Aliskiren, extracorporeal treatments, sacubitril/valsartan; ACE inhibitor & angiotensin-receptor blocker, estramustine, co-trimoxazole (trimethoprim/sulfamethoxazole); antidiabetic agents, K-lowering drugs, non-K-sparing diuretics; racecadotril, mTOR inhibitors (eg, sirolimus, everolimus, temsirolimus); vasodilators, gliptins, sympathomimetics, gold, ciclosporin, tacrolimus. Increased lithium levels may produce signs of overdose, as occurs w/ Na-free diet. May increase hypoglycaemic effect in diabetics treated w/ insulin or hypoglycaemic sulphonamides. Potentiated antihypertensive effect w/ baclofen. Possible reduced antihypertensive effect & acute renal insufficiency in dehydrated patients w/ NSAID (systemic route), high-dose salicylates (aspirin ≥3 g daily). Increased antihypertensive effect & risk of orthostatic hypotension (additive effect) w/ TCAs, neuroleptics. Reduced antihypertensive effect w/ corticosteroids (salt & water retention) & tetracosactide. Perindopril:
Increased K levels (potentially lethal), particularly in cases of renal insufficiency (additive K-sparing effects) w/ spironolactone, triamterene (alone or in combination), K salts. 2.5 mg/0.625 mg:
May enhance hypotensive effects of certain anaesths. May lead to increased risk for leucopenia w/ allopurinol, cytostatic or immunosuppressant agents, corticosteroids (systemic route) or procainamide. Increased hypotensive effect w/ other antihypertensive agents. Indapamide:
Torsade de pointes (low K levels is a risk, as are bradycardia & preexisting long QT interval) w/ non-antiarrhythmic drugs prolonging QT interval or cause Torsade de pointes (astemizole, bepridil, erythromycin IV, halofantrine, pentamidine, sultopride, terfenadine, vincamine). Increased risk of low K levels (additive effect) w/ amphotericin B (IV route), glucocorticoids & mineralocorticoids (systemic route), tetracosactide, stimulant laxatives. Favoured cardiac glycoside toxic effects w/ low K levels. K-sparing diuretics (amiloride, spironolactone, triamterene) particularly in patients w/ renal insufficiency or diabetes. Torsade de pointes-producing antiarrhythmic drugs ie, class IA antiarrhythmic agents (quinidine, hydroquinone, disopyramide), amiodarone, bretylium, sotalol. Lactic acidosis possibly caused by renal insufficiency w/ metformin. Increased risk of acute renal insufficiency in case of dehydration caused by diuretics in high doses of iodinated contrast media. Increased Ca levels w/ Ca salts. Special care requiring: Allopurinol.