Patients on diuretics, especially those in whom diuretic therapy was recently instituted, may
occasionally experience an excessive reduction of blood pressure after initiation of therapy with Lotensin. The
possibility of hypotensive effects with Lotensin can be minimized by either discontinuing the diuretic or increasing
the salt intake prior to initiation of treatment with Lotensin. If this is not possible, the starting dose should be
Potassium Supplements and Potassium-Sparing Diuretics
Lotensin can attenuate potassium loss caused by thiazide diuretics. Potassium-sparing diuretics
(spironolactone, amiloride, triamterene, and others) or potassium supplements can increase the risk of hyperkalemia.
Therefore, if concomitant use of such agents is indicated, they should be given with caution, and the patient’s
serum potassium should be monitored frequently.
Interaction studies with warfarin and acenocoumarol failed to identify any clinically important
effects on the serum concentrations or clinical effects of these anticoagulants.
Increased serum lithium levels and symptoms of lithium toxicity have been reported in patients
receiving ACE inhibitors during therapy with lithium. These drugs should be coadministered with caution, and frequent
monitoring of serum lithium levels is recommended. If a diuretic is also used, the risk of lithium toxicity may be
No clinically important pharmacokinetic interactions occurred when Lotensin was administered
concomitantly with hydrochlorothiazide, chlorthalidone, furosemide, digoxin, propranolol, atenolol, naproxen, or
Lotensin has been used concomitantly with beta-adrenergic-blocking agents, calcium-channel-blocking
agents, diuretics, digoxin, and hydralazine, without evidence of clinically important adverse interactions.
Cibacen, like other ACE inhibitors, has had less than additive effects with beta-adrenergic blockers, presumably
because both drugs lower blood pressure by inhibiting parts of the renin-angiotensin system.