Moexipril and hydrochlorothiazide (Uniretic) is a combination of an ACE-inhibitor and a thiazide diuretic that is used in the treatment of patients with hypertension.
Moexipril and hydrochlorothiazide (Uniretic) Uses:
-
Hypertension:
- It is used to manage hypertension.
Note: Not first-line drug, dose vary person to person, if a patient is not controlled by monotherapy or is currently being maintained on both medications independently, can be swapped for individual components.
Moexipril and hydrochlorothiazide (Uniretic) Dose in the treatment of Hypertension:
- Oral:
- Initial: In hypertensive patients receiving unsuccessful monotherapy, moexipril 7.5 mg/hydrochlorothiazide 12.5 mg, moexipril 15 mg/hydrochlorothiazide 12.5 mg, OR moexipril 15 mg/hydrochlorothiazide 25 mg should be used once daily.
- Titrate dosage based on clinical response;
- Dose range: moexipril 3.75 to 30 mg/hydrochlorothiazide 6.25 to 50 mg once daily
Uniretic use in Children:
Not indicated.
Uniretic Pregnancy Risk Factor D
-
- [US Boxed Warning]Drugs that affect the renin/angiotensin systems (RAAS) may cause injury or death for the developing fetus. Use caution with females of childbearing age and immediately stop if you are pregnant.
- You can also contact individual agents.
Use of hydrochlorothiazide and moexipril during breastfeeding
- No information is provided on the presence of moexipril in breastmilk.
- Thiazide diuretics are found in breast milk.
- Due to its adverse effects on nursing infants, it is best to stop drug administration and to breastfeed.
Moexipril and hydrochlorothiazide (Uniretic) Dose in Kidney Disease:
-
CrCl >40 mL/minute/1.73 m²:
- No dosage adjustment is needed
-
CrCl ≤40 mL/minute/1.73 m²:
- Not recommended. Also, see individual agents.
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer’s labeling; Use with caution as hepatic impairment increases systemic exposure.
Side effects of Moexipril and hydrochlorothiazide (Uniretic):
See individual agents (Moexipril and hydrochlorothiazide).
Contraindications to Moexipril and hydrochlorothiazide (Uniretic):
-
-
- Hypersensitivity to any drug component,
- Angioedema due to an ACE inhibitor treatment in the past
- concomitant use with aliskiren in patients with diabetes mellitus;
- anuria
-
It is difficult to document allergenic cross-reactivity with ACE inhibitors. Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects. Notification:Although the FDA-approved product labelling warns that this medication should not be taken with other groups of drugs that contain sulfonamides, the scientific validity of this claim has been questioned.
Warnings and precautions
-
-
Angioedema
- Angioedema can be caused by the use of ACE inhibitors, most often at low doses. Edema usually affects the head, neck and intestines. This can cause severe breathing problems or abdominal pain.
- The most vulnerable population are African-Americans, hereditary angioedema and African-Americans.
- Angioedema can also be increased by the use of everolimus (eg, mTOR inhibitor) therapy.
- You may need to be monitored frequently if you have a tongue, glottis or larynx. They can cause serious complications such as airway obstruction.
- Patients who have had airway surgery are more at risk for obstruction.
- It is crucial to be aggressive early and appropriately managed.
- Contraindicated if there are any previous cases of angioedema related to ACE inhibitor therapy
-
Cholestatic jaundice
- Cholestatic jaundice is a rare side effect of ACE inhibitors. It can progress to fulminant hepatic neoplasm (some fatal); stop taking ACE inhibitors if you notice a marked increase in hepatic transaminases and jaundice.
-
Cough:
- In the first several months of treatment, it may result in a dry, unproductive cough. After therapy is stopped, this can disappear.
- Before discontinuing treatment, it is important to consider other causes of cough (eg, pulmonary congestion in heart failure patients).
-
Electrolyte disturbances:
- Hyperkalemia can occur when ACE inhibitors are used. Risk factors include kidney dysfunction, diabetes mellitus and concomitant potassium-sparing diuretics and potassium supplements.
