Drug General Information (ID: DDI9DX1VQN)
Drug Name			Indomethacin		Drug Info		Desirudin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Anticoagulants
Structure

Mechanism of Indomethacin-Desirudin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Indomethacin				Desirudin
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Indomethacin and Desirudin

Recommended Action
Management		Close clinical and laboratory observation for bleeding complications is recommended if thrombin inhibitors are used with drugs that interfere with platelet function, including long-term or chronic NSAIDs. In patients undergoing neuraxial intervention, coadministration of these agents should be approached with extreme caution and only after thorough assessment of risks and benefits. Besides bleeding complications, these patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction. Urgent diagnosis and treatment (e.g., spinal cord decompression) are required if signs or symptoms of spinal hematoma develop.

References
1	Product Information. Ipravask (desirudin). Aventis Pharmaceuticals, Swiftwater, PA.
2	Product Information. Pradaxa (dabigatran). Boehringer-Ingelheim, Ridgefield, CT.