Drug interactions
Enalapril-hydrochlorothiazide + Sotalol
Severity: Major
Enalapril-hydrochlorothiazide and Sotalol: major interaction.
Last updated Sources: UK SmPC
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 can cause hypokalemia and hypomagnesemia, which markedly increase the risk of QT prolongation and torsades de pointes with sotalol. Additive blood pressure and heart rate lowering can also occur.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Sotalol 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.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Sotalol belongs to Cardiovascular.
Why it happens
Thiazide-induced electrolyte depletion potentiates sotalol's class III QT-prolonging effect.
What to do
Correct potassium and magnesium before starting sotalol and monitor them regularly, along with QTc. Reduce the sotalol dose or change the diuretic if QTc becomes excessive.
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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References
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 Sotalol
- Arsenic trioxide + Sotalol Contraindicated
- Artemether / lumefantrine + Sotalol Contraindicated
- Disopyramide + Sotalol Contraindicated
- Dofetilide + Sotalol Contraindicated
- Dronedarone + Sotalol Contraindicated
- Droperidol + Sotalol Contraindicated
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Sotalol?
MediHelp rates the interaction as major. Enalapril-hydrochlorothiazide and Sotalol 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. Hydrochlorothiazide can cause hypokalemia and hypomagnesemia, which markedly increase the risk of QT prolongation and torsades de pointes with sotalol. Additive blood pressure and heart rate lowering can also occur.
How serious is the interaction between Enalapril-hydrochlorothiazide and Sotalol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Correct potassium and magnesium before starting sotalol and monitor them regularly, along with QTc. Reduce the sotalol dose or change the diuretic if QTc becomes excessive.
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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