Compatibility «Losartan» and «Perindopril arginine+Indapamide*»

• Interactions Losartan with Perindopril arginine+Indapamide*

  • Dangerous interactions
    • ⓘ 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 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.
    • ⓘ Some drugs or drugs of other pharmacological classes may increase the risk of hyperkalemia: aliskiren and aliskiren‑containing drugs, potassium salts, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists (ARA II), heparin, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim, drugs containing co-trimoxazole (trimethoprim + sulfamethoxazole).
    • ⓘ In patients with established 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.
    • ⓘ 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.
    • ⓘ 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.
    • ⓘ Diuretics reduce the renal clearance of lithium and significantly increase the risk of its toxic effects.
    • ⓘ 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.
  • Negative interactions
    • ⓘ Other antihypertensive agents.
    • ⓘ The possibility of hypotensive effects can be minimized by reducing the dose or canceling the diuretic, or increasing salt intake before starting treatment with perindopril.
    • ⓘ Double blockade (for example, with simultaneous use of an ACE inhibitor with ARA II) should be limited to individual cases with careful monitoring of renal function, potassium content and blood pressure.
    • ⓘ Concomitant use of ACE inhibitors with angiotensin II receptor antagonists.
    • ⓘ Antihypertensive and vasodilating agents.
    • ⓘ It enhances the antihypertensive effect of ACE inhibitors, blood pressure monitoring is required and, if necessary, dose adjustment of antihypertensive drugs.
    • ⓘ 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.
    • ⓘ Thiazide diuretics can increase the calcium content in blood plasma by reducing the excretion of calcium by the kidneys.
    • ⓘ The use of indapamide can sum up or potentiate the effect of other antihypertensive drugs.
    • ⓘ In limited controlled studies comparing the effects of indapamide in combination with other antihypertensive drugs with the effects of other antihypertensive drugs used as monotherapy, there were no noticeable changes in the nature or frequency of adverse reactions associated with combination therapy.
    • ⓘ Blood pressure should be monitored and, if necessary, the doses of antihypertensive drugs should be adjusted.
  • No interactions
    • ⓘ When taken simultaneously with thiazide diuretics, interaction with the following drugs may be observed.
  • Positive interactions
    • ⓘ The antihypertensive effect of perindopril may be enhanced when combined with other antihypertensive drugs, vasodilators, nitrates of short and prolonged action.
    • ⓘ Thiazide diuretics can inhibit the excretion of cytotoxic drugs through the kidneys and enhance their myelosuppressive effect.
  • Unclear interactions
    • ⓘ 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.

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