Generic drug: ibuprofen and famotidine

Brand name: Duexis

What is Duexis (ibuprofen and famotidine), and how does it work?

Duexis (ibuprofen and famotidine) is a prescription medicine used to treat the symptoms of Rheumatoid Arthritis and Osteoarthritis. Duexis may be used alone or with other medications.

Duexis belongs to a class of drugs called NSAIDs.

It is not known if Duexis is safe and effective in children.

What are the side effects of Duexis?

WARNING

RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS

Cardiovascular Thrombotic Events

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
  • Duexis is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal Bleeding, Ulceration, and Perforation

  • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Duexis may cause serious side effects including:

Get medical help right away, if you have any of the symptoms listed above.

The most common side effects of Duexis include:

Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Duexis. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the dosage for Duexis?

  • Carefully consider the potential benefits and risks of Duexis and other treatment options before deciding to use Duexis. Use ibuprofen at the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
  • The recommended daily dose of Duexis (ibuprofen and famotidine) 800 mg/26.6 mg is a single tablet administered orally three times per day.
  • Duexis tablets should be swallowed whole, and should not be cut to supply a lower dose. Do not chew, divide, or crush tablets.
  • Patients should be instructed that if a dose is missed, it should be taken as soon possible. However, if the next scheduled dose is due, the patient should not take the missed dose, and should be instructed to take the next dose on time. Patients should be instructed not to take 2 doses at one time to make up for a missed dose.
  • Do not substitute Duexis with the single-ingredient products of ibuprofen and famotidine.

What drugs interact with Duexis?

See Table 3 for clinically significant drug interactions with ibuprofen.

Table 3: Clinically Significant Drug Interactions with Ibuprofen and Famotidine

Drugs That Interfere with Hemostasis
Clinical Impact:
  • Ibuprofen and anticoagulants such as warfarin have a synergistic effect on bleeding. The concomitant use of ibuprofen and anticoagulants have an increased risk of serious bleeding compared to the use of either drug alone.
  • Serotonin release by platelets plays an important role in hemostasis. Case-control and cohort epidemiological studies showed that concomitant use of drugs that interfere with serotonin reuptake and an NSAID may potentiate the risk of bleeding more than an NSAID alone.
Intervention: Monitor patients with concomitant use of Duexis with anticoagulants (e.g., warfarin), antiplatelet agents (e.g., aspirin), selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs) for signs of bleeding.
Aspirin
Clinical Impact: Controlled clinical studies showed that the concomitant use of NSAIDs and analgesic doses of aspirin does not produce any greater therapeutic effect than the use of NSAIDs alone. In a clinical study, the concomitant use of an NSAID and aspirin was associated with a significantly increased incidence of GI adverse reactions as compared to use of the NSAID alone.
Intervention: Concomitant use of Duexis and analgesic doses of aspirin is not generally recommended because of the increased risk of bleeding. Duexis is not a substitute for low dose aspirin for cardiovascular protection.
ACE Inhibitors, Angiotensin Receptor Blockers, and Beta-blockers
Clinical Impact:
  • NSAIDs may diminish the antihypertensive effect of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers (including propranolol).
  • In patients who are elderly, volume-depleted (including those on diuretic therapy), or have renal impairment, co-administration of an NSAID with ACE inhibitors or ARBs may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible.
Intervention:
  • During concomitant use of Duexis and ACE-inhibitors, ARBs, or beta-blockers, monitor blood pressure to ensure that the desired blood pressure is obtained.
  • During concomitant use of Duexis and ACE-inhibitors or ARBs in patients who are elderly, volume-depleted or have impaired renal function, monitor for signs of worsening renal function.
Diuretics
Clinical Impact: Clinical studies, as well as post-marketing observations, showed that NSAIDs reduced the natriuretic effect of loop diuretics (e.g., furosemide) and thiazide diuretics in some patients. This effect has been attributed to the NSAID inhibition of renal prostaglandin synthesis.
Intervention: During concomitant use of Duexis with diuretics, observe patients for signs of worsening renal function, in addition to assuring diuretic efficacy including antihypertensive effects.
Digoxin
Clinical Impact: The concomitant use of ibuprofen with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin.
Intervention: During concomitant use of Duexis and digoxin, monitor serum digoxin levels.
Lithium
Clinical Impact: NSAIDs have produced elevations of plasma lithium levels and reductions in renal lithium clearance. The mean minimum lithium concentration increased 15%, and the renal clearance decreased by approximately 20%. This effect has been attributed to NSAID inhibition of renal prostaglandin synthesis.
Intervention: During concomitant use of Duexis and lithium, monitor patients for signs of lithium toxicity.
Methotrexate
Clinical Impact: Concomitant use of NSAIDs and methotrexate may increase the risk for methotrexate toxicity (e.g., neutropenia, thrombocytopenia, renal dysfunction).
Intervention: During concomitant use of Duexis and methotrexate, monitor patients for methotrexate toxicity.
Cyclosporine
Clinical Impact: Concomitant use of ibuprofen and cyclosporine may increase cyclosporine’s nephrotoxicity.
Intervention: During concomitant use of Duexis and cyclosporine, monitor patients for signs of worsening renal function.
NSAIDs and Salicylates
Clinical Impact: Concomitant use of ibuprofen with other NSAIDs or salicylates (e.g., diflunisal, salsalate) increases the risk of GI toxicity, with little or no increase in efficacy.
Intervention: The concomitant use of Duexis with other NSAIDs or salicylates is not recommended.
Pemetrexed
Clinical Impact: Concomitant use of ibuprofen and pemetrexed may increase the risk of pemetrexed-associated myelosuppression, renal, and GI toxicity (see the pemetrexed prescribing information).
Intervention:

