Compatibility «Losartan» and «Hydrochlorothiazide+Enalapril»

• Interactions Losartan with Hydrochlorothiazide+Enalapril

  • Dangerous interactions
    • ⓘ Double blockade of RAAS with ACE inhibitors, ARA II or aliskiren-containing drugs is contraindicated in patients with diabetes and/or renal insufficiency and is generally not recommended for other patients, since this has been associated with an increase in cases of severe hypotension, renal insufficiency and hyperkalemia.
    • ⓘ In some patients with impaired renal function (for example, elderly patients or patients with hypovolemia, receiving diuretics in pm) receiving NSAIDs, the combined use of ACE inhibitors or ARA II may lead to further deterioration of renal function.
    • ⓘ In elderly patients with a decrease in the volume of intercellular fluid (including those receiving diuretics) or with impaired renal function, the combined use of NSAIDs, including selective COX-2 inhibitors, with ARA II (including losartan) may lead to deterioration of renal function, including the possible development of acute renal failure.
    • ⓘ The simultaneous use of ARA II or diuretics and NSAIDs may cause an increased risk of deterioration of renal function, in pm acute renal failure and increased potassium content in blood plasma, especially in patients with initial renal impairment.
    • ⓘ Metformin should be used with caution due to the risk of lactic acidosis caused by possible functional renal failure associated with the use of hydrochlorothiazide.
    • ⓘ Diuretics reduce the renal clearance of lithium and significantly increase the risk of its toxic effects.
    • ⓘ It is recommended to avoid simultaneous use of hydrochlorothiazide with lithium preparations.
    • ⓘ In the case of high doses of salicylates, hydrochlorothiazide may enhance their toxic effect on the central nervous system.
    • ⓘ Hypokalemia or hypomagnesemia caused by thiazide diuretics may contribute to the development of arrhythmias induced by cardiac glycosides.
    • ⓘ In the case of dehydration caused by the use of diuretics, the risk of acute renal failure increases, especially when taking high doses of iodine preparations.
    • ⓘ 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 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.
    • ⓘ 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').
    • ⓘ Double blockade of RAAS with the use of ARA II, ACE inhibitors or aliskiren (renin inhibitor) is associated with an increased risk of arterial hypotension, syncope, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy.
    • ⓘ In some patients with impaired renal function (for example, in elderly patients or patients with dehydration, including those taking diuretics) receiving NSAID therapy (including 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.
  • Negative interactions
    • ⓘ Antihypertensive drugs.
    • ⓘ The combination of hydrochlorothiazide + enalapril may enhance the effect of other antihypertensive drugs (for example, guanethidine, methyldopa, beta-blockers, vasodilators, BCC, ARA II and direct renin inhibitors).
    • ⓘ The possibility of hypotensive effects when using enalapril can be minimized by discontinuing the diuretic or increasing salt intake before starting treatment with enalapril.
    • ⓘ Other antihypertensive agents.
    • ⓘ In the presence of ion exchange resins, the absorption of hydrochlorothiazide is impaired.
    • ⓘ Taking a single dose of colestyramine or colestipol leads to the binding of hydrochlorothiazide and a decrease in its absorption from the gastrointestinal tract by 85 and 43%, respectively.
    • ⓘ It may be necessary to adjust the dose of anti-gouty drugs, since hydrochlorothiazide can increase the concentration of uric acid in blood plasma.
    • ⓘ Concomitant use with thiazides may increase the incidence of hypersensitivity reactions to allopurinol.
    • ⓘ It is possible to increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and the rate of gastric emptying.
    • ⓘ Isolated cases of hemolytic anemia have been described in patients receiving hydrochlorothiazide and methyldopa at the same time.
    • ⓘ Thiazide diuretics can increase the calcium content in blood plasma by reducing the excretion of calcium by the kidneys.
    • ⓘ Hydrochlorothiazide can cause the development of electrolyte deficiency, especially hypokalemia.
    • ⓘ Other antihypertensive drugs.
    • ⓘ It may be necessary to adjust the dose of simultaneously prescribed antihypertensive drugs.
    • ⓘ The possibility of hypotensive effects when using enalapril can be minimized by stopping the diuretic or increasing salt intake before starting treatment with enalapril.
    • ⓘ Concomitant use of ACE inhibitors with angiotensin II receptor antagonists.
    • ⓘ (ARA II) is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
    • ⓘ Concomitant use of enalapril with potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), potassium preparations, potassium-containing salt substitutes and other drugs capable of increasing serum potassium content (including angiotensin II receptor antagonists, heparin, tacrolimus, cyclosporine; drugs containing co‑trimoxazole [trimethoprim + sulfamethoxazole]) can lead to a significant increase in the potassium content in blood plasma.
    • ⓘ When using enalapril simultaneously with other antihypertensive agents, especially with diuretics, an increased antihypertensive effect may be observed.
    • ⓘ NSAIDs, including selective COX‑2 inhibitors and acetylsalicylic acid in doses of 3 g/day and above, can reduce the antihypertensive effect of diuretics and other antihypertensive agents.
    • ⓘ As a result, the antihypertensive effect of ARA II antagonists or ACE inhibitors may be weakened when used concomitantly with NSAIDs, including selective COX inhibitors‑2.
    • ⓘ Blood pressure should be carefully monitored and, if necessary, the dose of antihypertensive drugs should be adjusted.
  • No interactions
    • ⓘ When taken simultaneously with thiazide diuretics, interaction with the following drugs may be observed.
  • Positive interactions
    • ⓘ Thiazide diuretics can inhibit the excretion of cytotoxic drugs through the kidneys and enhance their myelosuppressive effect.
  • Unclear interactions
    • ⓘ Hydrochlorothiazide.
    • ⓘ Treatment with thiazide diuretics may affect glucose tolerance.
    • ⓘ Due to the effect on calcium metabolism, thiazides can distort the results of tests to assess the function of the parathyroid glands.
    • ⓘ Losartan + Hydrochlorothiazide analgin and citramon are used together in 20 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.

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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: 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