Compatibility «Lisinopril» and «Hydrochlorothiazide+Losartan»

• Interactions Lisinopril with Hydrochlorothiazide+Losartan

  • Dangerous interactions
    • ⓘ There is evidence that the simultaneous use of ACE inhibitors, ARA II or aliskiren increases the risk of arterial hypotension, hyperkalemia and impaired renal function (including acute renal failure) when compared with the use of a single drug affecting RAAS.
    • ⓘ The use of a combination of hydrochlorothiazide + losartan in combination with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended for other patients (see 'Contraindications').
    • ⓘ There is evidence that the simultaneous use of ACE inhibitors, ARA II or aliskiren increases the risk of arterial hypotension, hyperkalemia and impaired renal function (including acute renal failure) compared with the use of a single drug that affects the RAAS.
    • ⓘ Concomitant use of losartan with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
    • ⓘ Starting lisinopril in patients taking diuretics may lead to an excessive decrease in blood pressure.
    • ⓘ In the elderly, patients with reduced BCC (in pm receiving diuretic therapy) or impaired renal function, the co-administration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including lisinopril, may lead to deterioration of renal function, including possible acute renal failure.
    • ⓘ 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.
    • ⓘ Double blockade of RAAS ARA II, ACE inhibitors or direct renin inhibitors (such as aliskiren) It is associated with an increased risk of hypotension, syncope, hyperkalemia and changes in renal function (including acute renal failure) compared to monotherapy.
    • ⓘ In patients treated with a combination of losartan and lisinopril, there were no additional advantages compared with monotherapy in relation to the combined endpoint of GFR reduction, end-stage renal failure or death, but there was an increased incidence of hyperkalemia and acute kidney damage compared with patients in the monotherapy group.
    • ⓘ In patients with atherosclerotic disease, heart failure or diabetes mellitus with target organ damage, simultaneous therapy with ACE inhibitor and ARA II is associated with a higher incidence of arterial hypotension, syncope, hyperkalemia and deterioration of renal function (including acute renal failure) compared with the use of only one drug that affects the RAAS.
    • ⓘ Concomitant use of ACE inhibitors with ARA II is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
    • ⓘ With simultaneous use of lisinopril with potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone), potassium preparations or potassium-containing substitutes for table salt and other drugs capable of increasing the potassium content in blood serum (including ARA II, heparin, tacrolimus, cyclosporine; preparations containing co-trimoxazole [trimethoprim + sulfamethoxazole]), the risk of hyperkalemia increases (especially in patients with impaired renal function).
    • ⓘ In some patients with impaired renal function (for example, in elderly patients or patients with dehydration) receiving NSAID therapy (in pm with selective COX-2 inhibitors), the simultaneous use of ACE inhibitors or ARA II may cause further deterioration of renal function, including the development of acute renal failure, and hyperkalemia.
    • ⓘ 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 with angiotensin receptor blockers, ACE inhibitors or aliskiren is associated with an increased risk of hypotension, syncope, hyperkalemia and changes in renal function (including acute renal failure) compared to monotherapy.
    • ⓘ Patients receiving losartan in combination with lisinopril did not have any additional advantages compared with monotherapy in relation to the combined endpoint of GFR reduction, end-stage renal failure or death, but among them there was an increased incidence of hyperkalemia and acute kidney injury compared with the monotherapy group.
  • Negative interactions
    • ⓘ Other antihypertensive agents.
    • ⓘ Other antihypertensive drugs.
    • ⓘ It may be necessary to adjust the dose of simultaneously prescribed antihypertensive drugs.
    • ⓘ It is recommended to stop taking hydrochlorothiazide 2-3 days before the start of therapy with ACE inhibitors to prevent the development of symptomatic arterial hypotension.
    • ⓘ Reversible increases in serum lithium concentrations have been reported with concomitant use of lithium preparations with ACE inhibitors, in very rare cases with ARA II.
    • ⓘ The possibility of hypotensive effects when taking lisinopril can be minimized by reducing or stopping the diuretic or increasing salt intake before starting treatment with lisinopril.
    • ⓘ Lisinopril attenuates potassium loss caused by thiazide-type diuretics.
    • ⓘ When used simultaneously with vasodilators, beta-blockers, BMCC, diuretics and other antihypertensive drugs, the severity of the antihypertensive effect of lisinopril increases.
    • ⓘ Blood pressure should be carefully monitored and, if necessary, the dose of antihypertensive drugs should be adjusted.
    • ⓘ Double blockade (for example, when combining an ACE inhibitor with ARA II) should be limited to individual cases with careful monitoring of renal function, potassium content and regular blood pressure monitoring.
    • ⓘ The VA NEPHRON-D study included 1,448 patients with type 2 diabetes, an increased ratio of albumin to creatinine in urine and a reduced calculated GFR (from 30 to 89.9 ml/min); they were randomized into groups receiving lisinopril or placebo on the background of losartan therapy, the follow-up lasted an average of 2.2 years.
  • Unclear interactions
    • ⓘ If this is not possible, then the initial dose of ACE inhibitors should be reduced.
    • ⓘ Diuretics.
    • ⓘ If it is necessary to continue taking a diuretic, the initial dose of lisinopril should be reduced.
    • ⓘ Lisinopril + Hydrochlorothiazide analgin and citramon are used together in 14 preparations.

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 of the drug.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

Video instruction

▶

Look at ▶Youtube

Additional information

• Kiberis checks interactions and evaluates drug compatibility for free online right in the instructions thanks to the latest artificial intelligence technologies. The accuracy of finding is more than 95%, the accuracy of the hazard assessment is more than 80%. The online medical service takes into account all the drug groups of the selected drugs and all their components. And since the database contains 25,000 drugs with detailed instructions, not every pharmacologist can compete with our artificial intelligence. List of popular interactions.
• Why do I need to
  • Avoid dangerous prescriptions for your patients.
  • Check the contraindications.
  • Evaluate the safety of therapy in the treatment of children.
  • See the compatibility of drugs with alcohol (enter it as a drug).
  • Point the doctor to the found interaction - you may need to adjust the therapy.
  • Do you need an API for interactions/drug analogues for your project? Write to us.
• 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: 169,994,378 possible combinations of drugs and their components were found 412,530 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2024-12-19

Category - medicine