During concomitant use of Duexis and pemetrexed, in patients with renal impairment whose creatinine clearance ranges from 45 to 79 mL/min, monitor for myelosuppression, renal and GI toxicity.
NSAIDs with short elimination half-lives (e.g., diclofenac, indomethacin) should be avoided for a period of two days before, the day of, and two days following administration of pemetrexed.
In the absence of data regarding potential interaction between permetrexed and NSAIDs with longer half-lives (e.g., meloxicam, nabumetone), patients taking these NSAIDs should interrupt dosing for at least five days before, the day of, and two days following pemetrexed administration.

Drugs Dependent on Gastric pH for Absorption
Clinical Impact Because famotidine lowers intra-gastric acidity, this may result in reduced absorption and loss of efficacy of concomitant drugs.
Intervention Concomitant administration of Duexis is not recommended with dasatinib, delavirdine mesylate, cefditoren, and fosamprenavir.
For administration instructions of other drugs whose absorption is dependent on gastric pH, refer to their prescribing information (e.g., atazanavir, erlotinib, ketoconazole, itraconazole, nilotinib, ledipasvir/sofosbuvir, and rilpivirine).
Tizanidine (CYP1A2 Substrate)
Clinical Impact Famotidine is considered a weak CYP1A2 inhibitor and may lead to substantial increases in blood concentrations of tizanidine, a CYP1A2 substrate.
Intervention Avoid concomitant use with Duexis.
If concomitant use is necessary, monitor for hypotension, bradycardia or excessive drowsiness.
Refer to the full prescribing information for tizanidine.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

Is Duexis safe to use while pregnant or breastfeeding?

  • Use of NSAIDs, including Duexis, during the third trimester of pregnancy increases the risk of premature closure of the fetal ductus arteriosus.
  • Avoid use of NSAIDs, including Duexis, in pregnant women starting at 30 weeks of gestation (third trimester).
  • There are no adequate and well-controlled studies of Duexis in pregnant women.
  • No studies have been conducted with the use of Duexis in lactating women.
  • Limited data from published literature report famotidine is present in human milk in low amounts.
  • Published literature also reports the presence of ibuprofen in human milk in low amounts. No information is available on the effects of famotidine or ibuprofen on milk production or on a breastfed infant.

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Medically Reviewed on 5/7/2021
References
All sections courtesy of the U.S. Food and Drug Administration