Interactions

The simultaneous use of various anticoagulants such as ASS 100, clopidogrel, ticagrelor, Xarelto, heparin or Marcumar® increases the risk of bleeding. Problems in the gastrointestinal tract (e.g. ulcers) occur more frequently if other non-steroidal anti-inflammatory drugs/antirheumatic drugs (NSAIDs) or cortisone preparations (corticosteroids) are taken in parallel or alcohol is consumed. The effect of diuretics (diuretic drugs) and antihypertensives (blood pressure reducers) can be reduced.

Furthermore, there is a large number of drugs which, together with Thomapyrin®, have an altered effect: For example, rifampicin and barbiturates increase the paracetamol concentration by modifying the activity of liver enzymes. The simultaneous administration of drugs that reduce the activity of the stomach results in a delayed onset of paracetamol, while activity-enhancing drugs shorten the onset of paracetamol. Other drugs with known interactions include chloramphenicol, gyrase inhibitors (antibiotics), various sedatives, zidovudine (antiviral – treatment of HIV), colestyramine (cholesterol-lowering drugs).

The caffeine contained in the product has an influence on the breakdown and action of sedatives (tranquilizers), which are thereby reduced in their effect, and of sympathetic stimulants (part of the nervous system responsible for increased activity in the body), which are increased in their effect (e.g. tachycardia). There is a risk of analgesic nephropathy if Thomapyrin® is used over a long period of time with other drugs that are attributed to kidney damage (nephrotoxic) effects. The combined use of paracetamol and ASA in Thomapyrin® is the main risk factor here. The blockage of cyclooxygenase and the resulting lack of production of vasodilating messengers (prostaglandins) can lead to circulatory disorders in the kidney, resulting in the destruction of renal tissue.Ultimately, the patient would become a renal failure and would have to undergo dialysis. Due to these and possibly other interactions that are not yet known or not mentioned, the treating physician or pharmacist should be consulted in case of uncertainty or questions.

Contraindications

The use of paracetamol should be avoided if there are incompatibilities or allergies to the active ingredients contained, i.e. the ASA, paracetamol and other components (lactose, caffeine). Damage and dysfunction of the liver and kidneys are exclusion criteria for the use of Thomapyrin®. In case of heart failure and existing bleeding tendency, the use of Thomapyrin® should also be avoided.

Children under 12 years of age should not take Thomapyrin®. In children, the use of ASA should be avoided, as it can lead to damage in the liver and brain – Reye’s syndrome. There is a particular risk in connection with febrile infections.

Children should be treated with paracetamol, for example, if necessary. During pregnancy, Thomapyrin® should not be taken within the last 3 months. Due to the ASA contained in Thomapyrin® there is a risk of damage to the unborn child.

It is also contraindicated in the case of known stomach ulcers, bleeding and perforations in the gastrointestinal tract. If a patient has a genetic deficiency of an important enzyme for the degradation of paracetamol (glucose-6-phosphate dehydrogenase), Thomapyrin® must not be used, as the missing or slowed down degradation of the ingredient paracetamol, or degradation using other enzymes, leads to toxic intermediates which destroy the liver cells. Thomapyrin® must not be used in case of additional medication with methothrexate, a drug for immunosuppression (e.g. in arthritis, lupus, tumors and other autoimmune diseases). Should the use of Thomapyrin® nevertheless be necessary for one of the medications or diseases, then this may only be done according to the instructions and under the control of the treating physician.