk of death.

Other Brand names for warfarin products on the market are: Jantoven, Marevan, Waran and Warfant.

What is the purpose of Tylenol?

Tylenol is a Brand name for a drug that contains acetaminophen (also known as paracetamol) that has antypiretic and analgesic properties. It is used for reducing pain and fever and also for relieving the symptoms of common cold, cough, headache, toothache, allergies and influenza. Usual per oral doses for Tylenol are 325-650 mg. It is available in tablets, caplets and liquid dosage forms.

Tylenol products on the market are:

Tylenol Extra Strength Caplets,
Tylenol Regular Strength Tablets,
Tylenol 8 HR Extended-Release Caplets,
Tylenol 8 HR Arthritis Pain,
Tylenol Sinus Congestion & Pain Caplets,
Tylenol Cold Multi-Symptom Caplets and Liquid,
Tylenol Cold Head Congestion Severe Caplets,
Tylenol PM Caplets and Tylenol Cold Sore Throat Liquid.

Tylenol Extra Strength are caplets containing only Acetaminophen 500mg as an active ingredient that is used as a pain reliever/fever reducer.

Tylenol Cold are also caplets containing: Acetaminophen 325mg as a pain reliever/fever reducer, Dextromethorphan 10mg as a cough suppressant and Phenylephrine HCl 5mg as a nasal decongestant.

Tylenol Sinus is another Tylenol product that is used for relieving the symptoms of: sinus headache, sinus pain and pressure, sinus congestion, aches and pain and runny nose and sneezing (in Nighttime only). It is available in tablet form containing: acetaminophen 500 mg as a pain reliever/fever reducer and phenylephrine hydrochloride, 5 mg as a nasal decongestant, and chlorpheniramine maleate 2mg as an antihistamine.

Tylenol-Codeine is a combination of acetaminophen 500 mg and codeine 8 mg that is used for relieving mild to moderate pain, fever reduce and as a cough suppressant.

How does Coumadin and Tylenol work in the body?

Warfarin works by inhibiting the enzyme activity of vitamin K reductase, which results in depletion of vitamin KH2 – the reduced form of vitamin K. Vitamin K is a cofactor for the carboxylation reactions of glutamate residues of vitamin K-dependent proteins, so this inhibition limits the gamma-carboxylation reactions and activation of the vitamin K-dependent coagulant proteins. Therefore, the synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X and anticoagulant proteins S and C is inhibited. Decreased levels of 3 of the 4 vitamin K-dependent coagulation factors (II, VII, and X) results in decreased prothrombin levels in blood and a decrease in the amount of thrombin generated and bound to fibrin. This reduces the thrombogenicity of clots.

Dextromethorphan acts on cough center in medulla by decreasing sensitivity of cough receptors and by interrupting impulse transmission.

Phenylephrine is sympathomimetic with direct action on the adrenergic receptor system. The vasoconstriction is produced after α-adrenergic receptors activation.

Chlorpheniramine is antagonist of histamine H1 receptor. It has been also shown that this drug is also a serotonin-norepinephrine reuptake inhibitor.

Codeine is an opioid analgesic which is chemically related to morphine but it has less potent analgesic properties and mild sedative effects. It also acts suppress cough by centrally mechanisms.

Can patients take Coumadin and Tylenol together?

Patients on a Coumadin anticoagulant therapy should be very careful before taking any drugs for the treatment of aches and pains. Taking NSAID (non-steroidal anti-inflammatory drugs) or aspirin for pain relief together with Coumadin can increase the risk for serious bleeding. However, pain relievers that contain acetaminophen, such as Tylenol, can be the best choice, and many doctors will recommend Tylenol for a short term treatment.

Prothrombin time or INR should be monitored closely. Patients should be advised to contact their doctor if they develop signs and symptoms of excessive anticoagulation, such as: bruising, vomiting, unusual or prolonged bleeding, headache, dizziness, change in stool or urine color, or weakness.

