What are the potential interactions between Pentasa (mesalamine) and naproxen (nonsteroidal anti-inflammatory drug, NSAID)?

From the Guidelines

Caution is advised when taking Pentasa (mesalamine) and naproxen together as this combination may increase the risk of gastrointestinal side effects, particularly in patients with a history of gastrointestinal complications or those taking concomitant medications that increase this risk. When considering the use of Pentasa and naproxen together, it's essential to weigh the potential benefits against the risks, especially in terms of gastrointestinal toxicity. According to the evidence from 1, the use of any NSAID, including naproxen, in conjunction with other medications that may affect the gastrointestinal tract, substantially increases the risk of ulcer complications. This risk is particularly concerning in patients with a history of peptic ulcer disease or gastrointestinal bleeding, as noted in 1 and 1.

Key Considerations

• The risk of gastrointestinal complications, including bleeding, perforation, or obstruction, is significantly increased when NSAIDs like naproxen are used, especially in combination with other medications that may irritate the gastrointestinal tract or affect platelet function, as discussed in 1 and 1.
• Patients with a history of gastrointestinal events, advanced age, or those taking concomitant medications such as anticoagulants, corticosteroids, or other NSAIDs, are at a higher risk of developing gastrointestinal complications, as highlighted in 1 and 1.
• The use of proton pump inhibitors (PPIs) or other gastroprotective agents may be considered to reduce the risk of gastrointestinal complications in high-risk patients taking NSAIDs, as suggested in 1 and 1.

Recommendations

• Monitor patients closely for signs of gastrointestinal complications, such as abdominal pain, bleeding, or perforation, when taking Pentasa and naproxen together.
• Consider alternative pain management strategies or the use of gastroprotective agents, especially in patients at high risk of gastrointestinal complications.
• Ensure adequate hydration and monitor renal function, as both medications can affect kidney function, particularly in patients with pre-existing kidney disease.
• Consult a healthcare provider before combining these medications to discuss the potential risks and benefits and to determine the best course of treatment for individual patients.

From the Research

Potential Interactions between Pentasa and Naproxen

The potential interactions between Pentasa (mesalamine) and naproxen (nonsteroidal anti-inflammatory drug, NSAID) are primarily related to the increased risk of gastrointestinal toxicity.

• Naproxen, as an NSAID, can cause gastrointestinal irritation and increase the risk of ulcers and bleeding 2.
• Pentasa, on the other hand, is used to treat inflammatory bowel disease and may have gastrointestinal side effects, although it is designed to reduce inflammation in the gut.
• The combination of Pentasa and naproxen may increase the risk of gastrointestinal complications, such as ulcers and bleeding, due to the additive effects of naproxen's gastrointestinal toxicity and the potential gastrointestinal side effects of Pentasa 2.
• However, there is limited direct evidence on the specific interaction between Pentasa and naproxen, and the risk of bleeding associated with their concomitant use is not well established.

Gastrointestinal Toxicity and Inflammatory Bowel Disease

• NSAIDs, including naproxen, have been associated with an increased risk of clinical relapse in inflammatory bowel disease patients, and their use should be avoided as long-term treatment or with high doses, especially in patients with active inflammation 2.
• The use of proton pump inhibitors (PPIs) may be recommended to reduce the risk of gastrointestinal complications associated with NSAID use, especially in patients at high risk of ulcers and bleeding 3, 4.
• The management of peptic ulcer bleeding, which may be a complication of NSAID use, involves the control of acid secretion, preferably with PPI therapy, and the elimination or modification of risk factors for ulcer recurrence, such as Helicobacter pylori infection and NSAID use 5.

Risk of Bleeding

• The risk of bleeding associated with NSAID use is increased in patients treated with anticoagulants or antiplatelet agents, and the concomitant use of these medications should be carefully monitored 6.
• The risk of gastrointestinal and nongastrointestinal bleeding increases after NSAID use in patients treated with anticoagulants, while the risk of gastrointestinal bleeding increases, but to a lesser extent, in those treated with antiplatelets 6.