Drug interactions
Enalapril + Hydrochlorothiazide
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.
Overview
Additive antihypertensive/diuretic effects can cause symptomatic hypotension (notably with first ACE inhibitor doses or volume depletion), acute declines in renal function, and electrolyte disturbances.
Mechanism of action
Pharmacodynamic additivity: thiazide-induced volume depletion augments RAAS blockade by enalapril; combined effects alter renal hemodynamics and electrolytes.
Clinical management
If on a diuretic, consider reducing/withholding it before starting enalapril; initiate enalapril at a low dose; correct volume depletion; monitor BP, serum creatinine/eGFR, and electrolytes within 1–2 weeks of initiation or dose change and as clinically indicated.
Drug reference
References
- Vasotec (enalapril maleate) Prescribing Information – Warnings: Hypotension and use with diuretics — FDA Label
- Enalapril: Drug information – Interactions with diuretics — Lexicomp
- Angiotensin-converting enzyme inhibitors: Drug information (first-dose hypotension; diuretic use) — UpToDate
Frequently asked questions
Can I take Enalapril with Hydrochlorothiazide?
The interaction is rated: Moderate. Additive antihypertensive/diuretic effects can cause symptomatic hypotension (notably with first ACE inhibitor doses or volume depletion), acute declines in renal function, and electrolyte disturbances.
How serious is the interaction between Enalapril and Hydrochlorothiazide?
The interaction is rated: Moderate. Evidence level: High.
How is the interaction between Enalapril and Hydrochlorothiazide managed?
If on a diuretic, consider reducing/withholding it before starting enalapril; initiate enalapril at a low dose; correct volume depletion; monitor BP, serum creatinine/eGFR, and electrolytes within 1–2 weeks of initiation or dose change and as clinically indicated.
Why do Enalapril and Hydrochlorothiazide interact?
Pharmacodynamic additivity: thiazide-induced volume depletion augments RAAS blockade by enalapril; combined effects alter renal hemodynamics and electrolytes.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.