Table of contraindications for taking anti-inflammatory drugs

In fact, in life, many people don’t know what the incompatibility table is. The incompatibility table is a table of contraindications for drug combinations. Because if many medicines are taken at the same time, it is easy to cause drug poisoning, which will affect the health of the body. So, do you know the contraindications of taking anti-inflammatory drugs? I believe that many people actually don’t know this. Today we will introduce to you the drug incompatibility table.

1. Summary of common drug incompatibility taboos

Incompatibility refers to direct physical or chemical interactions between drugs in vitro that may affect drug efficacy or cause toxic reactions. Incompatibility is generally divided into two categories: physical (uncommon) and chemical (common).

When several injection solutions are used together clinically, incompatibility may occur. It will reduce the efficacy of the drug or make it ineffective, and may even cause adverse drug reactions, so it should be avoided.

1. Water-soluble vitamin injection + KCl

Analysis: Adding strong electrolytes can produce common ion effect, point neutralization effect, salting-out effect, etc., which will reduce the solubility of organic acid salts (pantothenic acid, vitamin C, glycine, ethylenediaminetetraacetic acid, etc.), organic alkali salts (vitamin B1, vitamin B6, etc.) and methylparaben in water-soluble vitamins, thereby precipitating from the solution and increasing the insoluble particles.

2. Furosemide + dopamine + glucose injection

Analysis: Furosemide is a sodium salt injection made by adding alkali, which has a high alkalinity. Therefore, it should be diluted with sodium chloride injection rather than glucose injection for intravenous injection. Clinically, it is often used in combination with dopamine to enhance its diuretic function, but there are reports that the color of the two drugs changes slightly after mixing.

It is recommended that if the condition requires the use of these two drugs clinically, they should be used separately and should not be infused continuously. It is best to infuse 0.9% saline in the middle, that is, the infusion order is dopamine → saline → furosemide.

3. Dexamethasone + VitB6

Analysis: Mixing concentrated solutions of two drugs in the same container may produce turbidity or precipitation. VitB6 is a salt made from water-soluble substances. It itself is not precipitated by pH changes, but it can cause the precipitation of salts made from water-insoluble acidic substances such as dexamethasone phosphate.

4. Polyene phosphatidylcholine + KCl

Analysis: Polyene phosphatidylcholine is a clear colloidal solution and cannot be mixed with any other injection solution for injection. If it is to be prepared for intravenous infusion, it can only be diluted with glucose solution without electrolytes. It is strictly forbidden to use electrolyte solutions to avoid destroying its stability.

5. Vitc+vitk1

Analysis: VitK1 can be destroyed by VitC and become ineffective.

Reason for use: VitK1 can be used by the liver to synthesize prothrombin VII, IX, and X factors. VitC can participate in the body's redox and sugar metabolism processes, increase the density of capillaries and reduce their permeability and fragility, accelerate blood coagulation, and stimulate hematopoietic function. From the perspective of pharmacology and pathology, the combination of the two drugs is beneficial.

Reasons for incompatibility: VitC has strong reducing properties, and when mixed with the quinone drug VitK1, an oxidation-reduction reaction may occur, which may reduce the efficacy of VitK1.

6. Insulin + Vitamin C

Analysis: VitC has strong reducing properties and when mixed with insulin, it causes insulin inactivation.

7. Ceftriaxone + calcium gluconate

Analysis: The combined use of ceftriaxone and calcium-containing drugs (including calcium-containing solutions) may cause precipitation of ceftriaxone sodium-calcium salt, which may lead to fatal adverse events. Therefore, the two should not be mixed or used at the same time, even if different administration methods are used in different parts of the body, and calcium-containing drugs should not be used within 48 hours of using ceftriaxone.

8. vitk1+kcl

Analysis: There are reports that vitamin K1 and potassium chloride are incompatible, and potassium chloride can reduce the vitamin K1 content by more than 30%.

9. Aminophylline injection + ambroxol injection + α-chymotrypsin

Analysis: The pH of aminophylline is close to 9.6, and it is highly alkaline. Ambroxol free base may precipitate in a solution with a pH greater than 6.3. The α-chymotrypsin injection solution is most stable at pH 3~4. Aminophylline + ambroxol and aminophylline + α-chymotrypsin injection should not be mixed and used together.

10. Vitc + inosine

Analysis: Physical and chemical incompatibility. Mixed infusion in the same bottle will result in decreased efficacy and increased adverse reactions.

11. Calcium gluconate injection + dexamethasone sodium phosphate injection

Analysis: Calcium gluconate contains divalent calcium ions, and dexamethasone is dexamethasone sodium phosphate. Phosphate reacts with calcium to form calcium phosphate precipitate, and they cannot be mixed for drip infusion.

12. Omeprazole + vitC

Analysis: Omeprazole has the chemical structure of sulfinylbenzimidazole and is weakly alkaline. It is very unstable under acidic conditions and is prone to discoloration or aggregation precipitation. The solution prepared with this product should not be mixed with other drugs or used in the same infusion.

