Hypace Drug Interactions

Agents Causing Renin Release: The antihypertensive effect of enalapril maleate (Hypace) is augmented by antihypertensive agents that cause renin release (e.g., diuretics).
Other Cardiovascular Agents: Concomitant use with beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine and prazosin shows no evidence of clinically significant adverse interactions.
Agents Increasing Serum Potassium: Enalapril maleate (Hypace) may attenuate potassium loss caused by thiazide-type diuretics. Risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus and concomitant use of potassium-sparing diuretics (e.g., spironolactone, eplerenone, triamterene, or amiloride), potassium supplements, potassium-containing salt substitutes, or other drugs that may increase serum potassium (e.g., trimethoprim-containing products).
Antidiabetics: Concomitant administration of ACEI and antidiabetic agents may cause an increased risk of hypoglycemia more likely to occur during the first weeks of combined treatment and in patients with renal impairment.
Serum Lithium: As with other drugs which eliminate sodium, lithium clearance may be reduced. Therefore, the serum lithium levels should be monitored carefully if lithium salts are to be administered.
Non-Steroidal Anti-Inflammatory Drugs including Selective Cyclooxygenase-2 Inhibitors: NSAIDs including selective cyclooxygenase-2 inhibitors (COX-2 inhibitors) may reduce the effect of diuretics and other antihypertensive drugs. Administer with caution in patients with compromised renal function (e.g., elderly patients or patients who are volume-depleted, including those on diuretic therapy).
Combination Use of ACE Inhibitors or Angiotensin Receptor Antagonists, Anti-inflammatory drugs and Thiazide Diuretics: The use of ACEI or ARB, NSAID or COX-2 inhibitor, and a thiazide diuretic at the same time increases the risk of renal impairment. This includes use in fixed-dose combination products containing more than one class of drug.
Dual Blockade of the Renin-Angiotensin-Aldosterone System: Dual blockade of the renin-angiotensin-aldosterone system (RAAS) with ARB, ACEI, or direct renin inhibitors (such as aliskiren) is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Do not co-administer aliskiren with enalapril maleate (Hypace) in patients with diabetes. Avoid use of aliskiren with enalapril maleate (Hypace) in patients with renal impairment (GFR <60 mL/min).
Gold: Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACEI therapy.
Mammalian Target of Rapamycin (mTOR) Inhibitors: Patients taking concomitant mTOR inhibitor (e.g., temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema.
Neprilysin Inhibitors: Patients taking a concomitant neprilysin inhibitor (e.g., sacubitril) may be at increased risk for angioedema.