Drug interactions
Enalapril-hydrochlorothiazide + Salsalate
Severity: Moderate
Enalapril-hydrochlorothiazide and Salsalate: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Salsalate, a salicylate with NSAID-like prostaglandin inhibition, can blunt the blood pressure lowering of enalapril and hydrochlorothiazide. In patients who are volume depleted, elderly or have reduced kidney function, the combination can also cause acute deterioration of renal function.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Salsalate can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Inhibition of vasodilatory renal prostaglandin synthesis reduces renal perfusion and sodium excretion, opposing ACE inhibitor and diuretic effects.
What to do
Monitor blood pressure, serum creatinine and potassium when starting or stopping salsalate, and ensure adequate hydration. Prefer paracetamol or the lowest effective salsalate dose for the shortest time in at-risk patients.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Salsalate?
MediHelp rates the interaction as moderate. Enalapril-hydrochlorothiazide and Salsalate can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Salsalate, a salicylate with NSAID-like prostaglandin inhibition, can blunt the blood pressure lowering of enalapril and hydrochlorothiazide. In patients who are volume depleted, elderly or have reduced kidney function, the combination can also cause acute deterioration of renal function.
How serious is the interaction between Enalapril-hydrochlorothiazide and Salsalate?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure, serum creatinine and potassium when starting or stopping salsalate, and ensure adequate hydration. Prefer paracetamol or the lowest effective salsalate dose for the shortest time in at-risk patients.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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