Bioprexum Plus Drug Interactions

Perindopril and Indapamide: Concomitant Use Not Recommended: Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors. Concomitant use of thiazide diuretics may further increase lithium levels and enhance the risk of lithium toxicity with ACE inhibitors. Use of perindopril combined with indapamide with lithium is not recommended, but if the combination proves necessary, careful monitoring of serum lithium levels should be performed (see Precautions).
Concomitant Use which Requires Special Care: Baclofen: Potentiation of antihypertensive effect. Monitoring of blood pressure and renal function and antihypertensive dose-adaptation if necessary.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Including Acetylsalicylic Acid (ASA) at High Doses: When ACE inhibitors are administered simultaneously with NSAIDs (ie, ASA at anti-inflammatory dosage regimens, COX-2 inhibitors and nonselective NSAIDs), attenuation of the antihypertensive effect may occur. Concomitant use of ACE inhibitors and NSAIDs may lead to an increased risk of worsening of renal function, including possible acute renal failure and an increase in serum potassium, especially in patients with poor preexisting renal function. The combination should be administered with caution, especially in the elderly. Patients should be adequately hydrated and consideration should be given to monitoring renal function after initiation of concomitant therapy and periodically thereafter.
Concomitant Use which Requires Some Care: Imipramine-Like Antidepressants (Tricyclics), Neuroleptics: Increased antihypertensive effect and risk of orthostatic hypotension (additive effect).
Corticosteroids, Tetracosactide: Reduction in antihypertensive effect (salt and water retention due to corticosteroids).
Other Antihypertensive Agents: Use of other antihypertensive medicinal products with perindopril/indapamide could result in additional blood pressure lowering effect.
Perindopril: Concomitant Use Not Recommended: Potassium-Sparing Diuretics (Spironolactone, Triamterene, Alone or In Combination), Potassium (Salts): Angiotensin-converting enzymes inhibitors attenuate diuretic-induced potassium loss. Potassium-sparing diuretics eg, spironolactone, triamterene or amiloride, potassium supplements or potassium-containing salt substitutes may lead to significant increases in serum potassium (potentially lethal). If concomitant use is indicated because of documented hypokalaemia they should be used with caution and with frequent monitoring of serum potassium and by electrocardiogram (ECG).
Concomitant Use which Requires Special Care: Antidiabetic Agents (Insulin, Hypoglycemic Sulphonamides): Reported with captopril and enalapril.
The use of ACE inhibitors may increase the hypoglycemic effect in diabetics receiving treatment with insulin or with hypoglycaemic sulphonamides. The onset of hypoglycaemic episodes is very rare (improvement in glucose tolerance with a resulting reduction in insulin requirements).
Concomitant Use which Requires Some Care: Allopurinol, Cytostatic or Immunosuppressive Agents, Systemic Corticosteroids or Procainamide: Concomitant administration with ACE inhibitors may lead to an increased risk for leukopenia.
Anaesthetic Drugs: Angiotensin-converting enzymes inhibitors may enhance the hypotensive effects of certain anaesthetic drugs.
Diuretics (Thiazide or Loop Diuretics): Prior treatment with high-dose diuretics may result in volume depletion and in a risk of hypotension when initiating therapy with perindopril.
Gold: Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy including perindopril.
Indapamide: Concomitant Use which Requires Special Care: Torsade de Pointes-Inducing Drugs: Due to the risk of hypokalaemia, indapamide should be administered with caution when associated with medicinal products that induce Torsade de pointes eg, class IA antiarrhythmic agents (quinidine, hydroquinidine, disopyramide); class III antiarrhythmic agents (amiodarone, dofetilide, ibutilide, bretylium, sotalol); some neuroleptics (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), other neuroleptics (pimozide); other substances such as bepridil, cisapride, diphemanil, IV erythromycin, halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, vincamine IV, methadone, astemizole, terfenadine. Prevention of low potassium levels and correction if necessary by monitoring of the QT interval.
Potassium-Lowering Drugs: Amphotericin B (IV route), glucocorticoids and mineralocorticoids (systemic route), tetracosactide, stimulant laxatives cause increased risk of low potassium levels (additive effect). Monitoring of potassium levels and correction if necessary; particular consideration required in cases of treatment with cardiac glycosides. Nonstimulant laxatives should be used.
Cardiac Glycosides: Low potassium levels favor the toxic effects of cardiac glycosides. Potassium levels and ECG should be monitored and treatment reconsidered if necessary.
Concomitant Use which Requires Some Care: Metformin: Lactic acidosis due to metformin caused by possible functional renal insufficiency linked to diuretics and in particular to loop diuretics. Do not use metformin when plasma creatinine levels >15 mg/L (135 micromol/L) in men and 12 mg/L (110 micromol/L) in women.
Iodinated Contrast Media: In cases of dehydration caused by diuretics, there is an increased risk of acute renal insufficiency, particularly when high doses of iodinated contrast media are used. Rehydration should be carried out before the iodinated compound is administered.
Calcium (Salts): Risk of increased levels of calcium due to reduced elimination of calcium in the urine.
Ciclosporin: Risk of increased creatinine levels with no change in circulating levels of ciclosporin, even when there is no salt and water depletion.