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Anticoagulants

Enhances anticoagulant effects

Antidepressants SSRI or venlaflaxine

Bleeding risk increases

Antidiuretics eg sulphonamides

Enhances effects of sulphonamides

Antiepileptics eg phenytoin

Beta blockers

hypotensive effect antagonised

Calcium channel blockers

hypotensive effect antagonised

Cardiac glycosides

NSAIDS increase plasma concentration of cardiac glycosides

Clonidine

hypotensive effect antagonised

Clopidogrel

Increased risk of bleeding

Cytotoxics eg methotrexate

Increased risk of toxicity

Diazoxide

hypotensive effect antagonised

Diuretics

Increased risk of nephrotoxicity, antagonism of diuretic effect

Lithium

Reduce excretion of lithium

Methyldopa

hypotensive effect antagonised

Monoxidine

hypotensive effect antagonised

Muscle relaxants eg baclofen

Reduces excretion of baclofen, increased risk of toxicity

Nitrates

hypotensive effect antagonised

Penicillamine

Increased risk of nephrotoxicity

pentoxifylline

Increased risk of bleeding

Progestogens drospirenone

Monitor serum potassium - hyperkalaemia

Sibutramine

Increased risk of bleeding

Tacrolimus

Increased risk of nephrotoxicity

Vasodilators e.g hydralazine minoxidil, nitroprusside

hypotensive effect antagonised

Monitoring:

Us and Es if renal problem or risk of nephrotoxicity

K if on progestogens or drugs likely to cause hyperkalaemia (see above)

Dose:

Initially 1.2-1.8 g daily in divided doses preferably after food; increased if necessary to max 2.4g daily; maintenance does of 0.6-1.2 g daily to be adequate

Juvenile RA child over 7kg bodyweight 30-40mg/kg daily in 3-4 divided doses

Fever and pain in children: over 7kg 20-30mg/kg 3-4 times daily or 1-2 years 50mg 3-4 times daily, 3-7 years 100mg 3-4 times daily, 8-12 years 200mg 3-4 times daily

A usual dose is 200-400 mg TDS p.o. for mild pain/fever, going up to 800 mg tds for arthritis pain.

It can also be given topically as a gel for mild local inflammation

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