13. Omeprazole + 5% GS

Analysis: Omeprazole has the chemical structure of sulfinylbenzimidazole and is weakly alkaline. It is very unstable under acidic conditions and is prone to discoloration or aggregation precipitation. It is advisable to use NS as the solvent.

14. β-lactam drugs cannot be used in combination with acidic or alkaline drugs

Analysis: Cephalosporins (especially first-generation cephalosporins) should not be used in combination with high-efficiency diuretics (such as furosemide) to prevent severe renal damage. Mecillinam in the penicillin class cannot be used with it

15. Cefuroxime sodium has antagonistic effects with most cephalosporins, and their combined use may weaken the antibacterial efficacy. When used in combination with aztreonam, it has an antagonistic effect both in vivo and in vitro.

16. Aminoglycosides should not be used in combination with drugs that are ototoxic (such as erythromycin) and nephrotoxic (such as potent diuretics, cephalosporins, dextran, sodium alginate, etc.), nor with muscle relaxants or drugs with this effect (such as diazepam, etc.) to prevent enhanced toxicity. Drugs in this category should not be used together with each other.

17. When aminoglycosides (such as amikacin, netilmicin, etc.) are mixed with β-lactam antibiotics (such as penicillins, cephalosporins), they may inactivate each other and reduce their efficacy. During continuous infusion, 0.9% saline should be infused in between to flush the tube. At the same time, the combination of these two types of drugs can often increase renal toxicity.

18. When carbamazepine is used in combination with phenobarbital and phenytoin sodium, the metabolism of carbamazepine can be accelerated and its concentration can be reduced; while nicotinamide, antidepressants, macrolide antibiotics, isoniazid, cimetidine and other drugs can increase the blood concentration of carbamazepine, making it prone to toxic reactions. In addition, when the antimanic drug lithium salt and the antipsychotic drug thioridazine are used in combination with carbamazepine, this product may easily cause symptoms of neurological poisoning. Carbamazepine can also weaken the anticoagulant effect of the anticoagulant warfarin. When used in combination with oral contraceptives, heavy vaginal bleeding and contraceptive failure may occur. Therefore, special attention should be paid when using them together.

19. Drugs that inhibit intestinal flora can inhibit the decomposition of sulfasalazine in the intestine, thereby affecting the release of 5-aminosalicylic acid and possibly reducing the efficacy, especially various broad-spectrum antibiotics.

20. Alkaline drugs, anticholine drugs, and H2 receptor blockers can reduce the acidity of gastric juice and reduce the absorption of quinolones, so they should be avoided from being taken together.

21. Tetracyclines should not be used in combination with antacids, calcium salts, iron salts and other drugs containing heavy metal ions to prevent complex reactions that may block the absorption of tetracyclines. Milk has a similar effect.

22. Codeine-based central nervous system analgesics and central nervous system depressants may produce additive effects when used together.

23. The combined use of dextromethorphan and monoamine oxidase inhibitors can cause high fever, coma, and even death.

24. The combined use of ephedrine and monoamine oxidase inhibitors may cause high blood pressure.

25. Morphine should not be used together with chlorpromazine injection. Pethidine should not be used in combination with promethazine multiple times to avoid respiratory depression; combined use with monoamine oxidase inhibitors (MAOIs) may cause excitement, high fever, sweating, and confusion. Fentanyl also has this reaction.

26. Antidepressants should not be used in combination with MAOIs. Because the two drugs have similar effects and both have antidepressant effects, the dosage must be reduced when used together. In addition, it should not be used in combination with adrenergic drugs. Antidepressants may enhance the pressor effects of adrenergic drugs.

27. Tramadol should not be used in combination with monoamine oxidase inhibitors. Because the two effects are contradictory and cancel each other out.

28. Levodopa should not be used in combination with monoamine oxidase inhibitors, ephedrine, reserpine and adrenergic drugs. Carbidopa should not be used with amantadine, benztropine, procyclidine, and trihexyphenidyl.

29. Cimetidine should not be used together with antacids or metoclopramide. If they must be used together, there should be a 1-hour interval between them. In addition, it should not be used in combination with theophylline, benzodiazepine tranquilizers, digoxin, quinidine, caffeine, warfarin anticoagulants, captopril and aminoglycosides.

30. Enzyme digestive aids should not be used together with antacids, otherwise their activity will be reduced.

31. Gastrokinetic drugs (domperidone, cisapride) should not be used together with anticholine drugs as their effects will offset each other.

32. Smecta may affect the absorption of other drugs. If they must be used together, other drugs should be taken 1 hour before taking this product.

33. Iron supplements should not be used together with drugs containing calcium, phosphates, tannic acid, antacids and strong tea, otherwise, precipitation may form and affect their absorption; when used together with tetracyclines, they may affect each other's absorption.

34. Verapamil should not be used together with beta-blockers, otherwise, hypotension, bradycardia, conduction block, or even cardiac arrest may occur.

35. Macrolide drugs can inhibit the normal metabolism of theophylline. The combined use of the two may cause an abnormal increase in the concentration of theanine in the blood, leading to poisoning or even death. Therefore, the blood concentration of theanine should be monitored when they are used in combination to prevent accidents.