With the simultaneous use of ASA strengthens action of the following medicines; if it is necessary to simultaneously apply ASA with the listed means, consider the need to reduce the dose of these funds:
- methotrexate, by reducing renal clearance and displacing it from the bond with plasma proteins;
- with simultaneous use with anticoagulants, thrombolytic and other antiplatelet agents (ticlopidine, clopidogrel) there is an increased risk of bleeding as a result of synergism of the main therapeutic effects of the drugs used;
- when used simultaneously with drugs that have anticoagulant, thrombolytic or antiplatelet effect, there is an increase in the damaging effect on the gastrointestinal mucosa;
- selective serotonin reuptake inhibitors, which may lead to an increased risk of bleeding from the upper GI tract (synergy with ASA);
- digoxin, due to a decrease in its renal excretion, which may lead to overdose;
- hypoglycemic agents for oral administration (sulfonylurea derivatives) and insulin due to hypoglycemic properties of ASA itself at high doses and displacement of sulfonylurea derivatives from binding to plasma proteins;
- when used with valproic acid, its toxicity increases due to the displacement of its binding to blood plasma proteins;
- NSAIDs and salicylic acid derivatives in high doses (increased risk of ulcerogenic effect and bleeding from the gastrointestinal tract as a result of synergism of action); when used simultaneously with ibuprofen, antagonism is noted with respect to irreversible platelet suppression caused by the action of ASA, which leads to a decrease in the cardioprotective effects of ASA;
- ethanol (increased risk of damage to the mucous membrane of the gastrointestinal tract and prolonged bleeding time due to the mutual enhancement of the effects of ASA and ethanol).
Simultaneous use of ASA in high doses can loosen action of the medicines listed below; if it is necessary to simultaneously prescribe ASA with the listed means, consideration should be given to the need to correct the dose of the listed drugs:
- any diuretics (when combined with ASA in high doses, there is a decrease in the glomerular filtration rate (GFR) as a result of a decrease in the synthesis of prostaglandins in the kidneys);
- angiotensin converting enzyme (ACE) inhibitors (marked dose-dependent decrease in glomerular filtration rate by inhibiting prostaglandins possessing vasodilating action, respectively, the attenuation of the hypotensive action. Clinically significant decrease in GFR is observed at a daily dose of ASA 160 mg. In addition, there is a decrease of positive cardioprotective effects of ACE inhibitors assigned to patients for the therapy of chronic heart failure. This effect is also apparent when used in conjunction with ASA Olsha doses).
- drugs with uricosuric action - benzbromarone, probenecid (reduction of uricosuric effect due to competitive suppression of renal tubular excretion of uric acid);
- when used simultaneously with systemic glucocorticosteroids (with the exception of hydrocortisone used for the replacement therapy of Addison's disease), there is an increase in salicylate excretion and, correspondingly, a weakening of their action.