Preterax Drug Interactions

Contra-indicated: Aliskiren (in diabetic or impaired renal patients), Extracorporeal treatments, Sacubitril/valsartan.
Not recommended: Aliskiren (in other patients), lithium, potassium-sparing diuretics, concomitant therapy with ACE inhibitor and angiotensin-receptor blocker, Estramustine, Co-trimoxazole (trimethoprim/sulfamethoxazole), potassium salts.
Special care: Baclofen, nonsteroidal anti-inflammatory medicinal products (including aspirin ≥3g/day), antidiabetic agents, torsades de pointes-inducing drugs, potassium-lowering drugs, non-potassium-sparing diuretics, potassium-sparing diuretics, digitalis preparation, Racecadotril, mTOR inhibitors (e.g. sirolimus, everolimus, temsirolimus) and allopurinol.
Some care: Imipramine-like antidepressants (tricyclics), neuroleptics, antihypertensive agents and vasodilatators, allopurinol, cytostatic or immunosuppressive agents, systemic corticosteroids or procainamide or tetracosactide, anesthetic drugs, gliptins, sympathomimetics, gold, metformin, iodinated contrast media, calcium (salts), ciclosporin, tacrolimus.
Combination Which Is Not Recommended: Lithium: An increase in lithium levels may produce signs of overdose, as occurs with a sodium-free diet (reduction in renal excretion of lithium). If the combination of an angiotensin-converting enzyme inhibitor and a potassium-sparing diuretic is unavoidable, strict monitoring of lithium levels and adjustment of the dose are necessary.
Combinations Which Require Special Care: Antidiabetic Agents (Insulin, Hypoglycaemic Sulphonamides): Reported with captopril and enalapril. The use of angiotensin-converting enzyme inhibitors may increase the hypoglycaemic 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).
Baclofen: Potentiation of antihypertensive effect. Monitoring of blood pressure and renal function and dose adaptation of the antihypertensive if necessary.
NSAID (systemic route), High-Dose Salicylates: Acute renal insufficiency in dehydrated patients (reduction in glomerular filtration). The patient should be well hydrated; renal function should be monitored at the start of treatment.
Combinations Which Require Some Care: Imipramine-like Antidepressants (Tricyclics), Neuroleptics: Increased antihypertensive effect and increased risk of orthostatic hypotension (additive effect).
Corticosteroids, Tetracosactide: Reduction in antihypertensive effect (salt and water retention due to corticosteroids).
Linked to Perindopril: Combinations Which Are Not Recommended: Potassium-Sparing Diuretics [Spironolactone, Triamterene, alone or in combination, Potassium (salts)]: Increased levels of potassium (potentially lethal), particularly in cases of renal insufficiency (addition of potassium-sparing effects). Potassium-raising agents should not be combined with angiotensin-converting enzyme inhibitors, except when potassium levels are low.
Preterax 2.5 mg: Anaesthetics: Angiotensin-converting enzyme inhibitors may enhance the hypotensive effects of certain anaesthetic drugs.
Allopurinol, Cytostatic or Immunosuppressant Agents, Corticosteroids (systemic route) or Procainamide: Concomitant administration with angiotensin-converting enzyme inhibitors may lead to an increased risk for leucopenia.
Antihypertensive Agents: Increase in the hypotensive effect of the angiotensin-converting enzyme inhibitors.
Linked to Indapamide: Combinations Which Are Not Recommended: Non-antiarrhythmic drugs which prolong the QT interval or cause Torsade de pointes (astemizole, bepridil, erythromycin IV, halofantrine, pentamidine, sultopride, terfenadine, vincamine): Torsade de pointes (low potassium levels is a risk, as are bradycardia and preexisting long QT interval).
Substance which do not have the unwanted effect of causing Torsade de pointes should be used in cases of low potassium levels.
Combinations Which Require Special Care: NSAID (systemic route), High-Dose Salicylates: Possible reduction in the antihypertensive effect of indapamide. Acute renal insufficiency in dehydrated patients (reduction in glomerular filtration).
Hydrate the patient; monitor renal function at the start of treatment.
Potassium-Lowering Drugs: Amphotericin B (IV route), glucocorticoids and mineralocorticoids (systemic route), tetracosactide, stimulant laxatives: 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. Non-stimulant laxatives should be used.
Cardiac Glycosides: Low potassium levels favour the toxic effects of cardiac glycosides. Potassium levels and ECG should be monitored and treatment reconsidered if necessary.
Combinations Which Require Some Care: Potassium-Sparing Diuretics (Amiloride, Spironolactone, Triamterene): The rational combination, which is useful for some patients, does not exclude the onset of low potassium levels or, particularly in patients with renal insufficiency or diabetes, raised potassium levels. Potassium levels and ECG should be monitored and treatment reconsidered if necessary.
Antiarrhythmic Drugs which Produce Torsade de Pointes: Class IA Antiarrhythmic Agents (Quinidine, Hydroquinone, Disopyramide), Amiodarone, Bretylium, Sotalol: Torsade de pointes (low potassium levels is a risk factor, as bradycardia and a preexisting long QT interval).
Prevention of low potassium levels and correction if necessary: Monitoring of the QT interval. Antiarrhythmics should not be administered in cases of Torsade de pointes (treat using pacing).
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 creatinine levels exceed 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.
Imipramine-like Antidepressants (Tricyclics), Neuroleptics: Increased antihypertensive effect and increased risk of orthostatic hypotension (additive effect).
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 circulation levels of ciclosporin, even when there is no salt and water depletion.
Corticosteroids, Tetracosactide (systemic route): Reduction in antihypertensive effect (salt and water retention due to corticosteroids).