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. Atorvastatin & amlodipine: Not recommended: Bioavailability may be increased w/ grapefruit or grapefruit juice. Perindopril & amlodipine: Hypotensive effects may be increased w/ antihypertensive agents & vasodilators. Perindopril: May increase blood glucose-lowering effect of antidiabetic medicines eg, insulins, oral hypoglycaemic agents. Increased antihypertensive effect w/ baclofen. Antihypertensive effect may be attenuated w/ NSAIDs (eg, aspirin ≥3 g daily, COX-2 inhibitors & non-selective NSAIDs) & may be reduced w/ sympathomimetics. May increase risk of angioedema w/ racecadotril; mTOR inhibitors eg, sirolimus, everolimus, temsirolimus. Increased risk of angioedema w/ gliptins eg, linagliptin, saxagliptin, sitagliptin, vildagliptin. May further reduce BP w/ TCAs/antipsychotics/anesth. Nitritoid reactions w/ injectable gold (Na aurothiomalate). Contraindicated: Risk of hyperkalaemia, worsening renal function & increased CV morbidity & mortality w/ aliskiren in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m²). Increased risk of severe anaphylactoid reactions w/ extracorporeal treatments. May increase risk of angioedema w/ sacubitril/valsartan. Not recommended: Aliskiren. Higher frequency of hypotension, syncope, hyperkalaemia, & worsening renal function (including acute renal failure) w/ angiotensin-receptor blocker. Risk of increased adverse effects eg, angioneurotic oedema w/ estramustine. Reversible increased serum conc & toxicity of lithium. May increase risk of hyperkalaemia w/ co-trimoxazole. Hyperkalaemia w/ K-sparing diuretics (eg, triamterene, amiloride, eplerenone, spironolactone), K salts. Atorvastatin: Plasma conc may be increased w/ moderate CYP3A4 inhibitors (eg, erythromycin, diltiazem, verapamil & fluconazole) & may be reduced w/ inducers of cytochrome P450 3A (eg, rifampicin, St. John's wort). Increased steady-state digoxin conc. May increase risk of rhabdomyolysis w/ ezetimibe; fusidic acid; gemfibrozil/fibric acid derivatives. Increased systemic exposure w/ transport proteins eg, ciclosporine, letermovir. Decreased prothrombin time w/ warfarin. Myopathy has been reported w/ colchicine. Lowered plasma conc w/ colestipol. Increased plasma conc of norethindrone & ethinyl oestradiol. Contraindicated: Increased risk of myopathy w/ glecaprevir/pibrentasvir. Not recommended: Plasma conc may be increased & increased risk of myopathy w/ potent CYP3A4 inhibitors [eg, ciclosporine, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole, antivirals for HCV (eg, elbasvir/grazoprevir) & HIV PIs (eg, ritonavir, lopinavir, atazanavir, indinavir, darunavir)]; inhibitors of transport proteins; other medicinal products that may induce myopathy eg, fibric acid derivatives & ezetimibe. Amlodipine: Exposure may be increased by strong or moderate CYP3A4 inhibitors eg, PIs, azole antifungals, macrolides (eg, erythromycin or clarithromycin), verapamil or diltiazem. Increased risk of hypotension w/ clarithromycin. Plasma conc may vary w/ strong CYP3A4 inducers eg, rifampicin, Hypericum perforatum
. Risk of increased tacrolimus blood levels. May increase exposure of mTOR inhibitors. Not recommended: Lethal ventricular fibrillation & CV collapse associated w/ hyperkalemia w/ dantrolene infusion.