hydrocodone and ibuprofen, Vicoprofen (cont.)

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Opioids such as hydrocodone can slow bowel motility. When combined with medications that possess anticholinergic activity, this effect on the bowel may be accentuated, leading to marked constipation. Such drugs include dicyclomine (Bentyl), some antihistamines (for example, carbinoxamine [Rondec], clemastine [Tavist], diphenhydramine [Benadryl], promethazine [Phenergan]); some phenothiazines (for example, thioridazine [Mellaril], triflupromazine [Stelazine]); some tricyclic antidepressants (for example, amitriptyline [Elavil, Endep] amoxapine [Asendin], clomipramine [Anafranil], protriptyline [Vivactil]); clozapine (Clozaril), cyclobenzaprine (Flexeril), and disopyramide (Norpace). The use of antidiarrheals (for example, diphenoxylate [Lomotil], loperamide [Imodium]) in persons taking opioid analgesics such as hydrocodone can lead to severe constipation and possibly greater sedation.

Cimetidine (Tagamet), when used with opiate analgesics such as hydrocodone, can cause confusion, disorientation, seizures or respiratory depression by increasing blood concentrations of the opiate.

Ibuprofen, which has blood thinning (anticoagulant) properties, is used with caution in patients taking other blood thinning anticoagulants such as warfarin (Coumadin), because of an increased risk of bleeding. Concurrent use of ibuprofen and clopidogrel (Plavix) can also lead to increased risk of bleeding. Patients taking lithium (Eskalith, Lithobid) can develop toxic blood lithium levels if ibuprofen is taken at the same time. Ibuprofen may increase methotrexate (Rheumatrex, Trexall) toxicity when used together.



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