Drug General Information (ID: DDIBP93O62)
Drug Name			Nabumetone		Drug Info		Ramucirumab		Drug Info
Drug Type		Small molecule				Monoclonal antibody
Therapeutic Class		Nsaids/Analgesics				Vegf/Vegfr Inhibitors

Mechanism of Nabumetone-Ramucirumab Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Nabumetone				Ramucirumab
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Antiplatelet/anticoagulant effects
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 Nabumetone and Ramucirumab

Recommended Action
Management		Caution is advised if ramucirumab must be used with chronic NSAID or salicylate therapy. Close clinical and laboratory observation for bleeding complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools. Ramucirumab should be permanently discontinued in patients who experience severe bleeding or gastrointestinal perforation.

References
1	Product Information. Cyramza (ramucirumab). Eli Lilly and Company, Indianapolis, IN.