Enalapril and hydrochlorothiazide and Torsemide interaction
Enalapril and hydrochlorothiazide and Torsemide: both prescribing labels describe an interaction that usually calls for monitoring, a dose change, or spacing the doses.
Usually manageable with monitoring or a dose change. Tell your pharmacist you take both.
What the FDA labels say
From the Enalapril and hydrochlorothiazide (Vaseretic) label · effective 2020-08-31
WARNINGS General Enalapril Maleate Hypotension: Excessive hypotension was rarely seen in uncomplicated hypertensive patients but is a possible consequence of enalapril use in severely salt/volume depleted persons such as those treated vigorously with diuretics or patients on dialysis.
Such patients should be followed closely for the first two weeks of treatment and whenever the dose of enalapril and/or diuretic is increased.
Hypotension – Patients on Diuretic Therapy Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with enalapril.
If it is necessary to continue the diuretic, provide medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour (see WARNINGS and DOSAGE AND ADMINISTRATION ).
Non-steroidal Anti-inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including enalapril, may result in deterioration…
From the Torsemide label · effective 2026-07-21
Ototoxicity Tinnitus and hearing loss (usually reversible) have been observed with loop diuretics, including torsemide.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects; risk of renal impairment.
Organic Anion Drugs: May decrease diuretic activity of torsemide.
The antihypertensive and diuretic effects of torsemide can be reduced by NSAIDs.
Monitor diuretic effect and blood pressure when used in combination with CYP2C9 inhibitor or inducer.
Taking more than these two? Interactions stack. Check your whole list at once; it stays in your browser.
Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.