Reduced BP response to ACE inhibitors

Possible attenuation of hemodynamic actions of ACE inhibitors in patients with CHF

Reduced hyponatremic effect of ACE inhibitors

Increased risk of bleeding

May displace warfarin from protein-binding sites, leading to prolongation of PT and bleeding time

May displace phenytoin from binding sites; possible decrease in total plasma phenytoin concentrations, with increased free fraction

May displace valproic acid from binding sites; possible increase in free plasma valproic acid concentrations; possible increased risk of bleeding

Reduced BP response to β-adrenergic blocking agents

Potential for salt and fluid retention

Increased risk of salicylate toxicity

Increased plasma acetazolamide concentrations; increased risk of acetazolamide toxicity

Increased plasma methotrexate concentrations

Inhibition of renal clearance of methotrexate leading to bone marrow toxicity, especially in geriatric patients or patients with renal impairment

Increased risk of bleeding, GI ulceration, decreased renal function, or other complications

No consistent evidence that low-dose aspirin mitigates increased risk of serious cardiovascular events associated with NSAIAs

Pharmacokinetic interactions with many NSAIAs

Antagonism (ibuprofen, naproxen) of the irreversible platelet-aggregation inhibitory effect of aspirin; may limit the cardioprotective effects of aspirin

Minimal risk of attenuating effects of low-dose aspirin with occasional use of ibuprofen

Not known whether ketoprofen interferes with the antiplatelet effect of aspirin

Decreased peak plasma concentration and AUC of diclofenac; limited data indicate that diclofenac does not inhibit antiplatelet effect of aspirin

Concomitant use not recommended

Pharmacokinetic interactions unlikely to be clinically important

Immediate-release aspirin: Administer a single dose of ibuprofen 400 mg for self-medication≥8 hours before or ≥30 minutes after administration of aspirin

Enteric-coated low-dose aspirin: No recommendations regarding timing of administration with single dose of ibuprofen

Consider use of alternative analgesics that do not interfere with antiplatelet effect of low-dose aspirin (e.g., acetaminophen, opiates) for patients at high risk of cardiovascular events

Concomitant use with prescription NSAIAs not recommended because of potential for increased adverse effects

Manufacturer of varicella virus vaccine live recommends that individuals who receive the vaccine avoid use of salicylates for 6 weeks following vaccination

For children who are receiving long-term salicylate therapy, AAP suggests weighing theoretical risks of vaccination against known risks of wild-type virus; ACIP states that children who have rheumatoid arthritis or other conditions requiring therapeutic salicylate therapy probably should receive varicella virus vaccine live in conjunction with subsequent close monitoring