toxicity. .methscopolamineMonitor Closely (1)diphenhydramine and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.methyclothiazideMonitor Closely (1)ibuprofen increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .Minor (1)methyclothiazide will increase the level or effect of ibuprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.methyl aminolevulinateSerious - Use Alternative (1)ibuprofen, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.methylenedioxymethamphetamineMonitor Closely (1)diphenhydramine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methylprednisoloneMonitor Closely (1)ibuprofen, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.metoclopramide intranasalSerious - Use Alternative (1)diphenhydramine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.metolazoneMonitor Closely (1)ibuprofen increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)metolazone will increase the level or effect of ibuprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.metoprololMonitor Closely (3)metoprolol and ibuprofen both increase serum potassium. Use Caution/Monitor. diphenhydramine will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ibuprofen decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.metronidazoleMinor (1)metronidazole will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.mexiletineMonitor Closely (1)diphenhydramine will increase the level or effect of mexiletine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.miconazole vaginalMinor (1)miconazole vaginal will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.midazolamMonitor Closely (1)diphenhydramine and midazolam both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam intranasal, diphenhydramine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineMonitor Closely (1)diphenhydramine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.milnacipranMonitor Closely (1)milnacipran, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.mipomersenMonitor Closely (1)mipomersen, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.mirtazapineMonitor Closely (1)diphenhydramine and mirtazapine both increase sedation. Use Caution/Monitor.mistletoeMonitor Closely (1)ibuprofen increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.modafinilMonitor Closely (1)diphenhydramine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.moexiprilMonitor Closely (1)moexipril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.Serious - Use Alternative (1)ibuprofen, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.morphineMonitor Closely (2)diphenhydramine will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. diphenhydramine and morphine both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)diphenhydramine and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinMonitor Closely (1)moxifloxacin, ibuprofen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.moxisylyteMonitor Closely (1)ibuprofen decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.moxonidineMonitor Closely (1)diphenhydramine and moxonidine both increase sedation. Use Caution/Monitor.mycophenolateMonitor Closely (1)ibuprofen will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.nabiloneMonitor Closely (1)diphenhydramine and nabilone both increase sedation. Use Caution/Monitor.nabumetoneMonitor Closely (2)ibuprofen and nabumetone both increase anticoagulation. Use Caution/Monitor. ibuprofen and nabumetone both increase serum potassium. Use Caution/Monitor.Minor (1)ibuprofen will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.nadololMonitor Closely (2)ibuprofen decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. nadolol and ibuprofen both increase serum potassium. Use Caution/Monitor.nalbuphineMonitor Closely (1)diphenhydramine and nalbuphine both increase sedation. Use Caution/Monitor.naproxenSerious - Use Alternative (3)ibuprofen will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Therapeutic duplication ibuprofen and naproxen both increase anticoagulation. Avoid or Use Alternate Drug. Therapeutic duplication ibuprofen and naproxen both increase serum potassium. Avoid or Use Alternate Drug. Therapeutic duplicationnateglinideMinor (1)nateglinide will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.nebivololMonitor Closely (3)ibuprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. nebivolol and ibuprofen both increase serum potassium. Use Caution/Monitor. diphenhydramine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nefazodoneMonitor Closely (1)nefazodone, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.neomycin POMinor (1)ibuprofen increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.neostigmineMonitor Closely (1)neostigmine increases and diphenhydramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.nettleMonitor Closely (1)ibuprofen increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)nettle increases effects of diphenhydramine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.nilotinibMinor (1)nilotinib will increase the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.nitazoxanideMinor (1)nitazoxanide, diphenhydramine. Either increases levels of the other by Mechanism: plasma protein binding competition. Minor/Significance Unknown.noni juiceMinor (1)ibuprofen and noni juice both increase serum potassium. Minor/Significance Unknown.norepinephrineMonitor Closely (2)ibuprofen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. diphenhydramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (3)diphenhydramine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. diphenhydramine and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor. diphenhydramine and nortriptyline both increase sedation. Use Caution/Monitor.ofloxacinMinor (1)ofloxacin, ibuprofen. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.olanzapineMonitor Closely (4)diphenhydramine decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. diphenhydramine decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. diphenhydramine and olanzapine both increase sedation. Use Caution/Monitor.oliceridineMonitor Closely (1)diphenhydramine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. olmesartanMonitor Closely (3)olmesartan, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. ibuprofen decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. olmesartan and ibuprofen both increase serum potassium. Use Caution/Monitor.olopatadine intranasalSerious - Use Alternative (1)diphenhydramine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. onabotulinumtoxinAMonitor Closely (1)onabotulinumtoxinA and diphenhydramine both decrease cholinergic effects/transmission. Use Caution/Monitor.opium tinctureMonitor Closely (1)diphenhydramine and opium tincture both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (2)diphenhydramine and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor. diphenhydramine and orphenadrine both increase sedation. Use Caution/Monitor.ospemifeneMonitor Closely (3)ibuprofen increases levels of ospemifene by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. ibuprofen, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely. diphenhydramine, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.oxaprozinSerious - Use Alternative (3)ibuprofen and oxaprozin both increase anticoagulation. Avoid or Use Alternate Drug. Therapeutic duplication ibuprofen will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug. Therapeutic duplication ibuprofen and oxaprozin both increase serum potassium. Avoid or Use Alternate Drug. Therapeutic duplicationoxazepamMonitor Closely (1)diphenhydramine and oxazepam both increase sedation. Use Caution/Monitor.oxybutyninMonitor Closely (1)diphenhydramine and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin topicalMonitor Closely (1)diphenhydramine and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.oxybutynin transdermalMonitor Closely (1)diphenhydramine and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.oxycodoneMonitor Closely (2)diphenhydramine will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. diphenhydramine and oxycodone both increase sedation. Use Caution/Monitor.Minor (1)diphenhydramine decreases effects of oxycodone by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of oxycodone to active metabolite morphine.oxymorphoneMonitor Closely (2)diphenhydramine will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. diphenhydramine and oxymorphone both increase sedation. Use Caution/Monitor.paliperidoneMonitor Closely (4)diphenhydramine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. diphenhydramine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. diphenhydramine and paliperidone both increase sedation. Use Caution/Monitor.panax ginsengMonitor Closely (1)ibuprofen and panax ginseng both increase anticoagulation. Use Caution/Monitor.pancuroniumMonitor Closely (1)diphenhydramine and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.papaveretumMonitor Closely (1)diphenhydramine and papaveretum both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)diphenhydramine and papaverine both increase sedation. Use Caution/Monitor.parecoxibMonitor Closely (2)ibuprofen and parecoxib both increase anticoagulation. Use Caution/Monitor. ibuprofen and parecoxib both increase serum potassium. Use Caution/Monitor.Minor (1)ibuprofen will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.paromomycinMinor (1)ibuprofen increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.paroxetineMonitor Closely (1)paroxetine, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.Minor (1)diphenhydramine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.passion flowerMonitor Closely (1)passion flower increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.pau d'arcoMonitor Closely (1)ibuprofen and pau d'arco both increase anticoagulation. Use Caution/Monitor.pegaspargaseMonitor Closely (1)pegaspargase increases effects of ibuprofen by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.peginterferon alfa 2bMonitor Closely (1)peginterferon alfa 2b decreases levels of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. When patients are administered peginterferon alpha-2b with CYP2C9 substrates, the therapeutic effect of these drugs may be altered.pemetrexedSerious - Use Alternative (1)ibuprofen increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Especially in pts. w/mild moderate renal insufficiency. D/C NSAIDs 2 5 d before and 2 d after pemetrexed administration.penbutololMonitor Closely (2)ibuprofen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. penbutolol and ibuprofen both increase serum potassium. Use Caution/Monitor.pentazocineMonitor Closely (1)diphenhydramine and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)diphenhydramine and pentobarbital both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of ibuprofen by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.perampanelMonitor Closely (1)perampanel and diphenhydramine both increase sedation. Use Caution/Monitor.perhexilineMinor (1)diphenhydramine will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.perindoprilMonitor Closely (1)perindopril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.Serious - Use Alternative (1)ibuprofen, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.perphenazineMonitor Closely (4)diphenhydramine decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form