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Drug Interactions between aurothioglucose and lisinopril

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

lisinopril aurothioglucose

Applies to: lisinopril and aurothioglucose

MONITOR: Concomitant ACE inhibitor therapy may potentiate the risk of nitritoid (vasomotor) reactions associated with injectable gold therapy. The mechanism of interaction is unknown, although investigators suggest that ACE inhibitors may unmask drug hypersensitivity reactions by preventing the breakdown of bradykinins. In one published case report, two patients with rheumatoid arthritis who had been treated with intramuscular sodium aurothiomalate for over 20 years without incident developed nitritoid reactions after they were started on ACE inhibitor therapy within the previous 15 months. The interaction was also suspected in several other reported cases. One patient experienced anaphylaxis and cardiac arrest after a gold injection. She had been on gold therapy for 16 months and lisinopril for 12 months. Two other cases occurred 1 to 4 weeks after starting ACE inhibitor therapy. The patients were switched to gold sodium aurothioglucose with no further problems. In general, nitritoid reactions can occur in approximately 5% of patients treated with gold. Most are transient and occur within a few minutes of drug administration within the first year of treatment. Serious sequelae including myocardial infarction have been reported.

MANAGEMENT: Patients on injectable gold therapy in combination with an ACE inhibitor should be monitored for symptoms of nitritoid reactions such as facial flushing, nausea, vomiting, and hypotension following an injection. Elderly patients in particular should be observed following treatment. Oxygen, intravenous fluids, epinephrine, steroids, and other supportive therapy may be necessary for treatment.

References

  1. (2002) "Product Information. Prinivil (lisinopril)." Merck & Co., Inc
  2. Nixon J, Pande I (2006) "Gold, nitritoid reactions and angiotensin-converting enzyme inhibitors." Rheumatology (Oxford), 45, p. 118-9

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Drug and food interactions

Moderate

lisinopril food

Applies to: lisinopril

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References

  1. (2002) "Product Information. Vasotec (enalapril)." Merck & Co., Inc
  2. Good CB, McDermott L (1995) "Diet and serum potassium in patients on ACE inhibitors." JAMA, 274, p. 538
  3. Ray K, Dorman S, Watson R (1999) "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens, 13, p. 717-20

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Moderate

lisinopril food

Applies to: lisinopril

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

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