Renitec Drug Interactions

ANTIHYPERTENSIVE THERAPY: Additive effect may occur when RENITEC is used together with other antihypertensive therapy.
SERUM POTASSIUM: See also HYPERKALEMIA under PRECAUTIONS.
In clinical trials, serum potassium usually remained within normal limits. In hypertensive patients treated with RENITEC alone for up to 48 weeks, mean increases in serum potassium of approximately 0.2 mEq/L were observed. In patients treated with RENITEC plus a thiazide diuretic, the potassium-losing effect of the diuretic was attenuated usually by the effect of enalapril.
If RENITEC is given with a potassium-losing diuretic, diuretic-induced hypokalemia may be ameliorated.
Risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus, and concomitant use of potassium-sparing diuretics (e.g. spironolactone, eplerenone, triamterene or amiloride), potassium supplements, potassium-containing salt substitutes, or other drugs that may increase serum potassium (e.g., trimethoprim-containing products).
The use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or other drugs that may increase serum potassium, particularly in patients with impaired renal function, may lead to a significant increase in serum potassium.
If concomitant use of RENITEC and the previously-mentioned agents is deemed appropriate, they should be used with caution and with frequent monitoring of serum potassium.
ANTIDIABETICS: Epidemiological studies have suggested that concomitant administration of ACE inhibitors and antidiabetic medicines (insulins, oral hypoglycemic agents) may cause an increased blood-glucose-lowering effect with risk of hypoglycemia. This phenomenon appeared to be more likely to occur during the first weeks of combined treatment and in patients with renal impairment. In diabetic patients treated with oral antidiabetic agents or insulin, glycemic control should be closely monitored for hypoglycemia, especially during the first month of treatment with an ACE inhibitor.
SERUM LITHIUM: As with other drugs which eliminate sodium, lithium clearance may be reduced. Therefore, serum lithium levels should be monitored carefully if lithium salts are to be administered.
NON-STEROIDAL ANTI-IMFLAMMATORY DRUGS including SELECTIVE CYCLOOXGENASE-2 INHIBITORS: Non-steroidal anti-inflammatory drugs (NSAIDs) including selective cyclooxygenase-2 inhibitors (COX-2 inhibitors) may reduce the effect of diuretics and other antihypertensive drugs. Therefore, the antihypertensive effect of angiotensin II receptor antagonists or ACE inhibitors may be attenuated by NSAIDs including selective COX-2 inhibitors.
In some patients with compromised renal function (e.g., elderly patients or patients who are volume-depleted including those on diuretic therapy) who are being treated with non-steroidal anti-inflammatory drugs including selective cyclooxgenase-2 inhibitors, the co-administration of angiotensin II receptor antagonists or ACE inhibitors may result in a further deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Therefore, the combination should be administered with caution in patients with compromised renal function.
DUAL BLOCKADE OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM: Dual blockade of the renin-angiotensin-aldosterone system (RAAS) with angiotensin receptor blockers, ACE inhibitors, or direct renin inhibitors (such as aliskiren) is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Closely monitor blood pressure, renal function, and electrolytes in patients on RENITEC and other agents that affect the RAAS. Do not co-administer aliskiren with RENITEC in patients with diabetes. Avoid use of aliskiren with RENITEC in patients with renal impairment (GFR <60ml/min).
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 enalapril.
MAMMALIAN TARGET OF RAPAMYCIN (mTOR) INHIBITORS: Patients taking concomitant mTOR inhibitor (e.g., temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema (see PRECAUTIONS).
NEPRILYSIN INHIBITORS: Patients taking a concomitant neprilysin inhibitor (e.g., sacubitril) may be at increased risk for angioedema (see CONTRAINDICATIONS and PRECAUTIONS).