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| Interactions: | Allopurinol
Adverse Effect: hypersensitivity reactions (Stevens-Johnson syndrome, skin eruptions, anaphylactic coronary spasm) Clinical Management: If these drugs are used concurrently, monitor for hypersensitivity reactions.
Amiloride
Adverse Effect: hyperkalemia Clinical Management: Although such increases are usually transient, monitor serum potassium levels for persistent elevations in patients on this combination, especially in patients with renal dysfunction or diabetes and the elderly. Severe arrhythmias and death have been reported from hyperkalemia with such combinations.
Aspirin
Adverse Effect: decreased captopril effectiveness Clinical Management: Although studies have suggested an interaction between Enalapril and aspirin, the clinician should weigh the benefits against the risks of combining these two agents.
Bumetanide
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of the angiotensin converting enzyme (ACE) inhibitor in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Celecoxib
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Chlorthalidone
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of Enalapril in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Clomipramine
Adverse Effect: Clomipramine toxicity (confusion, insomnia, irritability) Clinical Management: Monitor for signs of clomipramine toxicity; lower doses may be required with concurrent therapy with enalapril.
Clopamide
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of Enalapril in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Cotrimoxazole
Adverse Effect: hyperkalemia Clinical Management: Avoid the concurrent use of Enalapril and Cotrimoxazole , especially in patients predisposed to renal dysfunction, or ensure careful monitoring of serum potassium. Substitution of an alternative antihypertensive agent during acute Cotrimoxazole use should be considered.
Diclofenac Preps.
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Erythropoietin
Adverse Effect: higher maintenance doses of erythropoietin to maintain the target hematocrit Clinical Management: Monitor patients receiving angiotensin converting enzyme inhibitors for erythropoietin efficacy. When given concomitantly, doses of erythropoietin may be higher than expected.
Flurbiprofen
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Frusemide
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of the angiotensin converting enzyme (ACE) inhibitor in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Ibuprofen
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Indapamide
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of the angiotensin converting enzyme (ACE) inhibitor in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Indomethacin
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Ketoprofen
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Ketorolac
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Lithium
Adverse Effect: Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicity Clinical Management: The combination of lithium and Enalapril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Enalapril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
Mefenamic Acid
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Meloxicam
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Metformin
Adverse Effect: Hyperkalemic lactic acidosis Clinical Management: Avoid metformin and enalapril in patients with renal insufficiency.
Nabumetone
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Naproxen
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Nimesulide
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Oxyphenbutazone
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Paracetamol
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Phenacetin
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Phenylbutazone
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Piroxicam
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Rifampicin
Adverse Effect: Decreased enalapril effectiveness Clinical Management: Monitor for continuing blood pressure control after the addition or withdrawal of rifampin, adjusting the enalapril dose to regain control. Substitution of an alternative ACE inhibitor or a different class of antihypertensive agent may be required for blood pressure control.
Spironolactone
Adverse Effect: hyperkalemia Clinical Management: Although such increases are usually transient, monitor serum potassium levels for persistent elevations in patients on this combination, especially in patients with renal dysfunction or diabetes and the elderly. Severe arrhythmias and death have been reported from hyperkalemia with such combinations.
Tenoxicam
Adverse Effect: Decreased antihypertensive and natriuretic effects Clinical Management: Caution should be used if a nonsteroidal antiinflammatory agent (NSAID) is to be coadministered with an angiotensin converting enzyme (ACE) inhibitor, especially in patients predisposed to or with preexisting nephropathy. Monitor blood pressure and cardiovascular function for a reduction in the efficacy of the ACE inhibitor. Also monitor patient for hyperkalemia or acute renal failure.
Xipamide
Adverse Effect: postural hypotension (first dose) Clinical Management: Start with a very low dose of the angiotensin converting enzyme (ACE) inhibitor in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments. |
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