Drug interactions
Enalapril-hydrochlorothiazide + Procainamide
Severity: Moderate
Enalapril-hydrochlorothiazide and Procainamide: moderate 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
Hydrochlorothiazide may compete with procainamide and its active metabolite NAPA for renal tubular secretion, raising their levels. Higher levels can increase the risk of QT prolongation and arrhythmia. Thiazide-induced hypokalemia can add to the proarrhythmic risk.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Procainamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Competition for renal tubular secretion of cationic drugs, plus pharmacodynamic risk from thiazide-induced electrolyte disturbance.
What to do
Monitor ECG and procainamide/NAPA concentrations when the combination is started or changed. Correct potassium and magnesium abnormalities.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Procainamide?
MediHelp rates the interaction as moderate. Enalapril-hydrochlorothiazide and Procainamide can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Hydrochlorothiazide may compete with procainamide and its active metabolite NAPA for renal tubular secretion, raising their levels. Higher levels can increase the risk of QT prolongation and arrhythmia. Thiazide-induced hypokalemia can add to the proarrhythmic risk.
How serious is the interaction between Enalapril-hydrochlorothiazide and Procainamide?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor ECG and procainamide/NAPA concentrations when the combination is started or changed. Correct potassium and magnesium abnormalities.
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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