Patients who consume substantial quantities of alcohol &/or have history of liver disease. Perform LFTs periodically especially on patients who develop signs or symptoms suggestive of hepatic dysfunction. Monitor patients who develop increased transaminase levels. Discontinue in patients who develop jaundice or marked elevations of hepatic enzymes. Myalgia, myositis & myopathy that may progress to rhabdomyolysis. Patients w/ pre-disposing factors for rhabdomyolysis (renal impairment; hypothyroidism; personal/familial history of hereditary muscular disorders; history of muscular toxicity w/ statin or fibrate; history of liver disease &/or where substantial quantities of alcohol are consumed; conditions where an increase in plasma levels may occur). Discontinue if creatinine kinase levels are significantly elevated (>5 times ULN); muscular symptoms are severe & cause daily discomfort even if the CK levels are elevated to ≤5 x ULN; CK levels (>10 x ULN) occur or rhabdomyolysis is diagnosed or suspected; ILD occurs. Closely monitor glycemic control during the 1st mth of therapy in diabetic patients treated w/ oral antidiabetic agents or insulin. Patients w/ severe heart failure (NYHA class III & IV) & CHF. Symptomatic hypotension in patients who have been vol-depleted (eg, diuretic therapy, dietary salt restriction, dialysis, diarrhea or vomiting) or w/ severe renin-dependent HTN; symptomatic heart failure w/ or w/o associated renal insufficiency. Aortic & mitral valve stenosis; recent kidney transplantation; bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Anaphylactoid reactions in patients dialysed w/ high flux membranes. Risk of angioedema in patients w/ history of angioedema unrelated to ACE inhibitor therapy. Anaphylactoid reactions during LDL apheresis w/ dextran sulphate; desensitization treatment (eg, hymenoptera venom). Risk of neutropenia/agranulocytosis, thrombocytopenia & anemia; extreme caution in patients w/ collagen vascular disease, immunosuppressant therapy, treatment w/ allopurinol or procainamide especially w/ pre-existing impaired renal function (periodic monitoring of WBC & report any sign of infection eg, sore throat, fever). Black patients. Cough. Discontinue 1 day prior to surgery. Risk of hyperkalemia in patients w/ renal insufficiency, worsening renal function, DM, dehydration, acute cardiac decompensation, metabolic acidosis & concomitant use of K-sparing diuretics (eg, spironolactone, eplerenone, triamterene, or amiloride), K supplements or K-containing salt substitutes; other drugs associated w/ increases in serum K (eg, heparin). Avoid concomitant use of ARBs in patients w/ diabetic nephropathy. Not recommended in patients w/ primary aldosteronism. Concomitant use w/ potent CYP3A4 inhibitors or transport proteins (eg, ciclosporine, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole, letermovir & HIV PIs including ritonavir, lopinavir, atazanavir, indinavir, darunavir, tipranavir/ritonavir); gemfibrozil & other fibric acid derivatives, antivirals for HCV (boceprevir, telaprevir, elbasvir/grazoprevir), erythromycin, niacin & ezetimibe; other NEP inhibitors eg, racecadotril; mTOR inhibitors (eg, sirolimus, everolimus, temsirolimus). Do not co-administer w/ systemic formulations of fusidic acid or w/in 7 days of stopping fusidic acid treatment. Combination w/ lithium or dual blockage of RAAs (through combined use of ACE inhibitors, ARBs or aliskiren) is not recommended. Galactose intolerance, glucose-galactose malabsorption or total lactase deficiency. May impair ability to drive or operate machinery. Severe hepatic impairment. Not suitable for moderate to severe renal impairment (<60 mL/min). Women of childbearing potential should use appropriate contraceptive measures during treatment. Contraindicated in pregnancy & lactation. Elderly >70 yr. Childn & adolescents.
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