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On call: Can two medications be worse than one?

On call

Can two medications be worse than one?

Q. I was diagnosed with congestive heart failure last month. By now, my breathing is back to normal, and I feel well. My doctor has prescribed several medications recommended for the condition, but he said that since I’m taking Vasotec, I should stop my aspirin. Do you agree?

A. It’s a legitimate recommendation. The issue is a possible adverse interaction between angiotensin converting enzyme inhibitors (ACEIs), such as your Vasotec (enalapril), and aspirin. Both drugs have major cardiac benefits, but some studies suggest that aspirin may diminish the benefits of ACEIs in patients who have congestive heart failure. But other studies disagree, and many cardiologists continue to use both medications in heart failure patients.

An interesting Italian study may help explain the contradictory findings. The scientists evaluated 344 heart failure patients who were taking ACEIs. One group did not take aspirin, a second group took low-dose aspirin (defined as 160 mg a day or less), and the third took high-dose aspirin (325 mg a day or more). During a follow-up period that averaged over three years, the high-dose aspirin group had a higher mortality rate than did the other groups; low-dose aspirin did not blunt the benefits of ACEI therapy.

It’s only one study, and more research is needed to sort out this important issue. At present, however, a daily aspirin dose of 81 mg (one “baby” aspirin) would seem to be a wise compromise. It’s probably the best preventive dose even in people who don’t have complex issues like yours.

It’s nice to hear that you’re doing well. With or without aspirin, it sounds like you’re getting fine treatment.

— Harvey B. Simon, M.D. Editor, Harvard Men’s Health Watch

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Last updated:	August 21, 2006