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Hydrochlorothiazide / lisinopril Disease Interactions

There are 17 disease interactions with hydrochlorothiazide / lisinopril:

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Angioedema

Severe Potential Hazard, Moderate plausibility

Applies to: Angioedema

Patients with a history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema while receiving an ACE inhibitor. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with ACE inhibitors should be discontinued permanently if angioedema develops in association with therapy.

References

  1. Seidman MD, Lewandowski CA, Sarpa JR, et al "Angioedema related to angiotensin-converting enzyme inhibitors." Otolaryngol Head Neck Surg 102 (1990): 727-31
  2. Gianos ME, Klaustermeyer WB, Kurohara M, et al "Enalapril induced angioedema." Am J Emerg Med 8 (1990): 124-6
  3. Chin HL, Buchan DA "Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor ." Ann Intern Med 112 (1990): 312-3
View all 34 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Bone Marrow Suppression

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts, Renal Dysfunction, Collagen Vascular Disease

ACE inhibitors may cause bone marrow suppression, rarely in uncomplicated individuals but more frequently in patients with renal impairment, especially if they also have a collagen-vascular disease such as systemic lupus erythematosus or scleroderma. Neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, eosinophilia and thrombocytopenia have been reported, mostly with captopril. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting blood dyscrasias or complications that may increase the risk of bone marrow depression during ACE inhibitor therapy. Monitoring of blood counts, particularly white blood cells, should be considered.

References

  1. Davies RO, Irvin JD, Kramsch PK, Walker JF, Moncloa F "Enalapril worldwide experience." Am J Med 77 (1984): 23-35
  2. Knapp LE, Frank GJ, McLain R, Rieger MM, Posvar E, Singer R "The safety and tolerability of quinapril." J Cardiovasc Pharmacol 15 (1990): s47-55
  3. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
View all 38 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Chf

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure

ACE inhibitors can cause marked renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic and sometimes excessive hypotension can occur in susceptible individuals, particularly during the initiation of treatment, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with ACE inhibitors may be associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia and death. Therapy with ACE inhibitors should be initiated under very close medical supervision in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. Patients should be monitored closely for several hours after an initial dose until blood pressure has stabilized, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased. If feasible, the risk of severe hypotension may be minimized by reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days prior to starting ACE inhibitor therapy. In patients who experience a worsening of renal function, discontinuation of ACE inhibitor therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with ACE inhibitors. After blood pressure stabilizes, therapy can usually be reinstated with caution, although a lower dosage of the ACE inhibitor and/or dosage reduction or discontinuation of concomitantly administered diuretics may be necessary.

References

  1. Moyses C, Higgins TJ "Safety of long-term use of lisinopril for congestive heart failure." Am J Cardiol 70 (1992): c91-7
  2. "Product Information. Altace (ramipril)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
View all 21 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Hemodialysis

Severe Potential Hazard, Moderate plausibility

Applies to: hemodialysis

Anaphylactoid reactions have been reported in patients undergoing hemodialysis with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor. The frequency and mechanism of this interaction have not been established, and it is not known whether the interaction occurs with other membrane types. Therapy with ACE inhibitors should be administered cautiously in patients requiring hemodialysis.

References

  1. "Product Information. Capoten (captopril)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
  3. "Product Information. Altace (ramipril)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 10 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Hyperkalemia

Severe Potential Hazard, High plausibility

Applies to: Hyperkalemia

In patients with hyperkalemia, especially that associated with impaired renal function or congestive heart failure, ACE inhibitors may further raise serum potassium levels. Therapy with ACE inhibitors should be administered cautiously in patients with or predisposed to hyperkalemia, and serum potassium levels should be carefully monitored. Risk factors for the development of hyperkalemia during ACE inhibitor therapy include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes.

References

  1. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company, Whippany, NJ.
  2. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  3. "Product Information. Vasotec (enalapril)." Merck & Co, Inc, West Point, PA.
View all 18 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Dehydration, hemodialysis, Hyponatremia, Ischemic Heart Disease, Diarrhea, Vomiting, Cerebrovascular Insufficiency

ACE inhibitors can cause symptomatic hypotension, most often during the initiation of therapy and in patients who are volume- and/or sodium-depleted or treated for congestive heart failure (CHF). Therapy with ACE inhibitors should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if it was recently instituted; those on dietary salt restriction; those with severe or prolonged diarrhea or vomiting; and renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with ACE inhibitors, and the patient should be hemodynamically stable. If concomitant diuretics and/or dietary sodium restriction are employed, reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days in advance can help minimize the risk of severe hypotension in patients who are able to tolerate such adjustments. ACE inhibitors should also be used cautiously in patients in whom excessive hypotension may have serious consequences, such as patients with coronary or cerebrovascular insufficiency. Patients at risk for excessive hypotension should initiate ACE inhibitor therapy under very close medical supervision, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased.

References

  1. "Product Information. Vasotec (enalapril)." Merck & Co, Inc, West Point, PA.
  2. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  3. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
View all 32 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Anuria

Severe Potential Hazard, High plausibility

Applies to: Anuria

The use of thiazide diuretics is contraindicated in patients with anuria.

References

  1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
View all 9 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Electrolyte Losses

Severe Potential Hazard, High plausibility

Applies to: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration

The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic.

