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Advised to take Pharmapress Verahexal, Ecotrin, Aspavor and Carbilev. Any side effects if taken together?

Dec 2012
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General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
My wife is currently required to take the following items:
Are there any possible adverse reactions as a result of the combination of these items?

Posted Wed, 31 Jul 2013 in Medicines and Side Effects
Answered by Dr. Nsah Bernard 1 hour later

Thanks for posting on XXXXXXX

- Pharmpress (generic: enalapril) is an ACE inhibitor which can individual present with its own side effects (your wife must not necessarily present with any SE). Combination between ecotrin (aspirin) can results to potential interaction. Either increases toxicity of the other. So significant interaction possible, so need for close monitoring. May result in renal function deterioration, particularly in elderly or volume depleted individuals. May also interact with carbilev (generic: carbidopa-levodopa) as it increases effects of enalapril by pharmacodynamic synergism.

- Verahexal (generic: Verapamil) is a nondihydropyridine calcium-channel blocker comes with potential side effects. There is a significant interaction between Aspavor (generic: atorvastatin) and carbilev, so there is a need to monitor closely. Dose reduction for some of the medication might be required. Minor interaction between ecotrin and verahexal.

- Ecotrin, Aspavor and carbilev already has interactions with above medications as mentioned above. But there seem not to be any significant interactions between three drugs.

In any case, it will be best to seek the opinion of your wife's doctor before taking any decisions as regarding the use of the above medications.

Hope this helps and wish you the best.
Dr. Nsah
Above answer was peer-reviewed by
Follow-up: Advised to take Pharmapress Verahexal, Ecotrin, Aspavor and Carbilev. Any side effects if taken together? 19 hours later
Thank you for your response.
Sadly, as a non-medical individual, I do not know the meanings of technical medical terms.
Nevertheless, please, what exactly does " it increases effects of enalapril by pharmacodynamic synergism." mean?
You have indicated that there could be some side effects. What should I be looking for that would show me that a side effect is happening?
And, if this occurs, what action should I take?
And, if so, with what degree of urgency?
Answered by Dr. Nsah Bernard 1 hour later

Thanks for return question,

Oh sorry for providing you with some medical terminologies that you are unfamiliar with. I will try to make it simply this time around.
Well, increasing pharmacodynamic synergism simply means that it increases the effect of enalapril, there could increase its potency i.e increase its effect by a fraction of a percentage which means it could present like your wife is taking a higher dosage than the actual dosage of the medication.
As for the side effects of the medications they are many (the list is long);

- pharmapress (enalapril): dizziness (occurs in 4-8% of patients that take it), hypotension, headache, chest pain, cough, rash, fatigue, nausea, vomiting, hyperkalamia (<6.7). Most of them hardly manifest with severity, but if they do occur, please do inform your doctor. You will hardly be able to determine hypotension/low blood pressure and hyperkalamia/high levels of potassium at home, so with the help of routine medical check up, it could be identified (if it comes up) by a health care professional.
- Verahexal (verapamil): headache, gingival thickening/hyperplasia (occur in >10%), constipation, dizziness, hypotension, dyspepsia/indigestion, nausea, edema, rash, increased liver enzymes, sleep disturbance, dyspnea (< 10% in order of decreasing frequency respectively: 10%-1%). If you can identify some, you can inform her doctor as well. Others might require laboratory monitoring and others serious side effects that require urgent medical attention as soon as identified.
- Ecotrin (aspirin: angioedema/Quincke's edema (rapid swelling/edema of the dermis, subcutaneous tissue, mucosa and submucosal tissues), Central nervous system alteration (such as confusion, amnesia, confusion etc), skin problems, gut pain/ulceration, bleeding, liver damage, hearing loss, nausea, platelet aggregation inhibition, premature hemolysis, pulmonary edema/lung wall swellings, rash, renal damage, tinnitus, urticaria/hives, vomiting etc. Most of them will only be determined in the lab and are severe medical conditions and unfortunately the frequencies can not be defined.
- Aspavor (atorvastatin): headache (>10%), chest pain, peripheral edema, sinusitis, joints pain, diarrhea, weakness, rash, abdominal pain, bronchitis, constipation, pharyngitis, liver damage, indigestion, flatulence etc Most may pause serious conditions that require that you call your doctor as soon as possible.
- Carbilev (carbidepo-levodopa): swelling agitation, anxiety, ataxia, confusion, daytime somnolence, decreased attention span, dyskinesia, dystonia, euphoria, insomnia, fainting, fatigue, increased trembling of hands, insouciance, malaise, memory loss, nightmares, nervousness, restlessness, trismus, vivid dreams, alopecia, hot flashes, increased or dark perspiration, skin eruptions etc.

The rule of thumb is this, just notice any abnormal (new) symptom after the initiation of the treatment. The chances of it related to the drug is likely. If the symptoms seem intolerable or you seem worried, just call your doctor immediately.

Hope this helps further and let me know if you have any other questions.
Dr. Nsah
Above answer was peer-reviewed by
Follow-up: Advised to take Pharmapress Verahexal, Ecotrin, Aspavor and Carbilev. Any side effects if taken together? 44 hours later
Thank you for the additional detail. I now have a better understanding of the situation.
Answered by Dr. Nsah Bernard 42 hours later
You are welcome and wish you both a better health.

Dr. Nsah
Above answer was peer-reviewed by
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