Clinically Important Drug Interactions in Hypertension:

More presentations from Naina Mohamed Pakkir Maideen

Hypertension (High blood pressure) is a long term medical condition in which the force of the blood against artery walls is high.

©     Blood pressure is determined by Heart Rate (HR), Stroke Volume (SV) and Peripheral Vascular Resistance.

©    Common Antihypertensives include…

Ø Angiotensin converting enzyme inhibitors (ACEIs) (Captopril, Lisinopril, perindopril, etc)

Ø Angiotensin receptor blockers (ARBs) (Losartan, Valsartan, Telmisartan, etc)

Ø Direct Renin Inhibitors (DRIs) (Aliskiren)

Ø Calcium channel blockers (CCBs) (Nifedipine, Amlodipine, Nicardipine, etc)

Ø Diuretics (Frusemide, Thiazides, Spiranolactone, etc)

Ø Adrenergic Beta Blockers (Atenolol, Bisoprolol, Cervedilol, etc),

Ø Adrenergic Alpha Blockers (Prazosin, Terazosin, etc)

Ø Vasodilators (Nitrates, Hydralazine, Minoxidil, etc)

©    The patients with Hypertension may take one or more Antihypertensives along with other prescription and over-the-counter (OTC) medications, herbal products, vitamins and/or foods which may result adverse drug interactions.

©    The Antihypertensives which should not be combined (Contraindications) with other drugs include…

Ø ACEIs or ARBs + Aliskiren

Ø Felodipine or Nisoldipine + Ketoconazole or Itraconazole

Ø Verapamil + Dofetilide

Ø Verapamil or Diltiazem + Colchicine

Ø Diltiazem + Cisapride

Ø Nitrates + PDE 5 Inhibitors (Sildenafil, Tadalafil, Vardenafil, Avanafil)

Ø Nitrates + Riociguat

©    The combinations (Antihypertensives + Other drugs) which increase the risk of Hyperkalemia include…

Ø ACEIs or ARBs + Aliskiren

Ø ACEIs or ARBs + Potassium Sparing Diuretics

Ø ACEIs or ARBs + Trimethoprim

Ø ACEIs + Potassium Supplements

Ø ACEIs + Cyclosporine

Ø Potassium sparing diuretics  + Arginine

Ø Potassium sparing diuretics  + Trimethoprim

Ø Potassium sparing diuretics + Potassium supplements

©    The combinations (Antihypertensives + Other drugs) which increase the risk of Cardiotoxicity include…

Ø Felodipine or Nisoldipine  + Ketoconazole or Itraconazole

Ø Verapamil + Dofetilide

Ø Diltiazem + Cisapride

Ø Verapamil or Diltiazem + Macrolides

©    The combinations (Antihypertensives + Other drugs) which increase the risk of Hypotension include…

Ø ACEIs or ARBs + Aliskiren

Ø Nitrates + PDE 5 Inhibitors (Sildenafil, Tadalafil, Vardenafil, Avanafil)

Ø Nitrates + Riociguat

Ø ACEIs + ARBs

Ø Dihydropyridines + CYP3A4 Inhibitors

Ø Verapamil or Diltiazem & Beta Blockers

Ø Beta blockers + Antiarrhythmics  (Amiodarone, Dronedarone)

Ø Beta blockers + CCBs (Verapamil, Diltiazem)

Ø Alpha 1 blockers + PDE 5 Inhibitors (Sildenafil, Tadalafil)

©    Minimizing the risk for drug interactions should be a goal in drug therapy to reduce the occurrence of significant morbidity and mortality.

©    The patients with hypertension should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.