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Inadvisable combinations: The combination of perindopril with potassium supplements or potassium-sparing diuretics may induced hyperkalemia in particular in renal failure. Converting enzyme inhibitors must not be combined with hyperkalemia drugs except in the case of hypokalemia.
If this combination is nevertheless required, it must be prescribed with care and in particular with frequent monitoring of the blood potassium levels.
Combinations justifying a warning: In certain patients already receiving a diuretic drug, and in particular if this treatment was instituted recently, there may be a severe initial fall in blood pressure at the start of perindopril treatment.
The risk of symptomatic hypotension may be reduced by withdrawing the diuretic several days before institution of perindopril therapy.
Combinations to be taken into account: As with all antihypertensive drugs, combination with a neuroleptic or a tricyclic antidepressant increases the risk of orthostatic hypotension.