The table below shows the incidence of side effects after Coumadin and Tylenol administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Frequency not defined

Cholesterol embolus syndrome, Abdominal pain, Intraocular hemorrhage, Alopecia, Rash, Pruritus, Headache, Lethargy, Taste disturbance, Tissue necrosis, Hematuria, Anemia, Hepatitis, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, “Purple toe” syndrome, Increased fracture risk with long-term usage, Dizziness, Blood dyscrasias, Flatulence, Fever, Hyperammonemia, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Urticaria, Hepatotoxicity, Liver failure, Nephrotoxicity, Pneumonitis

Special precautions and warnings during Coumadin and Tylenol administration:

Patients should tell their doctor and pharmacist if they are allergic to Coumadine or Tylenol, or any other medications, or any of the ingredients in these products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interactions with warfarin and those interactions can cause serious side effects.
Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: atherosclerosis, diabetes, some liver or kidney disease, bleeding problems, porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
Patients using Coumadin should tell thir doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve. Coumadin may harm the fetus.
If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking warfarin before the surgery or procedure or change your dosage of warfarin before the surgery or procedure.
Cigarette smoking may decrease the effectiveness of Coumadin
Acetaminophen overdose can lead to acute liver failure. Acetaminophen administration shouldn’t exceed the doses of 4g per day.
Patients should tell their doctor if they have ever had a rash while taking acetaminophen.
Patients with phenylketonuria should avoid these medicines.
Patients should also know that combination acetaminophen products for cough and colds containing cough suppressants expectorants, nasal decongestants and antihistamines, should not be used in children younger than 2 years of age. In children 2 through 11 years of age such combinations should be used carefully and only according to the directions on the label.
Tylenol can cause unusual results with certain laboratory tests for glucose in the urine.

“Can I take both thyroxine and folic acid table at the same time?“
“Interactions between aspirin oral and high-dose-aspirin-ticagrelor“

Is Coumadin a blood thinner?

Other Brand names for warfarin products on the market are: Jantoven, Marevan, Farin, Waran and Warfant.

Is Ibuprofen a blood thinner?

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen is a generic name for a drug containing the same name active ingredient. It is used as a pain reliever for various conditions such as: headaches, dental pain, muscle pain, tendinitis (inflammation or irritation of a tendon, a thick cord that attaches bone to muscle), menstrual cramps, and for the treatment of pain, swelling and joint stiffness caused by arthritis, osteoarthritis, juvenile arthritis, bursitis, ankylosing spondylitis, psoriatic arthritis and gout. It can also be used to temporarily reduce fever and for the treatment of common cold symptoms. Ibuprofen may be used intravascular with opiates for relieving moderate to severe pain. Ibuprofen lysine may be also used intravscular as a therapy for premature neonates with ductus arteriosus.

Common Brand names for ibuprofen are: Advil, Motrin, Brufen, Calprofen, Genpril, Ibu, Midol, Nuprin, Cuprofen, Nurofen, Ibuprofen 800 and PediaCare Children’s Pain Reliever/Fever Reducer IB.

How does Coumadin and Ibuprofen work in the body?

Can patients take Coumadin and Ibuprofen together?

Patients on a Coumadin anticoagulant therapy should be very careful before taking any drugs for aches and pains. Taking NSAID (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, diclofenac, ketorolac, aspirin or other NSAID for pain relief together with Coumadin can increase the risk of serious bleeding. However, pain relievers that contain acetaminophen can be the best choice, and many doctors will recommend it. So, patients should never take Coumadin and Ibuprofen together without medical advice. Ibuprofen may impair the function of platelets which are important for blood clotting, while Couamdin impairs blood clotting in a different way, by impacting the INR level. Although there is no direct interaction between the two medicines, if they are taken together at the same time, they will attack the body’s ability to do blood clotting in two separate ways. This could greatly increase the risk of having significant bleeding.

Prothrombin time or INR should be monitored closely in patients on Coumadin therapy. Patients should be advised to contact their doctor if they develop signs and symptoms of excessive anticoagulation, such as: bruising, vomiting, unusual or prolonged bleeding, headache, dizziness, change in stool or urine color, or weakness.

