ModerateAntiplatelet agents (low dose) / NSAIDs (analgesic dose)×Angiotensin-converting enzyme inhibitors (ACEi)
Updated · Methodology
Mechanism
High aspirin doses (above 1 g/day) weaken the hypotensive and cardioprotective effects of the ACE-I via vasodilator prostaglandin suppression. At cardioprotective doses (75–100 mg/day), the clinical effect is minimal.
Symptoms
Gradual blood pressure rise at high aspirin doses. At cardioprotective doses, no significant changes.
Management
Cardioprotective aspirin doses (75–100 mg) are acceptable without adjustment. At high aspirin doses, monitor blood pressure and increase enalapril if needed. Alternative analgesic: paracetamol.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- AHA: Use of Nonsteroidal Antiinflammatory Drugs: An Update for Clinicians. A Scientific Statement From the American Heart Association (2007)– Circulation 2007;115(12):1634–1642
- AGS: American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use (2023)– By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2023;71(7):2052-2081.
- AEMPS: Ficha técnica: Enalapril (nº registro 63355), sección 4.5 (2025)– AEMPS, CIMA, nº registro 63355, revisión 08/2025, sección 4.5