Hydrochlorothiazide with Spirapril Interaction Details

Brand Names Associated with Hydrochlorothiazide

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 08, 2023

Interaction Effect

Reduction of blood pressure

Interaction Summary

In patients on diuretic therapy, initiation of ACE inhibitor therapy may cause excessive reduction of blood pressure. Severe postural hypotension has been reported when ACE inhibitors are added to diuretic therapy. Although this problem has been more commonly observed with loop diuretics, first dose hypotension is common in patients with sodium depletion or hypovolemia due to diuretics or sodium restriction. This hypotensive response is usually transient . Before starting ACE inhibitor therapy, decreasing or discontinuing the diuretic or increasing salt intake may minimize the risk of hypotensive effects. If these measures are not possible, reduce the ACE inhibitor starting dose .

Severity

Moderate

Onset

Rapid

Evidence

Theoretical

How To Manage Interaction

In patients on diuretic therapy, initiation of ACE inhibitor therapy may cause excessive reduction of blood pressure. Before starting ACE inhibitor therapy, decreasing or discontinuing the diuretic or increasing salt intake may minimize the risk of hypotensive effects. If these measures are not possible, reduce the ACE inhibitor starting dose.

Mechanism Of Interaction

Vasodilation and relative intravascular volume depletion

Literature Reports

A) In a randomized crossover study (N=19), concomitant hydrochlorothiazide and enalapril administration in older patients (62 to 84 years) showed that the pharmacokinetics of enalapril were relatively unaffected by hydrochlorothiazide, but a there was a significant increase in AUC (0 to 24 hours) and a significant reduction in renal clearance of enalaprilat .

B) A minor reduction in peak serum levels of perindoprilat, and a decrease in the fraction of the perindopril dose excreted as perindoprilat in the urine, has been reported with concomitant administration of perindopril and hydrochlorothiazide .

Hydrochlorothiazide Overview

• Hydrochlorothiazide is used alone or in combination with other medications to treat high blood pressure. Hydrochlorothiazide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease and to treat edema caused by using certain medications including estrogen and corticosteroids. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

• High blood pressure is a common condition and when not treated, 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.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.