Benazepril with Canrenoate Interaction Details
Brand Names Associated with Benazepril
- Benazepril
- Lotensin®
- Lotrel® (as a combination product containing Benazepril, Amlodipine)
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Hyperkalemia
Interaction Summary
Angiotensin-converting enzyme (ACE) inhibitors lower aldosterone levels and can cause potassium retention[1]. Concurrent use of potassium-sparing diuretics (spironolactone, canrenoate potassium, amiloride, triamterene) and an ACE inhibitor has been reported to increase serum potassium by 1 to 1.5 mEq/L when compared to either drug used alone [2][3]. This has occasionally resulted in significant arrhythmias and death [4][5].
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Although such increases are usually transient, monitor serum potassium levels for persistent elevations in patients on this combination, especially in patients with renal dysfunction or diabetes and the elderly. Severe arrhythmias and death have been reported from hyperkalemia with such combinations.
Mechanism Of Interaction
Increased potassium retention secondary to lowered aldosterone levels
Literature Reports
A) A study evaluated the safety of adding an ACE inhibitor (captopril) to a thiazide/potassium-sparing diuretic in 332 hypertensive patients whose blood pressure had not normalized with the diuretics alone. There was only one case of hyperkalemia (6 mmol/liter) and a very low incidence of hypotension (1.6%) [6].
B) The effect of adding spironolactone to an ACE inhibitor and a loop diuretic was evaluated in 214 patients with severe chronic congestive heart failure. Patients were randomized to one of five parallel treatment groups: placebo or spironolactone at a single daily dose of 12.5 mg, 25 mg, 50 mg, or 75 mg for 12 weeks. Hypokalemia (serum potassium less than 3.4 mmol/L) occurred in 10% of placebo-treated patients and in 0.5% of the spironolactone group. The incidence of hyperkalemia (serum potassium greater than or equal to 5.5 mmol/L) was 5% for the placebo group, whereas it was 5%, 13%, 20%, and 24% for the 12.5-, 25-, 50- and 75-mg spironolactone treatment groups, respectively. Predictors of hyperkalemia included the use of ACE inhibitors other than captopril, ACE inhibitor dose, and baseline elevation of serum creatinine or potassium levels. The authors concluded that daily doses of 12.5 mg to 25 mg of spironolactone coadministered with conventional therapy of ACE inhibitors, loop diuretics, and digitalis are relatively safe, provided that serum potassium levels are monitored [7].
References
1 ) Product Information: Prinivil(R), lisinopril. Merck & Co., Inc., Whitehouse Station, NJ, 2003.
2 ) Armayor GM & Lopez LM: Lisinopril: a new angiotensin-converting enzyme inhibitor. Drug Intell Clin Pharm 1988; 22:365-372.
3 ) Burnakis TG & Mioduch HJ: Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984; 144:2371-2372.
4 ) Lakhani M: Complete heart block induced by hyperkalemia associated with treatment with a combination of captopril and spironolactone (letter). Br Med J 1986; 293:271.
5 ) Johnston RT, de Bono DP, & Nyman CR: Preventable sudden death in patients receiving angiotensin converting enzyme inhibitors and loop/potassium sparing diuretic combinations. Int J Cardiol 1992; 34:213-215.
6 ) Schohn DC, Spiesser R, Wehrlen M, et al: Aldactazine/captopril combination, safe and effective in mild to moderate systemic hypertension: report on a multicenter study of 967 patients. Am J Cardiol 1990; 65:4K-6K.
7 ) Anon: Effectiveness of spironolactone added to an angiotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure (The Randomized Aldactone Evaluation Study (RALES)). Am J Cardiol 1996; 78:902-907.
Benazepril Overview
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Benazepril is used alone or in combination with other medications to treat high blood pressure. Benazepril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly.
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High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
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