Norplus Drug Interactions

Imidapril hydrochloride: Potassium-sparing diuretics/potassium supplements/salt substitutes: May lead to significant increases in serum potassium. Use with caution and monitor serum potassium frequently.
Nonsteroidal anti-inflammatory drugs [NSAIDs, i.e., selective cyclooxygenase-2 inhibitors (COX-2) inhibitors, aspirin >3 g/day]: Reduced antihypertensive effect of imidapril. Concurrent administration of ACE inhibitors and NSAIDs may result in an increased risk of worsening of renal function (including possible acute renal failure) and an increase in serum potassium, particularly in patients with poor pre-existing renal function. The combination should be administered with caution, especially in the elderly. Regularly monitor renal function after initiation of concomitant therapy and adequately hydrate patients.
Dual blockade of the renin-angiotensin-aldosterone system (RAAS): Dual blockade of the RAAS with ACE inhibitors, angiotensin II receptor antagonists or aliskiren is associated with increased risk of hypotension, hyperkalemia and changes in renal function (including acute renal failure) compared with monotherapy. Closely monitor blood pressure, renal function and electrolytes in patients on imidapril and other agents that affect the RAAS. Do not coadminister imidapril with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²). Avoid concomitant use of ACE inhibitors and angiotensin II receptor antagonists in patients with diabetic nephropathy.
Non-potassium-sparing diuretics: Risk of sudden hypotension and/or acute renal impairment. Discontinue the diuretic before initiating imidapril, or initiate with a lower dose of imidapril and increase progressively. The diuretic can be reintroduced thereafter. Monitor renal function during the first few weeks of therapy.
Lithium: May decrease lithium excretion leading to lithium toxicity. Monitor serum lithium levels frequently.
Antidiabetic agents (e.g., insulin, hypoglycemic agents): ACE inhibitors may increase the hypoglycemic effect in diabetic patients receiving insulin or hypoglycemic agents.
Tricyclic antidepressants, neuroleptics: Increased antihypertensive effect and risk of orthostatic hypotension.
Rifampicin: May decrease the antihypertensive effect of imidapril.
Antacids: May decrease imidapril bioavailability.
Sympathomimetics: May decrease the antihypertensive effects of ACE inhibitors; patients should be carefully monitored to confirm that the desired effect is obtained.
Gold (sodium aurothiomalate): Nitroid reactions (including facial flushing, nausea, vomiting and hypotension) have been reported rarely in patients receiving concomitant therapy with ACE inhibitor and injectable gold.
Neprilysin (NEP) inhibitors (e.g., sacubitril, racecadotril): Concomitant inhibition of NEP and ACE may increase the risk of angioedema. Sacubitril/valsartan must not be administered until 36 hours after discontinuing imidapril therapy. Imidapril therapy must not be started until 36 hours after the last dose of sacubitril/valsartan. Concomitant use of other NEP inhibitors (e.g., racecadotril) and imidapril may also increase the risk of angioedema. A careful benefit-risk assessment is needed before initiating treatment with NEP inhibitors in patients on imidapril.
Other antihypertensive agents and vasodilators (e.g., nitroglycerin, nitrates): Increased blood pressure lowering effect of imidapril.
Hydrochlorothiazide: Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension.
Amantadine: Increased risk of adverse effects.
Aminoglycoside antibiotics: Diuretic-induced volume depletion can potentiate aminoglycoside nephrotoxicity.
Anticholinergic agents (e.g., atropine, biperidine): May increase availability of thiazide diuretics by decreasing gastrointestinal motility and stomach emptying rate.
Antidiabetic agents (e.g., insulin, hypoglycemic agents): Dosage adjustment of the antidiabetic agent may be necessary as thiazides may impair glucose tolerance.
Diazoxide: May enhance the hyperglycemic effect of diazoxide.
Antigout (e.g., probenecid, sulfinpyrazone, allopurinol): Dosage adjustment of the antigout medication may be necessary as HCTZ may raise level of serum uric acid; may increase hypersensitivity reaction with allopurinol.
Calcium salts, Vitamin D supplements: Increased serum calcium levels due to decreased excretion.
Carbamazepine: Symptomatic hyponatremia may occur. Monitor electrolytes during concomitant use.
Cardiac glycosides (e.g., digitalis): Thiazide-induced hypokalemia or hypomagnesemia may favor the onset of digitalis-induced cardiac arrhythmias.
Cholestyramine and colestipol resins: HCTZ absorption is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind HCTZ and reduce its absorption from the gastrointestinal tract by up to 85% and 43%, respectively.
Corticosteroids, ACTH, amphotericin B (parenteral), stimulant laxative, or glycyrrhizin (found in licorice): Intensified electrolyte depletion/electrolyte imbalance, particularly hypokalemia.
Cytotoxic agents (e.g., cyclophosphamide, methotrexate): Decreased renal excretion; increased myelosuppressive effects.
Ciclosporin: May increase the risk of hyperuricemia and gout-type complications.
Lithium: Increased serum lithium concentrations and increased risk of lithium toxicity. Monitor serum lithium levels during concomitant use.
Pressor amines (e.g., epinephrine): Possible decreased response to pressor amines but not sufficient to prevent their use.
NSAIDs including COX-2 Inhibitors: May reduce the diuretic, natriuretic and antihypertensive effects of diuretics in some patients.
Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine): Possible increased responsiveness to the muscle relaxant.
Selective serotonin reuptake inhibitors (e.g., citalopram, escitalopram, sertraline): May potentiate hyponatremia.
Topiramate: May increase topiramate serum concentrations; additive hypokalemia.
Iodinated contrast media: Increased risk of acute renal failure particularly when large doses of iodinated media are used.
Other antihypertensive agents: Additive effect.