The table below shows the incidence of side effects after Coumadin and Ibuprofen administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Frequency not defined

Cholesterol embolus syndrome, Abdominal pain, Intraocular hemorrhage, Alopecia, Rash, Pruritus, Headache, Lethargy, Taste disturbance, Tissue necrosis, Hematuria, Anemia, Hepatitis, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, “Purple toe” syndrome, Increased fracture risk with long-term usage, Dizziness, Epigastric pain, Heartburn, Nausea, Tinnitus, Rash Vomiting , Edema, Fluid retention, Constipation

Coumadin and Ibuprofen side effects

Special precautions and warnings during Coumadin and Ibuprofen administration:

Patients should tell their doctor and pharmacist if they are allergic to Coumadin or Ibuprofen, or any other medications, or any of the ingredients in these products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interactions with warfarin and those interactions can cause serious side effects.
Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: atherosclerosis, diabetes, some liver or kidney disease, bleeding problems, porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
Patients using Coumadin should tell their doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve, but only with medical supervision. Coumadin may harm the fetus.
If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking warfarin before the surgery or procedure or change your dosage of warfarin before the surgery or procedure.
Cigarette smoking may decrease the effectiveness of Coumadin.
Patients should tell their doctor if they have or have ever had any of following conditions such as: asthma, frequent stuffed or runny nose or nasal polyps, swelling of the inside of the nose, swelling of the arms, feet, ankles, hands, or lower legs; lupus or liver or kidney disease.
Patients should mention to their doctor if they are using following drugs: ACE inhibitors such as: enalapril , fosinopril, lisinopril, benazepril, captopril, moexipril, diuretics lithium and methotrexate. Doctor may need to change the doses of these medications or monitor more carefully for side effects.
Patients should not take nonprescription ibuprofen with any other analgesic unless doctor tells that should.
If patients are giving ibuprofen to a child, it is important to tell the child’s doctor if the child has not been drinking fluids or has lost a large amount of fluid from repeated vomiting or diarrhea.

“Coumadin and Tylenol Drug Interactions”
“Is it safe to take Cipro and Ibuprofen together?”

Is Aspirin NSAID?

Aspirin is an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain. Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack. Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time). This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin. The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897. Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

What is Niacin?

Niacin is a water-soluble vitamin that belongs to the vitamin B family and occurs in many animal and plant tissues, with antihyperlipidemic activity. The drug is available under generic names such as niacin, nicotinic acid, vitamin B3 and brand names Niacor, Niaspan, Slo-Niacin, Nicolar (discontinued). Niacin, also known as nicotinic acid is a synthetic pharmaceutical organic compound with molecular formula C₆H₅NO₂. The drug is supplied as tablets or capsules for oral administration by mouth. The tablets are available in varying strength of 250, 500, 750, and 1000 mg whereas capsules in strength of 250 and 500 mg. It is available in different forms such as immediate release, extended or sustained release and no-flush Niacin. Niacin is an antihyperlipidemic agent that is primarily used to reduce the levels of cholesterol and triglyceride in the blood stream. It is recommended for treatment of pellagra (arising due to Niacin deficiency). Niacin is also used for lowering the risk of osteoarthritis, Alzheimer’s disease, cataracts, and type 1 diabetes. It is also implicated for treatment of schizophrenia, depression, hallucinations, and memory loss, migraines, chronic brain syndrome, motion sickness, alcohol dependence, and edema. It is also recommended for treating acne, leprosy, attention deficit-hyperactivity disorder (ADHD), improving digestion, lowering blood pressure, improving circulation in some cases. Niacin is indicated in lowering the risk of recurrent myocardial infarction in case of patients with a history of myocardial infarction and hyperlipidemia. Besides, Niacin in combination therapy with a bile acid binding resin in patients with a history of coronary artery disease (CAD) and hyperlipidemia is recommended to treat atherosclerotic disease. Niacin is also prescribed as adjunctive therapy for treatment of severe hypertriglyceridemia.

How Aspirin and Niacin works?

ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly. Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid. Antipyretic effect of ASA results from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibits the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

Niacin is a precursor molecule to cofactors such as nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) and also binds to a number of receptors including Nicotinic acid phosphoribosyltransferase, Nicotinate D-ribonucleotide phyrophsopate phosphoribosyltransferase, Niacin and the Nicotinate N-methyltransferase receptor. However, the exact mechanism exerted by Niacin for altering lipid profiles is not well defined, but may involve many actions. These include lowering of hepatic triglycerides esterification, partial inhibition of release of free fatty acids from adipose tissue, and increase in the activity of enzyme lipoprotein lipase that may be responsible for increasing the rate of chylomicron triglyceride removal from plasma. Besides, Niacin also causes a decrease in the levels of apolipoprotein B-100 (apo B) which is the major component of the VLDL (very low-density lipoprotein) and LDL fractions and thus a decrease in their synthesis. Niacin does not exert any effect on fecal excretion of fats, sterols, or bile acids.

aspirin before niacin — **Aspirin Tabs**

Can both Aspirin and Niacin be taken together in combination?

Aspirin Low Strength and niacin Drug Interactions: Yes, both the drugs can be taken together in combination. Clinical studies indicate the safety and efficacy of using the combination of the drugs in reducing the severity and incidence of Niacin extended-release (NER) induced flushing. Although associated with cardiovascular benefits, Niacin mainly causes adverse effects such as vasomotor side effects and increase in liver enzymes (flushing and hepatotoxicity). This can be minimized with either small doses of Niacin or co-administration with Aspirin. It is generally recommended to take Aspirin 30 minutes prior to Niacin administration so as to inhibit COX1-dependent prostaglandin production in the skin that causes Niacin-induced flushing. Data demonstrates that higher doses of Aspirin shows greater efficacy in decreasing intolerability to Niacin in contrast to lower doses (80 or 160 mg compared to 325 mg). No combined formulation exists at present for Aspirin and Niacin, patents are being filed to develop fixed-dose combination product of sustained-release Aspirin (to maintain Aspirin at sufficient levels) and delayed and extended-release Niacin in order to increase patient compliance.

The combination of Aspirin and Niacin is usually very beneficial to minimize the risk of developing heart disease in patients with high cholesterol and showing a decreased response to Aspirin for the treatment of clogged arteries than patients with normal cholesterol levels.

Besides, clinical studies in healthy people and people with inflammation of the stomach caused by Helicobacter pylori infection (a bacterium causing ulcers) demonstrates the protective effect of Niacin/vitamin C on Aspirin side effects.

Safety and precautions while taking Aspirin: Niacin combination

Aspirin and Niacin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Aspirin or Niacin or any of the constituents.
Aspirin is generally not recommended to be taken in case of pregnancy and breastfeeding while only recommended amounts of Niacin should be taken during pregnancy which is 30 mg per day for women under 18 years of age, and 35 mg for women over 18.
Administration of the drugs (Aspirin and Niacin) is usually not recommended with alcohol because alcohol increases the level of acetylsalicylic acid about 50-100% in serum in case of Aspirin and causes worsening of flushing and itching in case of Niacin.
Do not share the medications with other persons having the similar kind of problems. Consult your doctor for more details.
Dosage adjustment of Aspirin is necessary during development of liver function abnormalities and Niacin is usually not recommended as it might increase liver damage.

“Does Coumadin Interact with Tylenol?”
“Is it ok to mix Oxycodone and Aspirin?”

What is Coumadin?

Coumadin is a Brand name for an anticoagulant (or blood thinner) drug that contains warfarin as an active ingredient. Warfarin prevents the formation of blood clots as well as their migration by inhibiting vitamin K-dependent coagulation factors. Coumadin is indicated for: treatment and prophylaxis of venous thrombosis and pulmonary embolism as its extension, treatment and prophylaxis of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, reduction of recurrent myocardial infarction and thromboembolic events (such as stroke or systemic embolization) after myocardial infarction and therefore the reduction the risk of death.

Other Brand names for warfarin products on the market are: Jantoven, Farin, Marevan, Waran and Warfant.

Why should you take Aspirin every day?

Aspirin is a Brand name for a drug that contains acetylsalicylic acid as active ingredient. It works by lowering the substances in the body that can cause fever, pain and inflammation. Aspirin is indicated to treat pain, and reduce inflammation and fever. Aspirin in lower dose (75-325mg) is sometimes used for a long-term treatment and prevention of heart attacks, strokes, and angina (chest pain) because it can prevent blood clothing. Low doses of aspirin are usually given immediately after a heart attack to lower the risk of another heart attack or the death of heart tissue. For cardiovascular conditions, Aspirin should be used only under the supervision of a doctor. Aspirin may be also effective in preventing certain types of cancer, such as colorectal cancer.

