Drug interactions
Candesartan + Enalapril-hydrochlorothiazide
Severity: Major
Candesartan and Enalapril-hydrochlorothiazide: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining an ACE inhibitor with an angiotensin receptor blocker produces dual renin-angiotensin system blockade. This raises the risk of hypotension, hyperkalemia and acute kidney injury without clear added cardiovascular benefit in most patients.
What this interaction means in plain words
Candesartan and Enalapril-hydrochlorothiazide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Candesartan belongs to Cardiovascular; Enalapril-hydrochlorothiazide belongs to Cardiovascular.
Why it happens
Additive inhibition of the renin-angiotensin-aldosterone system at two levels, reducing aldosterone and glomerular efferent tone.
What to do
Avoid the combination in most patients, particularly those with diabetic nephropathy or renal impairment. If used, monitor serum potassium, creatinine and blood pressure closely.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Other interactions of Candesartan
- Aliskiren + Candesartan Contraindicated
- Candesartan + Sparsentan Contraindicated
- Amifostine + Candesartan Major
- Amiloride + Candesartan Major
- Amlodipine-benazepril + Candesartan Major
- Amlodipine-hydrochlorothiazide-valsartan + Candesartan Major
Frequently asked questions
Can I take Candesartan with Enalapril-hydrochlorothiazide?
MediHelp rates the interaction as major. Candesartan and Enalapril-hydrochlorothiazide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining an ACE inhibitor with an angiotensin receptor blocker produces dual renin-angiotensin system blockade. This raises the risk of hypotension, hyperkalemia and acute kidney injury without clear added cardiovascular benefit in most patients.
How serious is the interaction between Candesartan and Enalapril-hydrochlorothiazide?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination in most patients, particularly those with diabetic nephropathy or renal impairment. If used, monitor serum potassium, creatinine and blood pressure closely.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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