Carbonic anhydrase inhibitors Aspirin

Food containing salicylate (curry powder, paprika, licorice, prunes, raisins, and tea) may increase the risk of adverse reactions. Coadministration of the salicylates with activated charcoal decreases the absorption of the salicylates. Antacids may decrease the effects of the salicylates. Coadministration with the carbonic anhydrase inhibitors increases the risk of salicylism. Aspirin may increase the risk of bleeding during... 

Drugs that may affect aspirin include activated charcoal, ammonium chloride, ascorbic acid or methionine, antacids and urinary alkalinizers, carbonic anhydrase inhibitors, corticosteroids, and nizatidine. Drugs that may be affected by aspirin include alcohol, ACE inhibitors, anticoagulants (oral), beta-adrenergic blockers, heparin, loop diuretics, methotrexate, nitroglycerin, NSAIDs, probenecid and sulfinpyrazone, spironolactone, sulfonylureas and exogenous insulin, and valproic acid. 

Salicylates Interference with renal excretion of drugs that undergo active tubular secretion. Salicylate renal excretion dependent on urinary pH when large doses of salicylate used. Aspirin (but not other salicylates) interferes with platelet function. Large doses of salicylates have intrinsic hypoglycemic activity. Salicylates may displace drugs from plasma protein binding sites. Carbonic anhydrase inhibitors [NE] Increased acetazolamide serum concentrations increased salicylate toxicity due to decreased blood pH. 

ASPIRIN CARBONIC ANHYDRASE INHIBITORS t risk of salicylate toxicity with high-dose aspirin Uncertain at present Use low-dose aspirin... 

In two children, aspirin potentiated the slight metabolic acidosis induced by carbonic anhydrase inhibitors (SEDA-9, 79) (104). 

These are canilyiic proteins that increase the rale of chemical reactions in the btxly. Drugs that act by inhibiting enz.ynie.s include anii-choiiiiesterases, which enhance the action of acetylcholine (Chapters 6 and 8) carbonic anhydrase inhibitors, which arc diuretics (i.c. increase urine flow. Chapter 14) montmmine ojiidase inhibitors, which are antidepres,sams (Chapter 28) and inhibitors of cych-oxygeitase (e.g. aspirin. Chapter 32). 

Aspirin or other Salicylates + Carbonic anhydrase inhibitors... 

Not fully established. One idea is that these carbonic anhydrase inhibitors (acetazolamide, diclofenamide) affect the plasma pH, so that more of the salicylate exists in the un-ionised (lipid-soluble) form, which can enter the CNS and other tissues more easily, leading to salicylate toxicity. However, carbonic anhydrase inhibitors also make the urine more alkaline, which increases the loss of salicylate (see also Aspirin or other Salicylates + Antacids , p.l35). Animal studies confirm that carbonic anhydrase inhibitors increase the lethal toxicity of aspirin. An alternative suggestion is that because salicylate inhibits the plasma protein binding of acetazolamide and its excretion by the kidney, acetazolamide toxicity, which mimics salicylate toxicity, may occur. ... 

Anderson CJ, Kaufman PL, Sturm RJ. Toxicity of combined therapy with carbonic anhydrase inhibitors and aspirin. Am J Ophthalmol (1978) 86, 516-19. 

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