ACE Inhibitors/High-Dose Aspirin Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Aspirin may prevent ACE inhibitor from working.

What might happen:

Your ACE inhibitor may not lower your blood pressure enough.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking aspirin. Your doctor may want to check your blood pressure while you are taking these medicines together. Your doctor may want to lower your dose of aspirin or change your blood pressure medicine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Dzeka TN, Townley R, Arnold JM. Effects of enalaprilat on venoconstriction to norepinephrine: role of prostaglandins. Cardiovasc Res 2003 Jul 1; 59(1):250-6.
  • 2.Viecili PR, Pamplona D, Park M, Silva SR, Ramires JA, Da Luz PL. Antagonism of the acute hemodynamic effects of captopril in decompensated congestive heart failure by aspirin administration. Braz J Med Biol Res 2003 Jun;36(6):771-80.
  • 3.Savenkov MP, Ivanov SN, Brodskaia SA. Antihypertensive effect of enalapril and lisinopril administered in combination with nonsteroid anti-inflammatory agents. Ter Arkh 2001;73(9):27-31.
  • 4.Nawarskas JJ, Townsend RR, Cirigliano MD, Spinler SA. Effect of aspirin on blood pressure in hypertensive patients taking enalapril or losartan. Am J Hypertens 1999 Aug;12(8 Pt 1):784-9.
  • 5.Guazzi M, Pontone G, Agostoni P. Aspirin worsens exercise performance and pulmonary gas exchange in patients with heart failure who are taking angiotensin-converting enzyme inhibitors. Am Heart J 1999 Aug;138(2 Pt 1):254-60.
  • 6.Katz SD, Radin M, Graves T, Hauck C, Block A, LeJemtel TH. Effect of aspirin and ifetroban on skeletal muscle blood flow in patients with congestive heart failure treated with Enalapril. Ifetroban Study Group. J Am Coll Cardiol 1999 Jul;34(1):170-6.
  • 7.Leor J, Reicher-Reiss 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 1999 Jun; 33(7):1920-5.
  • 8.Guazzi MD, Campodonico J, Celeste F, Guazzi M, Santambrogio G, Rossi M, Trabattoni D, Alimento M. Antihypertensive efficacy of angiotensin converting enzyme inhibition and aspirin counteraction. Clin Pharmacol Ther 1998 Jan;63(1):79-86.
  • 9.Alimento M, Campodonico J, Santambrogio G, Rossi M, Trabattoni D, Celeste F, Guazzi M. The antagonistic effect of aspirin on the expression of prostaglandin participation in the antihypertensive activity of ACE inhibitors. Cardiologia 1997 Jun;42(6):605-10.
  • 10.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 1997 Jan 15;79(2):115-9.
  • 11.Boger RH, Bode-Boger SM, Kramme P, Tsikas D, Gutzki FM, Frolich JC. Effect of captopril on prostacyclin and nitric oxide formation in healthy human subjects: interaction with low dose acetylsalicylic acid. Br J Clin Pharmacol 1996 Dec;42(6):721-7.
  • 12.Hall D, Zeitler H, Rudolph W. Counteraction of the vasodilator effects of enalapril by aspirin in severe heart failure. J Am Coll Cardiol 1992 Dec; 20(7):1549-55.
  • 13.MacIntrye IM, Jhund PS, McMurray JJ. Aspirin inhibits the acute arterial and venous vasodilator response to captopril in patients with chronic heart failure. Cardiovasc Drugs Ther 2005 Aug;19(4):261-5.
  • 14.Di Gennaro FP, Cingolani OH, Abbate AF, Toblli JE, Vilches A. High doses of aspirin reduce natriuresis in hypertensive patients treated with enalapril. Medicina (B Aires) 2004;64(4):301-5.
  • 15.Meune C, Mahe I, Mourad JJ, Cohen-Solal A, Levy B, Kevorkian JP, Jondeau G, Habib A, Lebret M, Knellwolf AL, Simoneau G, Caulin C, Bergmann JF. Aspirin alters arterial function in patients with chronic heart failure treated with ACE inhibitors: a dose-mediated deleterious effect. Eur J Heart Fail 2003 Jun;5(3):271-9.
  • 16.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 2002 Jul;50(7):1293-6.
  • 17.Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the ACC/AHA Task Force on Practice Guidelines Developed in Collaboration With the ISLHT. J Am Coll Cardiol 2009 Apr 14; 53(15):e1-e90.
  • 18.National Collaborating Centre for Acute and Chronic Conditions. Chronic heart failure. Management of chronic heart failure in adults in primary and secondary care (Clinical guideline; no. 108). London (UK): National Institute for Health and Clinical Excellence (NICE) Aug, 2010.
  • 19.Phansalkar S, van der Sijs H, Tucker AD, Desai AA, Bell DS, Teich JM, Middleton B, Bates DW. Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. J Am Med Inform Assoc 2012 Sep 25.
Full Drug Information

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.