- These agents should be used with caution and potassium should be monitored closely.
- Hypokalemia, hypochloremic acidosis, hypomagnesemia and hyponatremia can be caused by Thiazide diuretics.
-
Gout
- Hydrochlorothiazide can trigger gout in certain patients who have a history of gout or are at risk for chronic renal failure.
- Doses of 25 mg and more may increase the risk.
-
Hypersensitivity reactions
- Anaphylactic/anaphylactoid reactions can occur with ACE inhibitors.
- Anaphylactoid reactions can be severe during hemodialysis (eg CVVHD) and high-flux dialysis membranes, (eg AN69), or, rarely, during low density lipoprotein (low-density) apheresis using dextran sulfatecellulose.
- Patients who have received ACE inhibitors and are subject to sensitization with Hymenoptera (bee or wasp) venom have had rare cases of anaphylactic reactions.
- Hydrochlorothiazide can also cause hypersensitivity reactions. Patients with allergies or bronchial asthma are at greater risk.
-
Hypotension/ Syncope
- ACE inhibitors can cause hypotension, with or without syncope (usually after the first few doses). Patients with low volume are more likely to experience hypotension. It is important to ensure that the patient has sufficient volume before initiating treatment. Particularly with dosing increases and initial dosing, close monitoring is necessary. Blood pressure should be decreased at a pace that is appropriate for the patient's clinical conditions.
- Hypotension, even though it may be necessary to reduce doses, is not a reason to stop future ACE inhibitor usage. This is especially true for patients with heart disease where a decrease in systolic pressure is desirable.
-
Neutropenia/agranulocytosis:
- Another ACE medication, captopril, has been connected to extremely rare instances of neutropenia or agranulocytosis.
- The chance of developing neutropenia is increased in patients with severe renal impairment.
- Neutropenia is more likely to occur in patients with collagen vascular disease and renal impairment (such as systemic lupus erythematosus).
- In such patients, routinely do a differential CBC.
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Ocular effects
- Patients with acute visual acuity and ocular pain may experience hydrochlorothiazide-induced transient myopia or acute angle-closure vision loss.
- If intraocular pressure is not controlled, additional treatments may be required.
- Penicillin-allergic and sulfonamide users are at higher risk.
-
Photosensitivity
- Patients may develop photosensitivity.
-
Renal function deterioration:
- Particularly in patients with low renal bloodflow (such as those with kidney artery stenosis or heart failure), whose glomerular filter rate (GFR), is dependent on efferent arterial vasoconstriction (angiotensin 2), moexipril can cause a decline in renal function as well as an increase in serum creatinine and BUN; this may result in oliguria and acute renal failure.
- Small increases in serum creatinine may occur in patients whose renal function has significantly and gradually deteriorated.
-
Allergy to sulfonamide ("sulfa")
- Wide-ranging contraindications for patients who have previously experienced an adverse reaction to sulfonamides are listed on FDA-approved product labels for drugs that contain sulfonamide chemical groups.
- Cross-reactivity between members of a class is conceivable (eg two antibiotic sulfonamides).
- Crossreactivity issues have previously been brought up for all substances of the sulfonamide structural class (SO-NH).
- Cross-reactivity between sulfonamides that aren't antibiotic and those that are shows that cross-reactivity between antibiotic and nonantibiotic sulfonamides is improbable.
- Sulfonamides that are not antibiotics are not likely to result in anaphylaxis (anaphylaxis) or mechanisms of cross-reaction brought on by the formation of antibodies.
- T-cell-mediated (type IV), reactions (e.g. maculopapular skin rash) are less understood. It is difficult to exclude this possibility based on current knowledge.
- Some clinicians opt to avoid these classes in cases of severe reactions (Stevens Johnson syndrome/TEN).
-
Aortic stenosis
- Patients with aortic Stenosis should be cautious when using moexipril. It may cause coronary perfusion problems which could lead to ischemia.
