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8 Interactions found for:

lisinopril and Aspir 81
Interactions Summary
  • 4 Major
  • 3 Moderate
  • 1 Minor
  • lisinopril
  • Aspir 81

Drug Interactions

Moderate
Aspir 81 + Lisinopril

The following applies to the ingredients: Aspirin (found in Aspir 81) and Lisinopril

MONITOR: Some investigators suggest that coadministration with aspirin may attenuate the vasodilator and hypotensive effects of ACE inhibitors. In addition, some have found that the benefits of ACE inhibitors on morbidity and mortality in post-acute myocardial infarction, coronary heart disease, and particularly congestive heart failure may be compromised or even nullified by aspirin. The proposed mechanism is aspirin inhibition of cyclooxygenase, resulting in suppression of prostaglandin synthesis and prostaglandin-mediated hemodynamic effects of ACE inhibitors. However, evidence of a negative interaction is largely contradictory, and interpretation of relevant data has often been complicated by multiple confounding elements as well as the retrospective or post hoc nature of most studies. Available data seem to indicate that low-dose aspirin (less than 236 mg/day, and especially less than 100 mg/day) is unlikely, or at least significantly less likely, to interfere with ACE inhibitor effects, although susceptibility to the interaction may be subject to some degree of interpatient variability.

MANAGEMENT: Based on current data, it is difficult to determine the likelihood of a negative interaction between aspirin and ACE inhibitors and its clinical relevance during long-term therapy, particularly in congestive heart failure. Current recommendations generally do not preclude combination use in patients with cardiovascular diseases or risk factors that might otherwise benefit from the drugs independently. However, patients receiving long-term therapy with the combination should undergo regular blood pressure and other appropriate clinical monitoring such as renal function assessments. The lowest therapeutic dosage of aspirin should be used.

References

  1. Moore TJ, Crantz FR, Hollenberg NK "Contribution of prostaglandins to the antihypertensive action of captopril in essential hypertension." Hypertension 3 (1981): 168-73
  2. Silberbauer K, Stanek B, Templ H "Acute hypotensive effect of captopril in man modified by prostaglandin synthesis inhibition." Br J Clin Pharmacol 14 (1982): s87-93
  3. Pfeffer MA, Braunwald E, Moye LA, et al. "Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement Trial." N Engl J Med 327 (1992): 669-77
  4. Hall D, Zeitler H, Rudolph W "Counteraction of the vasodilator effects of enalapril by aspirin in severe heart failure." J Am Coll Cardiol 20 (1992): 1549-55
  5. Acute Infarction Ramipril Efficacy (AIRE) Study Investigators "Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure." Lancet 342 (1993): 821-8
  6. Polonia J, Boaventura I, Gama G, Camoes I, Bernardo F, Andrade P, Nunes JP, Brandao F, Cerqueiragomes M "Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients." J Hypertens 13 (1995): 925-31
  7. Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole DS, Auclert L, Pauly NC, et al. "A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group." N Engl J Med 333 (1995): 1670-6
  8. Nguyen KN, Aursnes I, Kjekshus J "Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the cooperative new scandinavian enalapril survival study II (CONSENSUS II)." Am J Cardiol 79 (1997): 115-9
  9. Oosterga M, Anthonio RL, deKam PJ, Kingma JH, Crijns HJGM, vanGilst WH "Effects of aspirin on angiotensin-converting enzyme inhibition and left ventricular dilation one year after acute myocardial infarction." Am J Cardiol 81 (1998): 1178-81
  10. Spaulding C, Charbonnier B, CohenSolal A, Juilliere Y, Kromer EP, Benhamda K, Cador R, Weber S "Acute hemodynamic interaction of aspirin and ticlopidine with enalapril: Results of a double-blind, randomized comparative trial." Circulation 98 (1998): 757-65
  11. Song KH, Fedyk R, Hoover R "Interaction of ACE inhibitors and aspirin in patients with congestive heart failure." Ann Pharmacother 33 (1999): 375-7
  12. Leor J, ReicherReiss H, Goldbourt U, Boyko V, Gottlieb S, Battler A, Behar S "Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors - A cohort study of 11,575 patients with coronary artery disease." J Am Coll Cardiol 33 (1999): 1920-5
  13. The Heart Outcomes Prevention Evaluation Study Investigators "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients." N Engl J Med 342 (2000): 145-53
  14. Massie BM, Teerlink JR "Interaction between aspirin and angiotensin-converting enzyme inhibitors: Real or imagined." Am J Med 109 (2000): 431-3
  15. Meune C, Mahe I, Mourad JJ, Simoneau G, Knellwolf AL, Bergmann JF, Caulin C "Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review." Eur J Clin Pharmacol 56 (2000): 609-20
  16. Mahe I, Meune C, Diemer M, Caulin C, Bergmann JF "Interaction between aspirin and ACE inhibitors in patients with heart failure." Drug Saf 24 (2001): 167-82
  17. Zanchetti A, Hansson L, Leonetti G, et al. "Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy." J Hypertens 20 (2002): 1015-1022
  18. Ahmed A "Interaction between aspirin and angiotensin-converting enzyme inhibitors: should they be used together in older adults with heart failure?" J Am Geriatr Soc 50 (2002): 1293-6
  19. Lapane KL, Hume AL, Barbour MM, Lipsitz LA "Does aspirin attenuate the effect of angiotensin-converting enzyme inhibitors on health outcomes of very old patients with heart failure?" J Am Geriatr Soc 50 (2002): 1198-204
  20. Nawarskas JJ, Spinler SA "Update on the interaction between aspirin and angiotensin-converting enzyme inhibitors." Pharmacotherapy 20 (2000): 698-710
  21. Nawarskas JJ, Spinler SA "Does aspirin interfere with the therapeutic efficacy of angiotensin-converting enzymen inhibitors in hypertension or congestive heart failure?" Pharmacotherapy 18 (1998): 1041-52
  22. Teo K, Yusuf S, Pfeffer M, et al. "Effects of long-term treatment with angiotensin-converting-enzyme inhibitors in the presence or absence of aspirin: a systematic review." Lancet 360 (2002): 1037
  23. Guazzi M, Brambilla R, Reina G, Tumminello G, Guazzi MD "Aspirin-angiotensin-converting enzyme inhibitor coadministration and mortality in patients with heart failure: a dose-related adverse effect of aspirin." Arch Intern Med 163 (2003): 1574-9

