hydrochlorothiazide/triamterene

Monitor blood pressure, renal function, and electrolytes in patients on lisinopril and hydrochlorothiazide tablets and other agents that affect the RAS. Do not coadminister aliskiren with lisinopril and hydrochlorothiazide tablets in patients with diabetes. No meaningful clinically important pharmacokinetic interactions occurred when lisinopril was used concomitantly with propranolol, digoxin, or hydrochlorothiazide.

Mechanism: Both of these medicines can cause your body to lose too much water and salt, which can lead to dehydration or electrolyte imbalances.

What to do: Your doctor should monitor your blood pressure and salt levels closely to ensure they stay in a healthy range.

Dual Blockade of the Renin-Angiotensin System (RAS): Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or direct renin inhibitors (such as aliskiren) is associated with increased risk of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Do not coadminister aliskiren with lisinopril and hydrochlorothiazide tablets in patients with diabetes. Avoid use of aliskiren with PRINZIDE in patients with renal impairment (GFR <60 ml/min).

Mechanism: Using these two drugs together can put too much stress on your kidneys and cause your blood pressure to drop to unsafe levels.

What to do: Do not use these together if you have diabetes, and your doctor should check your kidney health if you use both.

Drug Interactions Lisinopril Hypotension - Patients on Diuretic Therapy: Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with lisinopril. The possibility of hypotensive effects with lisinopril can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with lisinopril. If it is necessary to continue the diuretic, initiate therapy with lisinopril at a dose of 5 mg daily, and provide close...

Mechanism: Taking these two types of blood pressure medicines together can cause your blood pressure to drop too low, especially when you first start. This can make you feel very dizzy or lightheaded.

What to do: Your doctor may start you on a lower dose of the new medicine to keep your blood pressure steady. Be sure to stand up slowly and tell your doctor if you feel faint.

The VA NEPHRON trial enrolled 1448 patients with type 2 diabetes, elevated urinary-albumin-to-creatinine ratio, and decreased estimated glomerular filtration rate (GFR 30 to 89.9 ml/min), randomized them to lisinopril or placebo on a background of losartan therapy and followed them for a median of 2.2 years. Patients receiving the combination of losartan and lisinopril did not obtain any additional benefit compared to monotherapy for the combined endpoint of decline in GFR, end state renal disease, or death, but experienced an increased incidence of hyperkalemia and acute kidney injury...

Mechanism: Both of these medicines can cause your body to hold onto too much potassium. Having high potassium levels can be dangerous for your heart and may lead to kidney problems.

What to do: Your doctor will need to monitor your potassium levels and kidney health with regular blood tests. Seek medical help if you feel muscle weakness or notice a change in your heartbeat.

Use of lisinopril with potassium-sparing diuretics (e.g., spironolactone, eplerenone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.

Mechanism: Both drugs stop the kidneys from getting rid of potassium. This can cause potassium to build up to unsafe levels in your blood.

What to do: Your doctor should monitor your blood potassium levels closely. You may need to avoid this combination or have your doses adjusted.