References

  1. Peters RW, Hamilton J, Hamilton BP "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J 82 (1989): 966-9,
  2. Jorgensen FS, Brunner S "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  3. Medical Research Council Working Party on Mild to Moderate Hypertension. "Ventricular extrasystoles during thiazide treatment: substudy of MRC mild hypertension trial." Br Med J (Clin Res Ed) 287 (1983): 1249-53
View all 77 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Patients with severe liver disease or cirrhosis are very susceptible to thiazide-induced hypokalemic hypochloremic alkalosis. Blood ammonia concentrations may be further increased in patients with previously elevated concentrations. Hepatic encephalopathy and death have occurred secondary to the electrolyte alterations accompanying diuretic use. Therapy with thiazide diuretics should be administered cautiously in patients with impaired hepatic function or progressive liver disease, and discontinued promptly if signs of impending hepatic coma appear (e.g., tremors, confusion, and increased jaundice).

References

  1. Sherlock S, Senewiratne B, Scott A, Walker JG "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52
  2. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 12 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Lupus Erythematosus

Severe Potential Hazard, Moderate plausibility

Applies to: Lupus Erythematosus

The use of thiazide diuretics has been reported to possibly exacerbate or activate systemic lupus erythematosus. Reported cases have generally been associated with chlorothiazide and hydrochlorothiazide. Therapy with thiazide diuretics should be administered cautiously in patients with a history or risk of SLE.

References

  1. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  2. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 14 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Renal Function Disorders

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Thiazide diuretics may be ineffective when the glomerular filtration rate is low (GFR < 25 mL/min) because they are not expected to be filtered into the renal tubule, their site of action. In addition, thiazide diuretics decrease the GFR and may precipitate azotemia in renal disease. Cumulative effects may also develop because most of these drugs are excreted unchanged in the urine by glomerular filtration and active tubular secretion. Therapy with thiazide diuretics should be administered cautiously at reduced dosages in patients with renal impairment. If renal function becomes progressively worse, as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of thiazide therapy should be considered.

References

  1. Riess W, Dubach UC, Burckhardt D, Theobald W, Vuillard P, Zimmerli M "Pharmacokinetic studies with chlorthalidone (Hygroton) in man." Eur J Clin Pharmacol 12 (1977): 375-82
  2. Klunk LJ, Ringel S, Neiss ES "The disposition of 14C-indapamide in man." J Clin Pharmacol 23 (1983): 377-84
  3. el-Meheiry MM, Nabih AE, Soliman MD "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
View all 41 references

Ace Inhibitors (Includes Hydrochlorothiazide/lisinopril) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

With the exception of fosinopril, ACE inhibitors (and/or their active metabolites in some cases) are primarily eliminated by the kidney and may accumulate in patients with renal impairment. ACE inhibitors can also worsen renal function in some patients by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting renal dysfunction, particularly those with renovascular disease. Patients with moderate to severe renal impairment usually require lower or less frequent doses and smaller increments in dose. In addition, a dosage reduction or discontinuation of any concomitantly administered diuretics may be helpful. Fosinopril probably does not require dosage adjustments unless hepatic function is also significantly impaired.
<br />
<br />In patients with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, ACE inhibitors may reduce renal perfusion to a critically low level. Renal function should be monitored closely for the first few weeks of therapy.

References

  1. Champ JD "Case report: azotemia secondary to enalapril and diuretic use and the diagnosis of renovascular hypertension." Am J Med Sci 305 (1993): 25-7
  2. Forette B, Koen R, Vivaut E "Efficacy and safety of quinapril in the elderly hypertensive patient." Am Heart J 123 (1992): 1426-32
  3. "Moexipril: another ace inhibitor for hypertension." Med Lett Drugs Ther 37 (1995): 75-6
View all 32 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Abnormal Glucose Tolerance

Thiazide diuretics may cause hyperglycemia and glycosuria in patients with diabetes. They may also precipitate diabetes in prediabetic patients. These effects are usually reversible following discontinuation of the drugs. Therapy with thiazide diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during thiazide therapy, and their antidiabetic regimen adjusted accordingly.

References

  1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. Nielsen S, Schmitz A, Knudsen RE, Dollerup J, Mogensen CE "Enalapril versus bendroflumethiazide in type 2 diabetes complicated by hypertension." Q J Med 87 (1994): 747-54
  3. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2
View all 36 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

  1. Ames RP "A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides." Am J Cardiol 77 (1996): b12-6
  2. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  3. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
View all 23 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Hyperparathyroidism

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperparathyroidism

Urinary calcium excretion is decreased by thiazide diuretics during chronic administration. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported during prolonged therapy. However, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen. Clinicians should be cognizant of these effects when prescribing or administering thiazide therapy to patients with hyperparathyroidism. These drugs should be discontinued before carrying out tests for parathyroid function.

References

  1. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  2. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
View all 27 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Hyperuricemia

Moderate Potential Hazard, High plausibility

Applies to: Gout

Thiazide diuretics decrease the rate of uric acid excretion. Hyperuricemia occurs frequently but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with thiazide diuretics should be administered cautiously in such patients.

References

  1. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  2. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
View all 20 references

Thiazides (Includes Hydrochlorothiazide/lisinopril) ↔ Thyroid Function Tests

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

Thiazide diuretics may decrease serum PBI (protein-bound iodine) levels without associated thyroid disturbance. Clinicians should be cognizant of this effect when prescribing or administering thiazide therapy to patients with thyroid disorders.

References

  1. Bech K, Skovsted L, Siersbaek-Nielsen K, Hansen JM "Influence of thiazides on thyroid parameters in man." Acta Endocrinol (Copenh) 89 (1978): 673-8
  2. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  3. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 10 references

You should also know about...

hydrochlorothiazide / lisinopril drug Interactions

There are 862 drug interactions with hydrochlorothiazide / lisinopril

hydrochlorothiazide / lisinopril alcohol/food Interactions

There are 3 alcohol/food interactions with hydrochlorothiazide / lisinopril

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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