Karbis Special Precautions

Advise the patient to talk to the doctor or pharmacist before taking Karbis: if the patient has heart, liver or kidney problems, or is on dialysis; if the patient has recently had a kidney transplant; if the patient is vomiting, has recently had severe vomiting, or has diarrhoea; if the patient has a disease of the adrenal gland called Conn's syndrome (also called primary hyperaldosteronism); if the patient has low blood pressure; if the patient has ever had a stroke.
Dual blockade of the renin-angiotensin-aldosterone system (RAAS): there is evidence that the concomitant use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of hypotension, hyperkalaemia and decreased renal function (including acute renal failure). Dual blockade of RAAS through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is therefore not recommended.
If dual blockade therapy is considered absolutely necessary, this should only occur under specialist supervision and subject to frequent close monitoring of renal function, electrolytes and blood pressure. ACE-inhibitors and angiotensin II receptor blockers should not be used concomitantly in patients with diabetic nephropathy.
If the patient is taking any of the following medicines used to treat high blood pressure: an ACE-inhibitor (for example enalapril, lisinopril, ramipril), in particular if patient has diabetes related kidney problems; Aliskiren.
If the patient is taking an ACE-inhibitor together with a medicine which belongs to the class of medicines known as mineralocorticoid receptors antagonists (MRA). These medicines are for the treatment of heart failure (see Interactions).
Kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in the blood may be checked at regular intervals.
See also information under Contraindications.
The doctor may want to see the patient more often and do some tests if the patient has any of these conditions.
If the patient is going to have an operation, advise the patient to inform the doctor or dentist about taking Karbis. This is because Karbis, when combined with some anaesthetics, may cause a drop in blood pressure.
Karbis contains lactose and sodium: Karbis contains lactose. If the patient has been told by the doctor that he/she has an intolerance to some sugars, advise the patient to contact the doctor before taking this product.
This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium free'.
Driving and using machines: Some people may feel tired or dizzy when taking Karbis. If this happens, advise the patient not to drive or use any tools or machines.
Use in Children: Karbis has been studied in children. Advise patient for more information. Karbis must not be given to children under 1 year of age due to the potential risk to the developing kidneys.
Use in Pregnancy & Lactation: See USE IN PREGNANCY & LACTATION section for further information.