Drug Interaction Report

GENERALLY AVOID: Icatibant and angiotensin-converting enzyme (ACE) inhibitors may antagonize the pharmacological effects of one another. Icatibant is a competitive bradykinin B2 receptor antagonist. In contrast, ACE inhibitors enhance the levels of bradykinin, which is a vasodilator thought to be responsible for the characteristic symptoms of hereditary angioedema including localized swelling, inflammation, and pain. Following bradykinin challenge, intravenous administration of icatibant inhibited the development of bradykinin-induced hypotension, vasodilation, and reflex tachycardia in a dose- and time-dependent manner in healthy young subjects. Icatibant may, therefore, attenuate the antihypertensive effect of ACE inhibitors.

MANAGEMENT: Concomitant use of icatibant and ACE inhibitors should be avoided. Patients with hereditary angioedema (HAE) should generally not take ACE inhibitors because they may precipitate or exacerbate acute attacks of HAE.

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.