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Correct volume status in dehydrated or hypovolemic patients prior to initiating PonstelMonitor renal function in patients with renal or hepatic impairmentheart failuredehydrationor hypovolemia during use of Ponstelsee PRECAUTIONSDrug InteractionsAvoid the use of Ponstel in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal functionIf Ponstel is used in patients with advanced renal diseasemonitor patients for signs of worsening renal function.

A blood thinner such as warfarinCoumadina diureticwater pillsuch as furosemideLasixcyclosporineGengrafNeoralSandimmunelithiumEskalithLithobidmethotrexateRheumatrexTrexallsteroidsprednisone and othersor aspirin or NSAIDsnon-steroidal anti-inflammatory drugssuch as diclofenacVoltarenetodolacLodinefenoprofenNalfonflurbiprofenAnsaidibuprofenAdvilMotrinindomethacinIndocinketoprofenOrudisketorolacToradolmeclofenamateMeclomenmeloxicamMobicnabumetoneRelafennaproxenAleveNaprosynpiroxicamFeldeneand others.

Strategies to Minimize the GI Risks in NSAID-treated patients Use the lowest effective dosage for the shortest possible durationAvoid administration of more than one NSAID at a timeAvoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleedingFor such patientsas well as those with active GI bleedingconsider alternate therapies other than NSAIDsRemain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapyIf a serious GI adverse event is suspectedpromptly initiate evaluation and treatmentand discontinue Ponstel until a serious GI adverse event is ruled outIn the setting of concomitant use of low-dose aspirin for cardiac prophylaxismonitor patients more closely for evidence of GI bleedingsee PRECAUTIONSDrug Interactions

Advise females of reproductive potential who desire pregnancy that NSAIDsincluding Ponstelmay be associated with a reversible delay in ovulationsee PRECAUTIONSCarcinogenesisMutagenesisImpairment of Fertility

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