Hypotension, hyperkalemia & decreased renal function (including acute renal failure) w/ dual blockade of the RAAS through combined use of ACE inhibitors, angiotensin II receptor blockers, or aliskiren. Increased risk of angioedema w/ sacubitril/valsartan, racecadotril, mTOR inhibitors (eg, sirolimus, everolimus, temsirolimus) & gliptins (eg, linagliptin, saxagliptin, sitagliptin, vildagliptin); estramustine. Increase occurrence of hyperkalemia w/ aliskiren, K salts, K-sparing diuretics (eg, triamterene, amiloride, eplerenone, spironolactone), dantrolene (infusion), ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparins, immunosuppressant agents (eg, ciclosporin or tacrolimus), trimethoprim & co-trimoxazole; heparin. Risk of hyperkalemia, worsening of renal function & CV morbidity & mortality w/ aliskiren in diabetic or impaired renal patients. Increased risk of severe anaphylactoid reactions w/ extracorporeal treatments. Reversible increases in serum lithium conc & toxicity. Increased blood-glucose lowering effect w/ risk of hypoglycemia w/ antidiabetic agents (insulins, oral hypoglycemic agents). Increased antihypertensive effect w/ baclofen. Excessive reduction in BP w/ non-K-sparing diuretics. Attenuation of antihypertensive effect & increased risk of worsening of renal function w/ NSAIDs including aspirin ≥3 g/day (eg, acetylsalicylic acid at anti-inflammatory dosage regimens, COX-2 inhibitors & non-selective NSAIDs). May increase hypotensive effects w/ antihypertensive agents (eg, β-blockers) & vasodilators. Reduced BP w/ nitroglycerine & other nitrates or other vasodilators; certain anesth medicinal products, TCAs, antipsychotics. Reduced antihypertensive effects w/ sympathomimetics, corticosteroids, tetracosactide. Increased antihypertensive effect & risk of orthostatic hypotension w/ α-blockers (prazosin, alfuzosin, doxazosin, tamsulosin, terazosin). Nitritoid reactions w/ inj gold (Na aurothiomalate). Increased bioavailability w/ grapefruit or grapefruit juice. Amlodipine: Plasma conc may vary w/ strong CYP3A4 inducers (eg, rifampicin, Hypericum perforatum
). Increased exposure w/ strong or moderate CYP3A4 inhibitors (PIs, azole antifungals, macrolides eg, erythromycin or clarithromycin, verapamil or diltiazem). Increased risk of hypotension w/ clarithromycin. Potentiated antihypertensive effect w/ amifostine. Increased risk of tacrolimus blood levels. May increase exposure of mTOR inhibitors (eg, sirolimus, temsirolimus & everolimus).