Higher frequency of adverse events w/ angiotensin II receptor-blockers or aliskiren. Increased risk of hyperkalaemia w/ aliskiren, K salts, K-sparing diuretics, ACE inhibitors, AIIA, NSAIDs, heparins, immunosuppressant agents (eg, ciclosporine or tacrolimus), trimethoprim. Increased antihypertensive effect & risk of orthostatic hypotension w/ imipramine-like antidepressants (eg, tricyclics), neuroleptics. Additive BP-lowering effect w/ other antihypertensive agents. Reduced antihypertensive effect w/ corticosteroids, tetracosactide. Contraindicated: Increased risk of hyperkalaemia, worsening renal function & increased CV morbidity & mortality w/ aliskiren in diabetic or impaired renal patients. Increased risk of severe anaphylactoid reactions w/ extracorporeal treatments. May increase risk of angioedema w/ sacubitril/valsartan. Perindopril & indapamide: Increased antihypertensive effect w/ baclofen. May attenuate antihypertensive effect w/ NSAIDs (ie, acetylsalicylic acid at anti-inflammatory dosage regimens, COX-2 inhibitors & non-selective NSAIDs). Not recommended: Reversible increased serum conc & toxicity of lithium. Perindopril: May increase blood glucose-lowering effect of antidiabetic agents eg, insulin, oral hypoglycaemic agents. Excessive reduction in BP w/ non-K-sparing diuretics. Risk of hyperkalaemia w/ K-sparing diuretics eg, eplerenone, spironolactone. May increase risk of angioedema w/ racecadotril; mTOR inhibitors eg, sirolimus, everolimus, temsirolimus. May further reduce BP w/ nitroglycerin & other nitrates. May increase risk of leucopenia w/ allopurinol, cytostatic or immunosuppressive agents, systemic corticosteroids or procainamide. May enhance hypotensive effects of certain anaesth. May result in vol depletion & risk of hypotension w/ high-dose thiazide or loop diuretics. Increased risk of angioedema w/ gliptins eg, linagliptine, saxagliptine, sitagliptine, vildagliptine. May reduce antihypertensive effects w/ sympathomimetics. Nitritoid reactions w/ injectable gold (Na aurothiomalate). Not recommended: Risk of increased adverse effects eg, angioneurotic oedema w/ estramustine. Hyperkalaemia w/ K-sparing drugs (eg, triamterene, amiloride), K salts. Increased risk of hyperkalaemia w/ co-trimoxazole. Indapamide: Risk of hypokalemia w/ torsades de pointes-inducing drugs eg, class IA (eg, quinidine, hydroquinidine, disopyramide) & III (eg, amiodarone, dofetilide, ibutilide, bretylium, sotalol) antiarrhythmic agents, neuroleptics (eg, chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine; pimozide), benzamides (eg, amisulpride, sulpiride, sultopride, tiapride), butyrophenones (eg, droperidol, haloperidol), others (eg, bepridil, cisapride, diphemanil, IV erythromycin, halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, IV vincamine, methadone, astemizole, terfenadine). Increased risk of low K levels w/ amphotericin B (IV), glucocorticoids & mineralocorticoids (systemic), tetracosactide, stimulant laxatives. Toxic effects due to low K levels may occur w/ cardiac glycosides. May increase incidence of hypersensitivity reactions to allopurinol. May increase exposure w/ strong or moderate CYP3A4 inhibitors eg, PIs, azole antifungals, macrolides (eg, erythromycin or clarithromycin), verapamil or diltiazem. Increased risk of hypotension w/ clarithromycin. Lactic acidosis w/ metformin caused by possible functional renal insufficiency linked to loop diuretics. Increased risk of acute renal insufficiency w/ high-dose iodinated contrast media. Risk of increased Ca levels w/ Ca salts. Risk of increased creatinine levels w/ ciclosporine. Amlodipine: Plasma conc may vary w/ strong CYP3A4 inducers (eg, rifampicin, Hypericum perforatum
). May increase exposure w/ strong or moderate CYP3A4 inducers (eg, PIs, azole antifungals, macrolides ie, erythromycin or clarithromycin, verapamil or diltiazem). Risk of increased tacrolimus blood levels. May increase exposure of mTOR inhibitors. Increased exposure to simvastatin. Not recommended: Lethal ventricular fibrillation & CV collapse associated w/ hyperkalemia w/ dantrolene infusion. Bioavailability may be increased w/ grapefruit or grapefruit juice.