Colestyramine, given at the same time as an
NSAID, markedly reduced the oral absorption of diclofenac and
sulindac, modestly reduced the absorption of
ibuprofen, but only delayed and did not reduce the extent of absorption of
naproxen.
Administration of
colestyramine three or more hours after oral
sulindac,
piroxicam, or tenoxicam still markedly reduced their
plasma levels. Colestyramine, given after the
NSAID, markedly reduces the levels of
intravenous meloxicam or tenoxicam.
It is usually recommended that other drugs are given one hour before or 4 to 6 hours after
colestyramine. However,
meloxicam,
piroxicam,
sulindac, and tenoxicam undergo enterohepatic recirculation and so the interaction cannot be avoided by separating the doses, and it may be best to avoid using these drug combinations. The effect on
ibuprofen and
naproxen is probably not clinically important, although the delayed absorption may be relevant in the management of acute pain. Information on many other
NSAIDs appears to be lacking.