-
Bariatric surgery
- Dehydration: Do not take diuretics within the first 24 hours after bariatric surgery. Electrolyte imbalances and severe dehydration could occur.
- Once the patient has enough water, diuretics can be resumed.
-
Cardiovascular disease
- Patients with ischemic heart disease and cerebrovascular diseases should be closely monitored when initiating therapy. This is because of the possible consequences of falling blood pressure (eg stroke, MI).
- If necessary, fluid replacement may be required to restore blood pressure. Therapy may then resume.
- Patients with hypotension recur should be stopped from receiving therapy.
-
Collagen vascular disease:
- Patients with collagen vascular disease, especially those who also have concurrent renal impairment, should use ACE inhibitors with caution. They might be more likely to experience hematologic toxicities.
- Hydrochlorothiazide can trigger or exacerbate systemic lupus, which may lead to SLE.
-
Diabetes:
- Patients with diabetes should be cautious when using Hydrochlorothiazide. You may experience a decrease in glucose control.
-
Hepatic impairment
- Patients with hepatic impairment should be cautious
- In cases of advanced or severe liver illness, avoid acid/base imbalances and electrolyte imbalances. A coma or hepatic emboli may result from this.
-
Hypercalcemia:
- The excretion of calcium from the kidneys may be decreased by thiazide diuretics. If hypercalcemia is present, do not take thiazides.
-
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should be cautious. Thiazides can increase cholesterol and triglyceride levels.
-
Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)
- Patients with HCM or outflow tract obstruction should be cautious when using moexipril. A reduction in afterload could worsen the symptoms.
-
Parathyroid disease
- Calcium excretion is reduced by thiazide diuretics. Hypercalcemia and hypophosphatemia may occur as a result of ongoing parathyroid gland pathologic alterations. It's crucial to evaluate and monitor parathyroid function prior to beginning therapy.
-
Renal artery stenosis
- Moexipril is safe to use in patients with unstented unilateral/bilateral stenosis of the renal arteries, but there are precautions.
- If unstented bilateral renal arterial stenosis exists, it is best to avoid use unless the potential benefits outweigh the risks.
-
Renal impairment
- Preexisting renal impairments should be treated with caution. Dosage adjustments may be necessary.
- Do not increase your dose too quickly as this could cause further renal impairment.
- Patients with impaired renal function may experience cumulative effects, including azotemia.
- Hydrochlorothiazide should not be used in severe renal impairment.
- Contraindicated for anuric patients
-
Moexipril and hydrochlorothiazide: Drug Interaction
|
Ajmaline |
Sulfonamides might make ajmaline more harmful or poisonous. In particular, there may be an elevated risk for cholestasis. |
|
Alcohol (Ethyl) |
Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure. |
|
Alfuzosin |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Alteplase |
Angiotensin-Converting Enzyme Inhibitors may intensify Alteplase's harmful or hazardous effects. In particular, there may be an elevated risk for angioedema. |
|
Aminolevulinic Acid (Topical) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical). |
|
Amphetamines |
May lessen the effectiveness of antihypertensive agents. |
|
Angiotensin II |
The therapeutic efficacy of angiotensin II may be enhanced by angiotensin-converting enzyme inhibitors. |
|
Angiotensin-Converting Enzyme Inhibitors |
Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be enhanced by thiazide and thiazide-like diuretics. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics. |
|
Anticholinergic Agents |
May raise the levels of thiazide and thiazide-like diuretics in the blood. |
|
Antidiabetic Agents |
The therapeutic value of anti-diabetic agents may be diminished by thiazide and thiazide-like diuretics. |
|
Antidiabetic Agents |
The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents. |
|
Antipsychotic Agents (Second Generation [Atypical]) |
Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]). |
|
Aprotinin |
May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension. |
|
AzaTHIOprine |
AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors. |
|
Barbiturates |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Benazepril |
Benazepril's hypotensive impact may be strengthened by hydrochlorothiazide. Benazepril may have a more nephrotoxic effect when combined with hydrochlorothiazide. Benazepril may lower the level of HydroCHLOROthiazide in the blood. |
|
Benperidol |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Beta2-Agonists |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Brigatinib |