Drug and Food Interactions

Moderate
Lisinopril + Food

The following applies to the ingredients: Lisinopril

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References

  1. "Product Information. Vasotec (enalapril)." Merck & Co., Inc PROD (2002):
  2. Good CB, McDermott L "Diet and serum potassium in patients on ACE inhibitors." JAMA 274 (1995): 538
  3. Ray K, Dorman S, Watson R "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens 13 (1999): 717-20

The following applies to the ingredients: Lisinopril

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

Moderate
Aspir 81 + Food

The following applies to the ingredients: Aspirin (found in Aspir 81)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

Minor
Aspir 81 + Food

The following applies to the ingredients: Aspirin (found in Aspir 81)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6

Drug and Pregnancy Interactions

The following applies to the ingredients: Aspirin (found in Aspir 81)

100 mg/day or less: Use with caution
Greater than 100 mg/day: NSAIDs should be avoided at 20 weeks gestation and later

AU TGA pregnancy category: C
US FDA pregnancy category: Not Assigned

Risk Summary: Nonsteroidal anti-inflammatory drugs (NSAIDs) use in pregnant women at 30 weeks gestation and later may cause premature closure of the fetal ductus arteriosus; NSAID use at 20 weeks gestation or later may cause fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment.

Comments:
-Guidelines recommend low-dose aspirin prophylaxis (e.g., 81 mg/day) in women at high risk of preeclampsia; initiation should be between 12- and 28-weeks gestation (optimally before 16 weeks) and continued until delivery; the use aspirin at 81 mg/day dose for certain pregnancy-related conditions at any point in pregnancy is an exception to the FDA recommendations to avoid use of NSAIDs in pregnancy at 20 weeks or later.
-If NSAID use is necessary between 20- and 30-weeks' gestation, limit use to the lowest effective dose for the shortest duration possible; ultrasound monitoring of amniotic fluid should be considered if NSAID use extends beyond 48 hours; if oligohydramnios occurs, discontinue NSAID and treat appropriately.
-NSAID use is not recommended in women attempting to conceive as it may impair female fertility.

In animals, prostaglandin synthesis inhibitors have been shown to increase pre and post-implantation loss and embryo-fetal lethality. Epidemiologic studies suggest increased risk of miscarriage, cardiac malformations, and gastroschisis when used early in pregnancy; the absolute risk of cardiovascular malformations increased from less than 1% to up to approximately 1.5%. The risk is believed to increase with dose and duration of therapy.

Aspirin (acetylsalicylic acid) is a NSAID that inhibits cyclooxygenase (COX) isoenzymes 1 and 2. The effect on COX isoenzymes is dose-dependent with lower doses (60 to 150 mg) inhibiting platelet synthesis while higher doses results in inhibition of both COX-1 and COX-2 blocking all prostaglandin production. Low-dose aspirin has been used during pregnancy to prevent or delay the onset of preeclampsia. Daily low-dose aspirin has been shown to be associated with a low likelihood of serious maternal, or fetal complications. Guidelines should be consulted for specific use.

During the third trimester of pregnancy, administration of COX-1 and COX-2 blocking nonsteroidal anti-inflammatory drugs (NSAIDs) may cause premature closure of the fetal ductus arteriosus, oligohydramnios, fetal renal impairment, pulmonary hypertension, and prolongation of bleeding time. There are no controlled data in human pregnancy.

