Compatibility «Ramipril» and «Valsartan+Hydrochlorothiazide»

• Interactions Ramipril with Valsartan+Hydrochlorothiazide

  • Dangerous interactions
    • ⓘ Concomitant use of ARA II with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
    • ⓘ Simultaneous use of Ramipril-AKOS and ARA II is contraindicated in patients with diabetic nephropathy and is not recommended in other patients (see the section 'Contraindications', 'With caution', 'Special instructions').
    • ⓘ ACE inhibitors (C09A) + angiotensin ii receptor antagonists => Are associated with an increased risk of arterial hypotension, syncope, hyperkalemia and impaired renal function (in pm acute renal failure) compared with monotherapy.
    • ⓘ Double blockade of RAAS ARA II, ACE inhibitors or aliskiren is associated with an increased risk of hypotension, hyperkalemia and changes in renal function (including acute renal failure) compared to monotherapy.
    • ⓘ It should be used with caution with hypotensive drugs (their effect is potentiated, dose adjustment may be necessary), cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase the toxicity of digitalis), amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia), hypoglycemic oral medications (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effects of thiazides), non-depolarizing muscle relaxants (their effect may be enhanced), amantadine (clearance of amantadine may decrease with hydrochlorothiazide, which leads to an increase in plasma concentration of amantadine and possible toxicity), colestyramine (reduces absorption of hydrochlorothiazide), ethanol, barbiturates and narcotic analgesics, which enhance the effect of orthostatic hypotension.
  • Negative interactions
    • ⓘ With the simultaneous use of lithium preparations with ACE and ARA II inhibitors or thiazide diuretics, a reversible increase in the concentration of lithium in blood plasma and an associated increase in toxic manifestations were noted.
    • ⓘ Antihypertensive drugs.
    • ⓘ It is possible to enhance the antihypertensive effect when combined with other drugs that reduce blood pressure (ACE inhibitors, beta-blockers, BMCC, guanethidine, methyldopa, vasodilators, direct renin inhibitors, ARA II).
    • ⓘ Caution is required when combining ARA II, including valsartan, with other drugs that block RAAS, such as ACE inhibitors or aliskiren.
    • ⓘ When used concomitantly with ACE inhibitors and diuretics, cases of reversible increases in the plasma concentration of lithium and its toxic effects have been reported.
    • ⓘ Other antihypertensive drugs.
    • ⓘ The effects are enhanced by antihypertensive agents, including beta-blockers, in pm with significant systemic absorption from ophthalmic forms, diuretics, opioid analgesics, drugs for anesthesia, alcohol.
    • ⓘ The combined use of ACE inhibitors and a combination of ARA II and a neutral endopeptidase inhibitor (syn.
    • ⓘ If the patient needs these procedures, then other types of membranes should be used (in the case of plasmapheresis and hemofiltration) or the patient should be transferred to other groups of antihypertensive drugs.
    • ⓘ Concomitant use with angiotensin II receptor antagonists (ARA II).
    • ⓘ With potassium salts, potassium-sparing diuretics (for example, amiloride, spironolactone, triamterene, eplerenone (a derivative of spironolactone)), other drugs capable of increasing serum potassium (including ARA II, tacrolimus, cyclosporine; trimethoprim, sulfamethoxazole, which are part of co-trimoxazole (a combined antibacterial agent containing sulfamethoxazole and trimethoprim)).
    • ⓘ With antihypertensive drugs (for example, diuretics) and other drugs that reduce blood pressure (nitrates, tricyclic antidepressants, general and local anesthesia, baclofen, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin).
    • ⓘ Reduces secondary hyperaldosteronism and hypokalemia caused by diuretics.
    • ⓘ Potentiation of the antihypertensive effect; in relation to combination with diuretics, see also the sections 'Method of administration and doses', 'Side effect', 'Special instructions', when combined with diuretics, the sodium content in blood serum should be regularly monitored.
    • ⓘ It may be necessary to adjust the dose of simultaneously prescribed antihypertensive drugs.
  • Positive interactions
    • ⓘ Thiazide diuretics enhance the antihypertensive effect of other antihypertensive drugs (including guanethidine, methyldopa, beta-blockers, vasodilators, BMCC, ACE inhibitors, ARA II, renin inhibitors).
  • Unclear interactions
    • ⓘ Ramipril + Hydrochlorothiazide analgin and citramon are used together in 5 preparations.
    • ⓘ If this is not possible, then the initial dose of ACE inhibitors should be reduced.

Decoding the colors of interactions and contraindications

Dangerous	—	a pronounced negative interaction or contraindication.
Negative	—	negative interaction or side effect that may reduce effectiveness.
Positive	—	the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

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Additional information

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• The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
• The article is written: artificial intelligence Kiberis
• Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
• Total analyzed: 170,027,037 possible combinations of drugs and their components were found 412,563 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2026-01-01

Category - medicine