May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib. |
|
Brimonidine (Topical) |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Calcium Salts |
The excretion of calcium salts may be decreased by thiazide and thiazide-like diuretics. Metabolic alkalosis can also be brought on by continued concurrent usage. |
|
CarBAMazepine |
Thiazide and Thiazide-Like Diuretics may intensify CarBAMazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia. |
|
Cardiac Glycosides |
Cardiac Glycosides may have an increased negative or toxic effect when used with thiazide and thiazide-Like Diuretics. Particularly, the hypokalemic and hypomagnesemic impact of thiazide diuretics may worsen cardiac glycoside toxicity. |
|
Corticosteroids (Orally Inhaled) |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Corticosteroids (Systemic) |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Cyclophosphamide |
Thiazide and Thiazide-Like Diuretics may intensify Cyclophosphamide's harmful or hazardous effects. Particularly, granulocytopenia could be worsened. |
|
Dapoxetine |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Dexketoprofen |
Sulfonamides' harmful or poisonous effects could be amplified. |
|
Dexmethylphenidate |
May lessen the effectiveness of antihypertensive agents. |
|
Diacerein |
Could make diuretics' therapeutic effects stronger. Particularly, there may be a higher chance of hypokalemia or dehydration. |
|
Diazoxide |
Thiazide and Thiazide-Like Diuretics may intensify Diazoxide's harmful or toxic effects. |
|
Diazoxide |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Dichlorphenamide |
The hypokalemic impact of dichlorphenamide may be enhanced by thiazide and thiazide-like diuretics. |
|
Dipeptidyl Peptidase-IV Inhibitors |
May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Particularly, there may be a higher incidence of angioedema. |
|
Drospirenone |
Drospirenone's hyperkalemic impact may be enhanced by angiotensin-converting enzyme inhibitors. |
|
DULoxetine |
The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications. |
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Eplerenone |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Everolimus |
May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. Particularly, there may be a higher incidence of angioedema. |
|
Ferric Gluconate |
Angiotensin-Converting Enzyme Inhibitors might make ferric gluconate more harmful or poisonous. |
|
Ferric Hydroxide Polymaltose Complex |
Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses. |
|
Gelatin (Succinylated) |
Gelatin's harmful or toxic effects may be increased by angiotensin-converting enzyme inhibitors (Succinylated). Particularly, there may be a higher chance of a paradoxical hypotensive reaction. |
|
Gold Sodium Thiomalate |
Gold Sodium Thiomalate may have a more negative or toxic effect when used with angiotensin-converting enzyme inhibitors. Nitritoid responses are more likely now, it has been noted. |
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Heparin |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Heparins (Low Molecular Weight) |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
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Herbs (Hypertensive Properties) |
May lessen the effectiveness of antihypertensive agents. |
|
Herbs (Hypotensive Properties) |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Hypotension-Associated Agents |
The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications. |
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Icatibant |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Ipragliflozin |
The toxic and harmful effects of thiazide and thiazide-like diuretics may be increased. In particular, there may be an elevated risk for intravascular volume depletion. |
|
Ivabradine |
The arrhythmogenic impact of ivabradine may be enhanced by thiazide and thiazide-like diuretics. |
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Levodopa-Containing Products |
Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications. |
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Licorice |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Loop Diuretics |
May strengthen angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics. |
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Lormetazepam |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Methenamine |
The therapeutic effects of methenamine may be diminished by thiazide and thiazide-like diuretics. |
|
Methylphenidate |
May lessen the effectiveness of antihypertensive agents. |
|
Molsidomine |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
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Multivitamins/Fluoride (with ADE) |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
