Quinapril and hydrochlorothiazide and Torsemide interaction

…sometimes associated with oliguria and/or progressive azotemia, and rarely acute renal failure and/or death, include patients with the following conditions or characteristics: heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis or severe volume and/or salt depletion of any etiology.

The thiazide component of quinapril and hydrochlorothiazide tablets may potentiate the action of other antihypertensive drugs, especially ganglionic or peripheral adrenergic- blocking drugs.

Such patients should be followed closely for the first 2 weeks of treatment and whenever the dosage of quinapril or diuretic is increased.

In clinical studies in hypertensive patients with unilateral renal artery stenosis, treatment with ACE inhibitors was associated with increases in blood urea nitrogen and serum creatinine; these increases were reversible upon discontinuation of ACE inhibitor, concomitant diuretic, or both.

Some quinapril-treated hypertensive patients with no apparent preexisting renal vascular diseases have developed increases in blood urea nitrogen and serum creatinine, usually minor and transient, especially when quinapril has been given concomitantly with a diuretic.

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.