Altace

[Ramipril]

With diuretics:

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 ALTACE. The possibility of hypotensive effects with ALTACE can be minimized by either discontinuing the diuretic or increas-ing the salt intake prior to initiation of treatment with ALTACE. If this is not possible, the starting dose should be reduced. (See DOSAGE AND ADMINISTRATION.)

With potassium supplements and potassium-sparing diuretics:

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ALTACE 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.

With lithium:

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 cau-tion, and frequent monitoring of serum lithium levels is recommended. If a diuretic is also used, the risk of lithium toxicity may be increased.

With Oral Hypoglycemic Agents or Insulin:

Rarely, hypoglycemia has been reported during concomitant therapy. Upon initiation of ALTACE or with an increase in dose, such patients should be closely monitored for symptoms of hypoglycemic reactions with dosage adjustment of concomitant oral hypoglycemic agents or insulin therapy as necessary.

Other:

Neither ALTACE nor its metabolites have been found to interact with food, digoxin, antacid, furosemide, cimetidine, indomethacin, and simvastatin. The combination of ALTACE and propranolol showed no adverse effects on dynamic parameters (blood pressure and heart rate). The co-administration of ALTACE and warfarin did not adversely affect the anticoagulant effects of the latter drug. Additionally, co-administration of ALTACE with phenprocoumon did not affect minimum phenprocoumon levels or interfere with the subjects' state of anti-coagulation.

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