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Caldolor

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Caldolor

Side Effects
Interactions

SIDE EFFECTS

The following serious adverse reactions are discussed elsewhere in the labeling:

The most common adverse reactions reported in clinical studies are nausea, flatulence, vomiting, and headache.

The most common reason for discontinuation due to adverse events in controlled trials of Caldolor is pruritus ( < 1%).

Clinical Studies Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be compared directly to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

During clinical development, 560 patients were exposed to Caldolor, 438 in pain and 122 with fever. In the pain studies, Caldolor was started intra-operatively and administered at a dose of 400 mg or 800 mg every six hours for up to three days. In the fever studies, Caldolor was administered at doses of 100 mg, 200 mg, or 400 mg every four or six hours for up to 3 days.

The most frequent type of adverse reaction occurring with oral ibuprofen is gastrointestinal.

Pain Studies

The incidence rates of adverse reactions listed in the following table were derived from multi-center, controlled clinical studies in post-operative patients comparing Caldolor to placebo in patients also receiving morphine as needed for postoperative pain.

Table 1: Post-operative Patients with Adverse Reactions Observed in ≥ 3% of Patients in any Caldolor Treatment Group in Pain Studies*

Event Caldolor Placebo
(N=287)
400 mg
(N=134)
800 mg
(N=304)
Any Reaction 118 (88%) 260 (86%) 258 (90%)
Nausea 77 (57%) 161 (53%) 179 (62%)
Vomiting 30 (22%) 46 (15%) 50 (17%)
Flatulence 10 (7%) 49 (16%) 44 (15%)
Headache 12 (9%) 35 (12%) 31 (11%)
Hemorrhage 13 (10%) 13 (4%) 16 (6%)
Dizziness 8 (6%) 13 (4%) 5 (2%)
Edema peripheral 1 (<1%) 9 (3%) 4 (1%)
Urinary retention 7 (5%) 10 (3%) 10 (3%)
Anemia 5 (4%) 7 (2%) 6 (2%)
Decreased hemoglobin 4 (3%) 6 (2%) 3 (1%)
Dyspepsia 6 (4%) 4 (1%) 2 (<1%)
Wound hemorrhage 4 (3%) 4 (1%) 4 (1%)
Abdominal discomfort 4 (3%) 2 (<1%) 0
Cough 4 (3%) 2 (<1%) 1 ( < 1%)
Hypokalemia 5 (4%) 3 (<1%) 8 (3%)
* All patients received concomitant morphine during these studies.

Fever Studies

Fever studies were conducted in febrile hospitalized patients with malaria and febrile hospitalized patients with varying causes of fever. In hospitalized febrile patients with malaria, the adverse reactions observed in at least two Caldolortreated patients included abdominal pain and nasal congestion.

In hospitalized febrile patients (all causes), adverse reactions observed in more than two patients in any given treatment group are presented in the table below.

Table 2: Patients with Adverse Reactions Observed in ≥ 3% of Patients in any Caldolor Treatment Group in All- Cause Fever Study

Event Caldolor Placebo
N=28
100 mg
N=30
200 mg
N=30
400 mg
N=31
Any Reaction 27 (87%) 25 (83%) 23 (74%) 25 (89%)
Anemia 5 (17%) 6 (20%) 11 (36%) 4 (14%)
Eosinophilia 7 (23%) 7 (23%) 8 (26%) 7 (25%)
Hypokalemia 4 (13%) 4 (13%) 6 (19%) 5 (18%)
Hypoproteinemia 3 (10%) 0 4 (13%) 2 (7%)
Neutropenia 2 (7%) 2 (7%) 4 (13%) 2 (7%)
Blood urea increased 0 0 3 (10%) 0
Hypernatremia 2 (7%) 0 3 (10%) 0
Hypertension 0 0 3 (10%) 0
Hypoalbuminemia 3 (10%) 1 (3%) 3 (10%) 1 (4%)
Hypotension 0 2 (7%) 3 (10%) 1 (4%)
Diarrhea 3 (10%) 3 (10%) 2 (7%) 2 (7%)
Pneumonia bacterial 3 (10%) 1 (3%) 2 (7%) 0
Blood LDH increased 3 (10%) 2 (7%) 1 (3%) 1 (4%)
Thrombocythemia 3 (10%) 2 (7%) 1 (3%) 0
Bacteremia 4 (13%) 0 0 0

Read the Caldolor (ibuprofen in water for injection) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Aspirin

When ibuprofen is administered with aspirin, ibuprofen's protein binding is reduced, although the clearance of free ibuprofen is not altered. The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of Caldolor and aspirin is not generally recommended because of the potential for increased adverse effects.

Anticoagulants

The effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a higher risk of serious GI bleeding than users of either drug alone [see WARNINGS AND PRECAUTIONS].

ACE Inhibitors

NSAIDs may diminish the antihypertensive effect of ACE inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE inhibitors.

Diuretics

Clinical studies and postmarketing observations have shown that ibuprofen can reduce the natriuretic effects of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with NSAIDs, observe patients closely for signs of renal failure, as well as to assure diuretic efficacy [see WARNINGS AND PRECAUTIONS].

Lithium

NSAIDs have produced elevations of plasma lithium levels and a reduction in renal lithium clearance. The mean minimum lithium concentration increased 15%, and the renal clearance of lithium decreased by 20%. This effect has been attributed to inhibition of renal prostaglandin synthesis by the NSAID. Thus, when NSAIDs and lithium are administered concurrently, observe patients carefully for signs of lithium toxicity.

Methotrexate

NSAIDs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices. This indicates that NSAIDs may enhance the toxicity of methotrexate. Use caution when NSAIDs are administered concomitantly with methotrexate.

H-2 Antagonists

In studies of human volunteers, co-administration of cimetidine or ranitidine with ibuprofen had no substantive effect on ibuprofen serum concentrations.

Last reviewed on RxList: 1/29/2014
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
Interactions
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