Other Brand names for acetylsalicylic acid on the market are: Ascriptin, Arthritis Pain, Aspir-Low, Aspir 81, Bufferin Low Dose, Bayer Childrens Aspirin, Durlaza, Ecpirin, Ecotrin, Fasprin, Miniprin and Halfprin.

How does Coumadin and Asprin work in the body?

Aspirin manifest analgesic, anti-inflammatory and antipyretic poperties due to actions of both the acetyl and the salicylate portions of the molecule as well as by the active salicylate metabolite. Aspirin irreversibly and directly inhibits the activity of both cyclooxygenase (COX-1 and COX-2) which results in decrease of the formation of precursors of thromboxanes and prostaglandins from arachidonic acid. This makes acetylsalicylic acid different from other NSAIDS (such as ibuprofen, diclofenac or naproxen) which are reversible inhibitors. Aspirins antirheumatic actions are a result of its anti-inflammatory and analgesic. The platelet aggregation-inhibiting actions of aspirin specifically include aspirins ability to act as an acetyl functional group donor to cyclooxygenase enzyme. Irreversible acetylation renders cyclooxygenase enzyme inactive, thus preventing the formation of the aggregating agent thromboxane A2 in platelets. Since platelets lack can’t synthesize new proteins, the effects persist during the life of the exposed platelets (7-10 days). Acetylsalicylic acid may also inhibit production of prostaglandin I2 in blood vessel endothelial cells; however, inhibition of prostaglandin I2 is not permanent as endothelial cells can produce more cyclooxygenase to replace the non-functional enzyme.

Can patients take Coumadin and Aspirin together?

Patients on a Coumadin anticoagulant therapy should be very careful before taking any drugs for aches and pains. Taking NSAID (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, diclofenac, ketorolac, aspirin or any other NSAID for pain relief together with Coumadin can increase the risk of serious bleeding. However, pain relievers that contain acetaminophen can be the best choice, and many doctors will recommend it. So, patients should never take Coumadin and Aspirin together without medical advice. Aspirin will impair the function of platelets which are important for blood clotting, while Couamdin impairs blood clotting in a different way, by impacting the INR level. If these are taken together at the same time, they will attack the body’s ability to do blood clotting in two separate ways. This could greatly increase the risk of having significant bleeding.

However, in some cases under doctor supervision these drugs combination can make sense. Coumadin takes care of cardioembolic “red clot” that occurs in blood low-flow states such as venous thromboembolism and atrial fibrillation, and the antiplatelet drug such as Aspirin treats the “white clot” associated with atherosclerosis. Prothrombin time or INR should be monitored closely in patients on Coumadin therapy, and in many cases therapy need dose adjustment. Patients should be advised to contact their doctor if they develop signs and symptoms of excessive anticoagulation, such as: bruising, vomiting, unusual or prolonged bleeding, headache, dizziness, change in stool or urine color, or weakness.

The table below shows the incidence of side effects after Coumadin and Aspirin administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Frequency not defined

Cholesterol embolus syndrome, Abdominal pain, Intraocular hemorrhage, Alopecia, Rash, Pruritus, Headache, Lethargy, Taste disturbance, Tissue necrosis, Hematuria, Anemia, Hepatitis, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, “Purple toe” syndrome, Increased fracture risk with long-term usage, Dizziness, Angioedema, Bronchospasm, GI pain, ulceration, bleeding, Dermatologic problems, Premature hemolysis, Platelet aggregation inhibition, Pulmonary edema (salicylate-induced, noncardiogenic), Renal damage, Rash, Urticaria, Tinnitus, Vomiting

Special precautions and warnings during Coumadin and Aspirin administration:

