Compatibility «Hydrochlorothiazide+Enalapril» and «Acetylsalicylic acid»

• Interactions Hydrochlorothiazide+Enalapril with Acetylsalicylic acid

  • Dangerous interactions
    • ⓘ In some patients with impaired renal function (for example, elderly patients or patients with hypovolemia, receiving diuretics in pm) receiving NSAIDs, the combined use of ACE inhibitors or ARA II may lead to further deterioration of renal function.
    • ⓘ It should be used with caution with hypotensive drugs (their effect is potentiated, dose adjustment may be necessary), cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase the toxicity of digitalis), amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia), hypoglycemic oral medications (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effects of thiazides), non-depolarizing muscle relaxants (their effect may be enhanced), amantadine (clearance of amantadine may decrease with hydrochlorothiazide, which leads to an increase in plasma concentration of amantadine and possible toxicity), colestyramine (reduces absorption of hydrochlorothiazide), ethanol, barbiturates and narcotic analgesics, which enhance the effect of orthostatic hypotension.
    • ⓘ Hydrochlorothiazide may enhance the toxic effect of high doses of salicylates on the central nervous system.
    • ⓘ In the elderly, patients with hypovolemia (including those receiving diuretics) or impaired renal function, the simultaneous use of enalapril and NSAIDs, including selective COX-2 inhibitors, may lead to deterioration of renal function, including the development of acute renal failure.
    • ⓘ In some patients with impaired renal function (for example, in elderly patients or patients with dehydration, including those taking diuretics) receiving NSAID therapy (including selective COX‑2 inhibitors), the simultaneous use of ACE inhibitors or ARA II may cause further deterioration of renal function, including the development of acute renal failure, and hyperkalemia.
    • ⓘ Concomitant use of ACE inhibitors and NSAIDs should be carried out with caution (especially in elderly patients and in patients with impaired renal function).
    • ⓘ The use of enalapril in combination with acetylsalicylic acid as an antiplatelet agent is not contraindicated.
  • Negative interactions
    • ⓘ The antihypertensive effect of enalapril may decrease with the simultaneous use of NSAIDs, including selective COX-2 inhibitors.
    • ⓘ NSAIDs can reduce the diuretic and antihypertensive effects of hydrochlorothiazide.
    • ⓘ Increases the toxicity of methotrexate, reducing its renal clearance, the effects of narcotic analgesics (codeine), oral antidiabetic drugs, heparin, indirect anticoagulants, thrombolytics and inhibitors of platelet aggregation, reduces the effect of uricosuric drugs (benzbromarone, sulfinpyrazone), hypotensive agents, diuretics (spironolactone, furosemide).
    • ⓘ It is necessary to periodically monitor renal function in patients receiving enalapril and NSAIDs together.
    • ⓘ However, other studies suggest that NSAIDs may reduce the antihypertensive effect of ACE inhibitors.
    • ⓘ NSAIDs, including selective COX‑2 inhibitors and acetylsalicylic acid in doses of 3 g/day and above, can reduce the antihypertensive effect of diuretics and other antihypertensive agents.
    • ⓘ As a result, the antihypertensive effect of ARA II antagonists or ACE inhibitors may be weakened when used concomitantly with NSAIDs, including selective COX inhibitors‑2.
  • No interactions
    • ⓘ Enalapril can be used simultaneously with acetylsalicylic acid (as an antiplatelet agent), thrombolytics and beta‑blockers.
  • Positive interactions
    • ⓘ Nonsteroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 (COX-2) inhibitors and high doses of acetylsalicylic acid (≥3 g/day).
    • ⓘ Diuretics in combination with acetylsalicylic acid in higher doses.
    • ⓘ Nonsteroidal anti‑inflammatory drugs (NSAIDs), including selective cyclooxygenase‑2 (COX-2) inhibitors and high doses of acetylsalicylic acid (>3 g/day).
    • ⓘ ACE inhibitors in combination with acetylsalicylic acid in higher doses.
  • Unclear interactions
    • ⓘ NSAIDs, including COX-2 inhibitors.
    • ⓘ NSAIDs, including selective COX-2 inhibitors.
    • ⓘ Acetylsalicylic acid, thrombolytics and beta‑blockers.

Decoding the colors of interactions and contraindications

Dangerous	—	a pronounced negative interaction or contraindication.
Negative	—	negative interaction or side effect that may reduce effectiveness.
Positive	—	the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication of the drug.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

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Additional information

• Kiberis checks interactions and evaluates drug compatibility for free online right in the instructions thanks to the latest artificial intelligence technologies. The accuracy of finding is more than 95%, the accuracy of the hazard assessment is more than 80%. The online medical service takes into account all the drug groups of the selected drugs and all their components. And since the database contains 25,000 drugs with detailed instructions, not every pharmacologist can compete with our artificial intelligence. List of popular interactions.
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• The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
• The article is written: artificial intelligence Kiberis
• Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
• Total analyzed: 169,994,378 possible combinations of drugs and their components were found 412,530 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2024-12-19

Category - medicine