Drug interactions
Enalapril-hydrochlorothiazide + Protein a column
Severity: Contraindicated
Enalapril-hydrochlorothiazide and Protein a column: contraindicated 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
Patients on ACE inhibitors undergoing apheresis with a protein A immunoadsorption column have developed anaphylactoid reactions. Bradykinin accumulates because ACE inhibition blocks its breakdown, and column treatment can further activate bradykinin-related pathways.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Protein a column are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
ACE inhibitors block kininase II degradation of bradykinin, which accumulates during immunoadsorption and triggers anaphylactoid reactions.
What to do
Stop the ACE inhibitor well before the procedure (labeling advises about 72 hours) and use a non-ACE-inhibitor antihypertensive meanwhile.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
- Azathioprine + Enalapril-hydrochlorothiazide Major
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Protein a column?
MediHelp rates the interaction as contraindicated. Enalapril-hydrochlorothiazide and Protein a column are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Patients on ACE inhibitors undergoing apheresis with a protein A immunoadsorption column have developed anaphylactoid reactions. Bradykinin accumulates because ACE inhibition blocks its breakdown, and column treatment can further activate bradykinin-related pathways.
How serious is the interaction between Enalapril-hydrochlorothiazide and Protein a column?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Stop the ACE inhibitor well before the procedure (labeling advises about 72 hours) and use a non-ACE-inhibitor antihypertensive meanwhile.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Sacubitril / valsartan. The full list is on the Enalapril-hydrochlorothiazide page.
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