Patients should tell their doctor and pharmacist if they are allergic to Coumadin or Aspirin, or any other medications, or any of the ingredients in these products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interactions with warfarin and those interactions can cause serious side effects.
Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: atherosclerosis, diabetes, some liver or kidney disease, bleeding problems, porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
Patients using Coumadin should tell their doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve, but only with medical supervision. Coumadin may harm the fetus.
If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking warfarin before the surgery or procedure or change your dosage of warfarin before the surgery or procedure.
Cigarette smoking may decrease the effectiveness of Coumadin.
Patient using aspirin should tell their doctor if they have or have ever had asthma, frequent stuffed or runny nose, or nasal polyps. If they have these conditions, there is a high risk that they will have an allergic reaction to aspirin.
Patient using aspirin should also tell their doctor if they often have heartburn, stomach pain and if you have or have ever had ulcers, anemia, bleeding problems such as hemophilia, or liver or kidney disease.
Children and teenagers should not use Aspirin for flu or chicken pox symptoms before a doctor is consulted about Reye’s syndrome, a rare but very serious disease that is associated with Aspirin.

“Can you take ibuprofen while on blood thinners?”
“Aspirin for Preventing Flushing From Niacin”

Is coumadin a blood thinner?

Other Brand names for warfarin products on the market are: Jantoven, Marevan, Waran and Warfant.

What is Zocor?

Zocor is a Brand name for a drug that contain simvastatin as an active ingredient which belongs to a group of drugs called HMG CoA reductase inhibitors, also known as “statins.” Simvastatin works by reducing the levels of “bad” cholesterol – LDL (low-density lipoprotein), and triglycerides in the blood, while increasing levels of “good” cholesterol – HDL (high-density lipoprotein). It is also used to reduce the risk of heart attack, stroke and other heart complications in people with diabetes, coronary heart disease, or other risk factors. Zocor is used in adults and children who are at least 10 years old.

Other Brand names for drugs containing simvastatin as an active ingredient are: Cholestat, Lipex, Sinvacor, Sivastin, Sorfox and Statex.

How does Coumadin and Zocor work in the body?

Simvastatin is a lipid-lowering drug that is synthetically derived from the fermentation of fungi Aspergillus terreus. It is a potent competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, rate-limiting enzyme in biosynthesis of cholesterol. Interference with this enzyme activity reduces the quantity of mevalonic acid, a precursor of cholesterol. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL cholesterol.

Can patients take Coumadin and Zocor together?

Patients should never take Coumadin with Zocor without medical supervision. Warfarin is being co-prescribed increasingly with HMG-CoA inhibitors, such as simvastatin, for their benefits in reducing the risk of coronary events and stroke. Many mechanisms for the interaction between Coumadin and Zocor have been postulated, including inhibition of warfarin metabolism, alteration in vitamin K availability, or protein binding displacement. However, there are no relevant clinical data to confirm any of these. In conclusion, studies have found that concomitant simvastatin therapy results in alterations in warfarin pharmacokinetics, most likely through inhibition of the CYP450 enzymes: CYP2C9 and CYP3A4 which are responsible for the metabolism of warfarin rather than by modification of its pharmacodynamics. Health professionals should be aware of the interaction between these commonly co-prescribed drugs and patients receiving warfarin should be monitored carefully when concurrent therapy with simvastatin is initiated to avoid over-anticoagulation and the high risk of bleeding.

The table below shows the incidence of side effects after Coumadin and Zocor administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.

Frequency not defined

Cholesterol embolus syndrome, Abdominal pain, Intraocular hemorrhage, Alopecia, Rash, Pruritus, Headache, Lethargy, Taste disturbance, Tissue necrosis, Hematuria, Anemia, Hepatitis, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, “Purple toe” syndrome, Increased fracture risk with long-term usage, Dizziness, CPK elevation, Transaminases increased, Upper respiratory infection, Constipation, Flatulence, Myalgia, Eczema, Abdominal pain, Vertigo

Special precautions and warnings during Coumadin and Zocor administration:

Patients should tell their doctor and pharmacist if they are allergic to Coumadin or Zocor, or any other medications, or any of the ingredients in these products.
Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interactions with warfarin and those interactions can cause serious side effects.
Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: atherosclerosis, diabetes, some liver or kidney disease, bleeding problems, porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
Patients using Coumadin should tell their doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve, but only with medical supervision. Coumadin may harm the fetus.
If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking warfarin before the surgery or procedure or change your dosage of warfarin before the surgery or procedure.
Cigarette smoking may decrease the effectiveness of Coumadin.
In rare cases, simvastatin can cause a serious condition that result in skeletal muscle tissue breakdown, leading to kidney failure. Patients should call doctor immediately if they experience unexplained muscle pain, tenderness, or weakness especially if they also have unusual tiredness, fever and dark colored urine.
Before taking Zocor, patients should tell their doctor if they have ever had kidney or liver disease thyroid disorder or diabetes if they are Chinese descent, or if they drink more than 2 alcoholic beverages daily.
Grapefruit and grapefruit juice may interact with simvastatin leading to potentially dangerous effects. Patients should not consume grapefruit products while taking this medicine.

