Compatibility «Perindopril+Amlodipine» and «Hydrochlorothiazide»

• Interactions Perindopril+Amlodipine with Hydrochlorothiazide

  • Dangerous interactions
    • ⓘ Patients taking diuretics, especially those who have recently started treatment, may sometimes experience an excessive decrease in blood pressure after starting therapy with perindopril erbumin.
    • ⓘ The use of a diuretic may further increase the risk of lithium toxicity.
    • ⓘ In the elderly, patients with insufficient BCC (in pm receiving diuretic therapy) or with impaired renal function, the combined use of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including perindopril, may lead to deterioration of renal function, including possible acute renal failure.
    • ⓘ In patients receiving diuretics, especially with excessive excretion of fluid and / or electrolytes, at the beginning of perindopril therapy, an excessive decrease in blood pressure may be observed, the risk of which can be reduced by discontinuing the diuretic, replenishing fluid loss (intravenous infusion of 0.9% sodium chloride solution), as well as using perindopril in lower doses.
    • ⓘ When using diuretics in the case of CHF, an ACE inhibitor should be prescribed at a low dose, possibly after reducing the dose of a potassium-sparing diuretic used simultaneously.
    • ⓘ 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.
    • ⓘ Calcium channel blockers(C08) + Drugs that cause hypokalemia; Glucocorticosteroids (C03A, A01AB04,J02AA01,H02,D07 => Increases the likelihood of ventricular tachycardia and ventricular fibrillation. (A dangerous combination, it is necessary to eliminate hypokalemia before use).
  • Negative interactions
    • ⓘ Antihypertensive agents (e.g. beta-blockers) and vasodilators.
    • ⓘ In patients receiving diuretics, especially with excessive excretion of fluid and / or electrolytes, at the beginning of therapy with an ACE inhibitor, there may be a significant decrease in blood pressure, the risk of which can be reduced by discontinuing the diuretic, administering an increased amount of fluid and /or table salt, as well as prescribing perindopril at a low dose with a further gradual increase.
    • ⓘ 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.
    • ⓘ However, the bioavailability of perindoprilate was reduced by diuretics, which was associated with a decrease in ACE inhibition in plasma.
    • ⓘ In patients receiving diuretics that remove fluid and / or salts, at the beginning of Perindopril therapy, there may be a marked decrease in blood pressure, the risk of which can be reduced by discontinuing diuretics, replenishing the loss of fluid or salts before starting Perindopril therapy, as well as using Perindopril at a low dose with a further gradual increase.
    • ⓘ In hypertension in patients receiving diuretics, especially those that remove fluid and/or salts, diuretics should either be discontinued before the use of an ACE inhibitor (while a potassium-sparing diuretic may be prescribed again later), or an ACE inhibitor should be prescribed at a low dose with a further gradual increase.
    • ⓘ The additional use of thiazide diuretics against the background of the combined use of lithium preparations and ACE inhibitors increases the already existing risk of lithium intoxication.
    • ⓘ 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.
    • ⓘ Other antihypertensive drugs.
    • ⓘ It may be necessary to adjust the dose of simultaneously prescribed antihypertensive drugs.
    • ⓘ Other antihypertensive and antianginal drugs.
    • ⓘ Amlodipine can be safely used to treat hypertension together with thiazide diuretics, beta-blockers or ACE inhibitors.
  • No interactions
    • ⓘ Concomitant diuretics do not affect the rate and degree of absorption and excretion of perindopril.
  • Positive interactions
    • ⓘ The antihypertensive effect of perindopril may be enhanced when combined with other antihypertensive drugs, vasodilators, nitrates of short and prolonged action.
    • ⓘ It is possible to enhance the antianginal and antihypertensive effects of BMCC when combined with thiazide and loop diuretics, ACE inhibitors, beta-blockers and nitrates.
  • Unclear interactions
    • ⓘ Diuretics (thiazide and loop).
    • ⓘ Diuretics.
    • ⓘ Potassium-containing diuretics (eplerenone, spironolactone).
    • ⓘ Potassium-sparing diuretics.
    • ⓘ If this is not possible, then the initial dose of ACE inhibitors should be reduced.
    • ⓘ Amlodipine + Hydrochlorothiazide analgin and citramon are used together in Co-Exforge, Тритензин, Ko-Vamloset.

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