Indications for VASERETIC:
Hypertension (not for initial therapy).
Switching from monotherapy with either component: start with Vaseretic 10/25 once daily, then adjust; max 20mg enalapril/day and 50mg HCTZ/day. Allow 2–3 weeks for titration of HCTZ component. Or, substitute for individually titrated components.
History of ACEI-associated or other angioedema. Anuria. Sulfonamide allergy. Concomitant neprilysin inhibitors (eg, sacubitril); do not administer lisinopril within 36hrs of switching to or from sacubitril/valsartan. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Severe renal impairment. Salt/volume depletion. Severe CHF. Ischemic disease. Cerebrovascular disease. Renal artery stenosis. Dialysis (esp. high-flux membrane). Surgery. Diabetes. Gout. Asthma. SLE. Acute myopia. Secondary angle-closure glaucoma. Postsympathectomy. Monitor WBCs in renal or collagen vascular disease. Discontinue if angioedema, laryngeal edema, jaundice, or marked elevations in hepatic enzymes develop. Monitor BP, electrolytes, and renal function. Black patients may have higher rate of angioedema than non-Black patients. Elderly. Neonates. Pregnancy, nursing mothers: not recommended.
ACE inhibitor + diuretic (thiazide).
See Contraindications. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). May cause hyperkalemia with K+-sparing diuretics, K+ supplements, or K+ -containing salt substitutes. Hypokalemia with corticosteroids, ACTH. May increase digitalis, lithium toxicity. Increased risk of angioedema with concomitant mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus) or neprilysin inhibitors. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Alcohol, CNS depressants may increase orthostatic hypotension. Adjust antidiabetic, antigout medications. Potentiates nondepolarizing muscle relaxants. Antagonizes norepinephrine. Potentiated by, and hypotension with diuretics, other antihypertensives. May be antagonized by, and renal toxicity potentiated by NSAIDs, including COX-2 inhibitors (monitor renal function periodically in elderly and/or volume-depleted). Decreased absorption with cholestyramine, colestipol resins. May interfere with parathyroid tests.
Cough, dizziness, headache, fatigue, myalgia, nausea, asthenia, orthostatic hypotension, diarrhea, angioedema, fluid or electrolyte imbalance, impotence, hyperuricemia, renal impairment, arrhythmias, increased cholesterol and triglycerides; hepatic failure (rare); HCTZ: increased risk for non-melanoma skin cancer.