“Coumadin and Aspirin for atrial fibrillation”
“Niacin and Aspirin interaction”

Is aspirin an organic compound?

Aspirin is an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain. Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack. Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time). This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin. The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897. Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

What is Meprobamate?

Meprobamate belongs to the class of medications known as tranquilizers and is associated with sedative, hypnotic, anticonvulsant, anti-anxiety, and some indirect muscle relaxant properties. The drug is marketed by Wallace Laboratories and Wyeth, among others. The drug is available under generic name Meprobamate and brand names such as Amepromat, Quivet, Miltown, Equanil, Meprospan, Zirponand etc. Meprobamate is primarily used for the treatment of anxiety disorders. The drug is also indicated for the short-term management of insomnia, nervousness, tension and other conditions associated with anxiety. Besides, Meprobamate is also recommended for the treatment of muscle spasm and immobility due to strains, sprains, and injuries of the back. Meprobamate is a carbamate derivate, synthetic in nature and belongs to the class of organic compounds known as organooxygen compounds. The compound has a molecular formula C₉H₁₈N₂O₄. Meprobamate is chemically known as 2-Methyl-2- propyltrimethylene dicarbamate. The drug is supplied as tablets or capsules for oral administration by mouth with or without food. The tablets are available in varying strength of 200 and 400 mg whereas the capsules are available in extended release forms. The drug is usually taken two to four times a day. Meprobamate is available as a combination product with Aspirin and also with conjugated estrogens.

How Aspirin and Meprobamate work?

ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly. Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid. Antipyretic effect of ASA results from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibits the aggregation of platelets. This inhibitory effect of ASA results from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

Meprobamate possesses central nervous system (CNS) depressing activity like other barbiturates. The mechanism of action of Meprobamate remains unexplored. The drug potentiates the release of adenosine that is associated with its central effects. Animal studies indicate the action of the drug at multiple sites in the CNS that includes the hypothalamus, thalamus, limbic system, and spinal cord, excluding the medulla and the autonomic nervous system. Meprobamate binds to GABA_A receptors and brings about an interruption in the neuronal communication in the reticular formation and spinal cord thereby resulting in sedation and change in the perception of pain. The sedative effect of the drug also relaxes skeletal muscle tension.

Can both Aspirin and Meprobamate be taken together in combination?

Yes, both the drugs can be taken together in combination. The drugs are available as a fixed dose combination pill in the market only as a prescription drug under the brand names Equagesic and Micrainin. The combination medications consist of a non-steroidal anti-inflammatory drug (NSAID) and an anxiolytic agent. The drug is implicated in the short-term treatment of pain accompanied by tension and/or anxiety in patients with musculoskeletal disease. Meprobamate acts by calming certain areas of the brain whereas Aspirin decreases the pain. Clinical studies indicate a greater degree of pain relief in case of combination pill as compared to Aspirin alone. However, the combination pill is not recommended to be used longer than 10 days. Each tablet of Equagesic or Micrainin consists of 200 mg Meprobamate and 325 mg Aspirin. The usual dosage of the combination pill is one or two tablets to be taken by mouth 3 to 4 times a day. The combination drug is not recommended for patients below the age of 12 years.