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Multivitamins/Minerals (with ADEK, Folate, Iron) |
The effect of multivitamins and minerals on hypercalcemia may be enhanced by thiazide and thiazide-like diuretics (with ADEK, Folate, Iron). |
|
Multivitamins/Minerals (with AE, No Iron) |
The serum concentration of multiple vitamins and minerals may rise after taking thiazide and thiazide-like diuretics (with AE, No Iron). Particularly, thiazide diuretics may reduce calcium excretion, and long-term concurrent usage may result in metabolic alkalosis. |
|
Naftopidil |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Neuromuscular-Blocking Agents (Nondepolarizing) |
The neuromuscular-blocking action of neuromuscular-blocking agents may be enhanced by thiazide and thiazide-like diuretics (Nondepolarizing). |
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Nicergoline |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
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Nicorandil |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Nicorandil |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Nitroprusside |
Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications. |
|
Nonsteroidal Anti-Inflammatory Agents |
Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be increased by angiotensin-converting enzyme inhibitors. In particular, the combination may cause a marked decline in renal function. Angiotensin-Converting Enzyme Inhibitors' antihypertensive effects may be lessened by nonsteroidal anti-inflammatory drugs. |
|
Nonsteroidal Anti-Inflammatory Agents |
Nonsteroidal Anti-Inflammatory Agents' nephrotoxic effects may be intensified by thiazide and thiazide-like diuretics. Thiazide and Thiazide-Like Diuretics may have less of a therapeutic impact when used with nonsteroidal anti-inflammatory drugs. |
|
Opioid Agonists |
Could make diuretics' harmful or toxic effects worse. Opioid antagonists may reduce diuretics' therapeutic benefit. |
|
Oxcarbazepine |
Thiazide and Thiazide-Like Diuretics may intensify OXcarbazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia. |
|
Pentoxifylline |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Pholcodine |
Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications. |
|
Phosphodiesterase 5 Inhibitors |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Porfimer |
The photosensitizing effect of Porfimer may be strengthened by photosensitizing agents. |
|
Potassium Salts |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Potassium-Sparing Diuretics |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Pregabalin |
Angiotensin-Converting Enzyme Inhibitors may intensify Pregabalin's negative/toxic effects. Particularly, there may be a higher incidence of angioedema. |
|
Prostacyclin Analogues |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Quinagolide |
The hypotensive effects of blood pressure-lowering medications may be strengthened. |
|
Racecadotril |
May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. In particular, this combination may make angioedema more likely. |
|
Ranolazine |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Reboxetine |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Salicylates |
May intensify angiotensin-converting enzyme inhibitors' nephrotoxic effects. The therapeutic benefit of angiotensin-converting enzyme inhibitors may be reduced by salicylates. |
|
Selective Serotonin Reuptake Inhibitors |
Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact. |
|
Sirolimus |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Tacrolimus (Systemic) |
Tacrolimus's effect of making you more hyperkalemic may be enhanced by angiotensin-converting enzyme inhibitors (Systemic). |
|
Temsirolimus |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Thiazide and Thiazide-Like Diuretics |
May increase the angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics. |
|
TiZANidine |
May strengthen angiotensin-converting enzyme inhibitors' hypotensive effects. |
|
Tolvaptan |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Toremifene |
Toremifene's hypercalcemic impact may be enhanced by thiazide and thiazide-like diuretics. |
|
Trimethoprim |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. |
|
Verteporfin |
Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents. |
|
Vitamin D Analogs |
The hypercalcemic impact of vitamin D analogues may be enhanced by thiazides and thiazide-like diuretics. |
|
Yohimbine |
May lessen the effectiveness of antihypertensive agents. |
|
Risk Factor D (Consider therapy modification) |
|
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Aliskiren |
Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels. |
|
Allopurinol |
Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions. |
|
Amifostine |
Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped. |
|
