Interactions between non-steroidal anti-inflammatory drugs and H2-receptor antagonists or prostaglandin analogues

Published pharmacokinetic studies investigating possible interaction between H2-receptor antagonists (n = 22) or prostaglandin analogues (n = 6) and nonsteroidal anti-inflammatory drugs (NSAIDs) have been reviewed. With two exceptions the studies were carried out in young, healthy male volunteers rather than in arthritis patients. In addition some of the studies were poorly designed and inadequately described. Cimetidine appeared to increase the area under the plasma concentration-time curve, and hence to decrease the apparent oral clearance, of several NSAIDs including piroxicam, indomethacin, flurbiprofen, sulindac, oxaprozin and aspirin, while ranitidine co-administration resulted in similar changes for oxyprozin alone. The data currently available for prostaglandin analogues are insufficient to draw firm conclusions. It therefore remains a possibility that clinically relevant pharmacokinetic interactions may occur in elderly arthritic patients, and this issue needs to be addressed.