Pharmacotherapy in congestive heart failure: Do NSAIDs attenuate the therapeutic effect of ACE inhibitors in heart failure patients?
Heart failure (HF) is a disease which is prevalent in the elderly. Concomitant rheumatological diseases are also prevalent in this population which require treatment with NSAIDs. Aspirin is also routinely used for the primary and secondary prevention of coronary artery disease (CAD) which is a common cause of HF. ACE inhibitors are the cornerstone of drug therapy in managing patients with HF. Elderly patients with HF are frequently encountered with multiple drug therapy, such as nonsteroidal antiinflammatory drugs (NSAIDs) including aspirin and ACE inhibitors. In recent years there has been a concern of negative interaction between these two common drug therapies in patients with HF which may subsequently attenuate the beneficial effects of ACE inhibitors. Whereas some studies have shown that the coadministration of NSAIDs including aspirin with ACE inhibitors might diminish the degree of improvement in cardiovascular hemodynamics and adversely affect renal functions, other studies have failed to substantiate this. Furthermore, although potential opposing effects of NSAIDs and ACE inhibitors on prostaglandin synthesis has been cited as the mechanism responsible for the negative interactions, more work is needed in this area to better define the precise reasons responsible for it. However, based on the available data thus far, it is prudent to be aware of such negative interaction and especially in case of aspirin to avoid it by using relatively lower dosage. (c)1999 by CHF, Inc.
Department of Pharmacy and Medicine Services, Veterans Affairs of Central California Health Care System, Fresno, CA.
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Matalka
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Deedwania