Angiotensin II Receptor Blockers |
May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: According to US labelling, it is not advisable to take telmisartan and ramipril. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix. |
|
Bile Acid Sequestrants |
The absorption of thiazide and thiazide-like diuretics may be reduced. Also reduced is the diuretic reaction. |
|
Grass Pollen Allergen Extract (5 Grass Extract) |
Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). With regard to grass pollen allergen extract, ACE inhibitors may specifically enhance the likelihood of a severe allergic reaction (5 Grass Extract). |
|
Iron Dextran Complex |
Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients taking an ACE inhibitor may be more susceptible to events of the anaphylactic variety. Management: Adhere strictly to the instructions for iron dextran administration, including the use of a test dose before the initial therapeutic dose and the availability of resuscitation tools and qualified people. |
|
Lanthanum |
May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum. |
|
Lithium |
The excretion of lithium may be reduced by thiazide and thiazide-like diuretics. |
|
Lithium |
The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. Management: After adding an ACE inhibitor, lithium dosage decreases will probably be required. Following the addition or discontinuation of concurrent ACE inhibitor therapy, carefully monitor the patient's response to lithium. |
|
Obinutuzumab |
The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished. |
|
Sodium Phosphates |
The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ACEIs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided. |
|
Sodium Phosphates |
The nephrotoxic effects of sodium phosphates may be increased by diuretics. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking diuretics or look for an alternative to the oral sodium phosphate bowel preparation in order to prevent this combo. If the combination cannot be avoided, drink well and keep an eye on your kidney and fluid levels. |
|
Topiramate |
The hypokalemic impact of topiramate may be enhanced by thiazide and thiazide-like diuretics. The blood concentration of topiramate may rise in response to thiazide and thiazide-like diuretics. When using a thiazide diuretic, monitor for elevated topiramate levels and any negative consequences (such as hypokalemia). Serum potassium levels should be closely watched when receiving concurrent treatment. There may be a need to lower topiramate dosage. |
|
Urapidil |
Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy. |
|
Risk Factor X (Avoid combination) |
|
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Aminolevulinic Acid (Systemic) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic). |
|
Bromperidol |
The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol. |
|
Dofetilide |
The QTc-prolonging action of dofetilide may be strengthened by hydrochlorothiazide. The serum levels of Dofetilide may rise in response to HydroCHLOROthiazide. |
|
Fexinidazole [INT] |
Fexinidazole [INTability ]'s to induce arrhythmias may be enhanced by the use of thiazide and thiazide-like diuretics. |
|
Levosulpiride |
Thiazide and Thiazide-Like Diuretics may intensify Levosulpiride's negative/toxic effects. |
|
Mecamylamine |
Sulfonamides may intensify Mecamylamine's harmful or hazardous effects. |
|
Promazine |
Promazine's ability to prolong QTc may be enhanced by thiazide and thiazide-like diuretics. |
|
Sacubitril |
The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. In particular, this combination may raise the risk of angioedema. |
Monitoring parameters:
Blood pressure, BUN, serum creatinine, and electrolytes must all be regularly monitored. If the patient has renal impairment or collagen vascular disease, perform CBC with differentials more regularly.
How to administer Moexipril and hydrochlorothiazide (Uniretic)?
Oral: Administer one hour before a meal.
Mechanism of action of Moexipril and hydrochlorothiazide (Uniretic):
Moexipril
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- It prevents the ACE from turning angiotensin I into angiotensin II. This has potent vasoconstrictor properties. It lowers angiotensin II levels, which in turn leads to enhanced plasma renin activity and a reduction in aldosterone synthesis.
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Hydrochlorothiazide:
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- It prevents the distal tubules from reabsorbing sodium, increasing the excretion of sodium, water, potassium ions, and hydrogen ions.
See individual agents.
International Brand Names of Moexipril and hydrochlorothiazide:
- Fempress Plus
- Moex Plus
- Uniretic
- Univasc Plus
Moexipril and hydrochlorothiazide Brand Names in Pakistan:
No Brands Available in Pakistan.
 Injection.webp)