Safety and precautions while taking Aspirin: Meprobamate combination

Aspirin and Meprobamate may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements. It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult.
Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Aspirin or Meprobamate or any of the constituents.
The combination drug is generally not recommended to be taken in case of pregnancy and breastfeeding.
Administration of the drug is usually not recommended with alcohol and other CNS depressants due to the additive effects. It is recommended to consult with your doctor before taking any of the above during drug administration.
Do not share the medications with other persons having the similar kind of problems. Consult your doctor for more details.
The drug should not be stopped abruptly before consulting the doctor if used for a longer time or taken in large doses.
In case of surgery including dental surgery, uptake of Aspirin in the combination medicine should be stopped 5 days before the surgery as it may cause bleeding problems.
Meprobamate (contained in this combination medicine) may bring about dryness of the mouth and long term drying may increase the chance of dental disease such as tooth decay, gum disease, and fungus infections.
The combination drug should be taken with caution in patients with history of diabetes, high blood pressure, gout, growth in the nose, bleeding/blood-clotting disorders, kidney or liver disease, brain problems, mental illness, stomach problems, difficulty in urinating.
It is recommended not to drive a car or operate machinery while taking the combination medication due to associated dizziness or drowsiness.
The drug is not recommended for patients 12 years of age and below.

“Is it safe to take simvastatin with coumadin?“
“Is it safe to take aspirin and warfarin together?“

How does ibuprofen reduce fever

What is Excedrin

How does Ibuprofen and Excedrin work in the body

Can patients take Ibuprofen and Excedrin together

Special precautions and warnings during Ibuprofen and Excedrin administration:

What is Naproxen

What is Lortab

How does Naproxen and Lortab work in the body

Can patients take Naproxen and Lortab together

Special precautions and warnings during Naproxen and Lortab administration:

What is Ibuprofen

What is Cipro

How does Ibuprofen and ciprofloxacin work in the body

Can patients take Ibuprofen and Cipro together

Special precautions and warnings during Ibuprofen and Cipro administration:

How does Amoxicillin work

What is Clarithromycin

How does omeprazole work

How Amoxicillin, Clarithromycin and Omeprazole work

Can Amoxicillin, Clarithromycin and Omeprazole be taken together in combination

Clinical research and current scenario of Amxicillin/Clarithromycin/Omeprazole triple therapy

Amoxicillin Clarithromycin Omeprazole side effects

Safety and precautions while taking Omeprazole-Amoxicillin combination

What is Pregabalin

What is Oxycodone

How Pregabalin and Oxycodone works

Can both Pregabalin and Oxycodone be taken together in combination

Safety and precautions while taking Pregabalin: Oxycodone combination

what is levothyroxine

what is calcium

How does levothyroxine and calcium works in the body

Can pateints take levothyroxine and calcium together

Different activity profile of levothyroxine when co-administered with other drugs:

Adverse effects of levothyroxine

Adverse effects of calcium

What is Oxycodone

What is Aspirin

How Oxycodone and Aspirin works

Can both Oxycodone and Aspirin be taken together in combination

Safety and precautions while taking Oxycodone: Aspirin combination

What is Propranolol

What is Losartan

How Propranolol and Losartan works

Can both Propranolol and Losartan be taken together in combination

Safety and precautions while taking Propranolol: Losartan combination

What is Coumadin

What is Synthroid

How does Coumadin and Synthroid work in the body

Can patients take Coumadin and Synthroid together

Special precautions and warnings during Coumadin and Synthroid administration:

What is Aniracetam

What is Piracetum

How Aniracetam and Piracetam works

Can both Aniracetam and Piracetam be taken together in combination

Safety and precautions while taking Aniractam: Piracetam combination

What is amoxicillin used to treat

Mechanism of action in the body “How does amoxicillin work”

Side effects of amoxicillin

Amoxicillin use in pregnant women

Amoxicillin and lactating women

What does levothyroxine do to your body

Can you take levothyroxine with coffee

Is it advisable to take levothyroxine and amoxicillin together

What is Aspirin?

What is Clopidogrel?

How Aspirin and Clopidogrel work?

Can both Aspirin and Clopidogrel be taken together in combination?

Safety and precautions while taking Aspirin: Clopidogrel combination

What is folic acid

Where can folic acid be found

What is the normal folate levels for an healthy individual

Folic acid deficiency

Folic acid as supplement

Can patients take levothyroxine and folic acid together

Changes in homocysteine level with the combination therapy

What does Aspirin treat?

What is Ticagrelor?

How does Aspirin and Ticagrelor work in the body?

Can both Aspirin and Ticagrelor be taken together in combination?

Safety and precautions while taking Aspirin:Ticagrelor combination