Compatibility «Telmisartan» and «Indapamide+Perindopril»

• Interactions Telmisartan with Indapamide+Perindopril

  • Dangerous interactions
    • ⓘ Clinical research data show that double blockade of the RAAS as a result of the combined use of ACE inhibitors, ARA II or aliskiren leads to an increase in the incidence of adverse events such as arterial hypotension, hyperkalemia and decreased renal function (including acute renal failure), compared with situations where only one drug acting on the RAAS is used (see sections 'Pharmacodynamics', 'Contraindications' and 'Special instructions').
    • ⓘ The use of ACE inhibitors in combination with angiotensin II receptor antagonists (ARA II) is contraindicated in patients with diabetic nephropathy (see the section 'Contraindications').
    • ⓘ Previous therapy with high-dose diuretics, including furosemide (a 'loop' diuretic), may lead to a decrease in BCC and an increased risk of arterial hypotension at the beginning of telmisartan therapy.
    • ⓘ With the simultaneous use of lithium preparations and ACE inhibitors or ARA II, including telmisartan, there was a reversible increase in the concentration of lithium in blood plasma, accompanied by toxic effects.
    • ⓘ Clinical studies have shown that double blockade of the renin-angiotensin-aldosterone system (RAAS) due to the combined use of ACE inhibitors, angiotensin II receptor blockers or aliskiren is associated with a higher frequency of adverse reactions such as hypotension, hyperkalemia and decreased renal function (including acute renal failure) compared with the use of a single agent acting on RAAS (see sections 'Contraindications', 'Special instructions' and 'Pharmacodynamics').
    • ⓘ 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.
  • Negative interactions
    • ⓘ Blood pressure should be monitored and, if necessary, doses of antihypertensive drugs should be adjusted.
    • ⓘ Some drugs or classes of drugs may increase the incidence of hyperkalemia: aliskiren, potassium salts, potassium‑sparing diuretics, ACE inhibitors, ARA II, NSAIDs, heparins, immunosuppressants (such as cyclosporine or tacrolimus), trimethoprim and drugs containing co-trimoxazole (sulfamethoxazole + trimethoprim).
    • ⓘ Co-therapy with ACE inhibitors and angiotensin receptor antagonists.
    • ⓘ If the patient needs extracorporeal therapy, the possibility of using another type of dialysis membrane or another class of antihypertensive drugs should be considered.
    • ⓘ Combination of therapy with ACE inhibitors and ARA II.
    • ⓘ The use of double blockade of the RAAS (for example, in the case of combined use of ACE inhibitors and ARA II) should be limited to isolated cases with strict control of renal function, potassium content in blood plasma and blood pressure (see section 'Special instructions').
    • ⓘ Antihypertensive agents and vasodilators.
    • ⓘ ARA II, such as telmisartan, reduces potassium loss caused by diuretics.
    • ⓘ Other antihypertensive agents.
    • ⓘ The effect of telmisartan on lowering blood pressure can be enhanced by simultaneous administration of other antihypertensive medications.
    • ⓘ Based on their pharmacological properties, it can be expected that the following drugs can enhance the antihypertensive effect of all antihypertensive agents, including telmisartan: baclofen, amifostin.
    • ⓘ 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.
    • ⓘ The risk may increase when combined with other medications that can also provoke hyperkalemia (salt substitutes containing potassium, potassium‑sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, nonsteroidal anti‑inflammatory drugs (NSAIDs, including selective COX-2 inhibitors), heparin, immunosuppressants (cyclosporine or tacrolimus) and co-trimoxazole (trimethoprim + sulfamethoxazole).
    • ⓘ Concomitant use with ACE inhibitors or NSAIDs, including selective COX‑2 inhibitors, is accompanied by a lower risk of hyperkalemia, provided careful observance of precautions.
    • ⓘ 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.
  • Positive interactions
    • ⓘ The antihypertensive effect of perindopril may be enhanced when combined with other antihypertensive drugs, vasodilators, nitrates of short and prolonged action.
  • Unclear interactions
    • ⓘ 'Loop' and thiazide diuretics.

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: 170,039,738 possible combinations of drugs and their components were found 412,575 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2026-05-28

Category - medicine