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Drug Interactions between eprosartan / hydrochlorothiazide and Lopurin

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

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Interactions between your drugs

Moderate

allopurinol hydroCHLOROthiazide

Applies to: Lopurin (allopurinol) and eprosartan / hydrochlorothiazide

MONITOR: Serious hypersensitivity reactions to allopurinol have been well-documented in the medical literature. Case reports have suggested that thiazide diuretics may increase the risk of allopurinol-induced hypersensitivity reactions, especially in patients with renal insufficiency. The mechanism is unknown and pharmacokinetic studies with hydrochlorothiazide have not demonstrated any effects on the disposition of allopurinol or oxipurinol (its major metabolite).

MANAGEMENT: Patients should be advised to promptly report any signs of hypersensitivity, including rash, pruritus, fever, or chills.

References

  1. Hande KR "Evaluation of a thiazide-allopurinol drug interaction." Am J Med Sci 292 (1986): 213-6
  2. Maschio G, Tessitore N, D'Angelo A, Fabris A, Pagano F, Tasca A, Graziani G, Aroldi A, Surian M, Colussi G, Mandressi A, Trinchieri ARocco F, Ponticel "Prevention of calcium nephrolithiasis with low-dose thiazide, amiloride and allopurinol." Am J Med 71 (1981): 623-6
  3. Mills RM "Severe hypersensitivity reactions associated with allopurinol." JAMA 216 (1971): 799-802
  4. Loffler W, Landthaler R, Devries JX, Waltersack I, Ittensohn A, Voss A, Zollner N "Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects." Clin Investig 72 (1994): 1071-5
  5. Devries JX, Voss A, Ittensohn A, Waltersack I, Loffler W, Landthaler R, Zollner N "Interaction of allopurinol and hydrochlorothiazide during prolonged oral administration of both drugs in normal subjects. 2. kinetics of allopurinol, oxipurinol, and hydrochlorothiazide." Clin Investig 72 (1994): 1076-81
View all 5 references

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Drug and food interactions

Moderate

eprosartan food

Applies to: eprosartan / hydrochlorothiazide

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co., Inc PROD (2001):
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals PROD (2001):

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Moderate

hydroCHLOROthiazide food

Applies to: eprosartan / hydrochlorothiazide

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 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.

See also

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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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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