US FDA Drug Safety Communication (10-2020): The FDA is requiring a new warning be added to NSAID labeling describing the risk of fetal kidney problems that may result in low amniotic fluid. The FDA is recommending pregnant women avoid NSAID use at 20 weeks gestation or later; the use aspirin at 81 mg/day dose for certain pregnancy-related conditions at any point in pregnancy is an exception. Through 2017, the FDA has received 35 reports of low amniotic fluid levels or kidney problems in mothers who took NSAIDs while pregnant. Five newborns died; 2 had kidney failure and confirmed low amniotic fluid, 3 had kidney failure without confirmed low amniotic fluid. The low amniotic fluid started as early as 20 weeks of pregnancy. There were 11 reports of low amniotic fluid levels during pregnancy and the fluid volume returned to normal after the NSAID was stopped. The medical literature has reported low amniotic fluid levels with use of NSAIDs for varying amounts of time, ranging from 48 hours to multiple weeks. Complications of prolonged oligohydramnios may include limb contractures and delayed lung maturation. In some postmarketing cases of impaired neonatal renal function, invasive procedures such as exchange transfusion or dialysis were required. In other cases, the condition was reversible within 3 to 6 days of stopping the NSAID and in these cases reappeared when the same NSAID was restarted.

Administration during labor and delivery is not recommended as the onset of labor may be delayed and duration increased with greater bleeding tendency in mother and child.

A study of the use of low-dose aspirin (60 mg per day) to prevent and treat preeclampsia in 9364 pregnant women (the Collaborative Low-dose Aspirin Study in Pregnancy--CLASP) did "not support routine prophylactic or therapeutic administration of antiplatelet therapy in pregnancy to all women at increased risk of preeclampsia or IUGR." In that study, no excess of intraventricular hemorrhage, neonatal bleeds, or mortality attributable to bleeding were observed. The investigators did identify a possible role for low-dose aspirin in the treatment of early-onset preeclampsia severe enough to need very preterm delivery.

AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Clasp: a randomised trial lf low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women." Lancet 343 (1994): 619-29
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. US Food and Drug Administration "TITLE 21--FOOD AND DRUGS,CHAPTER I--FOOD AND DRUG ADMINISTRATION,DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER D--DRUGS FOR HUMAN USE,PART 341 COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FO. https://www.accessdata.fda.gov" (2016):
  5. Committee on Obstetric Practice Society for Maternal-Fetal Medicine "ACOG Committee Opinion No. 743: Low-dose aspirin use during pregnancy." Obstet Gynecol 132 (2018): e44-e52

The following applies to the ingredients: Lisinopril

AU: Use is contraindicated.
UK: Use is not recommended during the first trimester and use is contraindicated during the second and third trimesters.
US: This drug should not be used during pregnancy unless there are no alternatives and the benefit outweighs the risk to the fetus.

AU TGA pregnancy category: D
US FDA pregnancy category: Not assigned

Risk Summary: Use of drugs that act on the renin angiotensin system (RAS) during the second and third trimesters of pregnancy increases fetal and neonatal morbidity and death.

Comments:
-Adequate methods of contraception should be encouraged.
-Advise pregnant women and females of reproductive potential of the potential risk to a fetus.

Animal studies have revealed evidence of fetotoxicity. In humans, exposure to angiotensin-converting enzyme (ACE) inhibitors during the second and third trimesters has revealed evidence of fetal and neonatal toxicity and fetolethality. There are no controlled data in human pregnancy.

AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc PROD (2002):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. http://www.appco.com.au/appguide/default.asp" (2006):
  4. Cerner Multum, Inc. "Australian Product Information." O 0

Drug and Breastfeeding Interactions

The following applies to the ingredients: Aspirin (found in Aspir 81)

Benefit should outweigh risk

Excreted into human milk: Yes

Comments:
-This drug appears compatible with breastfeeding for occasional use and in low doses for anti-thrombosis; however, repeated use in normal doses and long-term use, especially in high doses should be avoided.
-Breastfed infants should be monitored for hemolysis, prolonged bleeding time, and metabolic acidosis.

This drug is excreted in human milk in small amounts. Low dose aspirin (75 to 162 mg/day) is considered by many experts to be compatible with breastfeeding. Peak milk salicylate levels have been reported up to 9 hours after maternal dosing with peak levels generally occurring 2 to 6 hours after nursing. Large doses may result in rashes, platelet abnormalities, and bleeding in nursing infants. Long-term, high dose maternal use was associated with 1 case of metabolic acidosis in breastfed infant. The risk for Reye's syndrome in infants with viral infections is unknown.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
  3. Department of Adolescent and Child Health and Development. UNICEF. World Health Organization "Breastfeeding and maternal medication: recommendations for drugs in the eleventh Who model list of essential drugs. http://whqlibdoc.who.int/hq/2002/55732.pdf?ua=1" (2014):
  4. US Food and Drug Administration "TITLE 21--FOOD AND DRUGS,CHAPTER I--FOOD AND DRUG ADMINISTRATION,DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER D--DRUGS FOR HUMAN USE,PART 341 COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FO. https://www.accessdata.fda.gov" (2016):

The following applies to the ingredients: Lisinopril

A decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Excreted into human milk: Unknown
Excreted into animal milk: Yes

Comments:
-ACE inhibitors have the potential to adversely affect a nursing infant.

References

  1. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc PROD (2002):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. http://www.appco.com.au/appguide/default.asp" (2006):
  4. Cerner Multum, Inc. "Australian Product Information." O 0

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Consumer Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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