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ACEI drug combination needs attention!
Angiotensin-converting enzyme inhibitors (ACEI) are widely used in clinical practice, and common representative drugs include captopril, enalapril, perindopril, etc.
As a drug for chronic diseases, the population base of ACEI application is large, and the drug users often have multiple diseases. Therefore, the interaction between ACEI and other drugs is very worthy of attention. Let’s pay attention to the combination of ACEI and other drugs~
Combination suggestions
Concomitant use of ACEIs and allopurinol increases the risk of leukopenia and serious infections, especially in patients with renal impairment.
1 case of hypersensitivity attributable to captopril in combination with allopurinol, hypersensitivity and myocardial infarction.
Relevant clinical research results
In 12 healthy subjects, no significant pharmacokinetic changes were observed following administration of allopurinol and captopril alone or in combination [1].
Captopril was discontinued in a report of fever, arthralgias, and myalgias in a male patient with chronic renal failure treated with both captopril and allopurinol for diabetes Afterwards, the patient’s symptoms improved [2].
2 cases of men taking enalapril developed acute allergic reaction with severe coronary spasm within 20 minutes after taking 100 mg of allopurinol, which eventually led to myocardial infarction. The patient recovered after treatment After that, enalapril was continued and allopurinol was discontinued [3].
UK captopril manufacturer warns: Neutropenia and agranulocytosis have occurred in patients taking captopril and other ACEIs, which can lead to serious infections Puritol is a complicating factor, especially in patients with renal impairment [4].
Interaction mechanism
Not yet clear. It is uncertain whether the above adverse reactions are due to the interaction of allopurinol and ACEI, because allopurinol and captopril alone can also cause hypersensitivity reactions, especially in the setting of renal failure.
Although this interaction has not been established, the adverse reactions described above are rare and unpredictable. Patients taking both drugs are still advised to monitor closely for any signs of hypersensitivity reactions (eg, skin reactions) or low white blood cell counts (eg, sore throat, fever), especially if renal impairment is present.
The UK manufacturer of captopril recommends a differential white blood cell count before adding allopurinol to an ACEI and every 2 weeks for the first 3 months of treatment once and periodically thereafter [4]. Producers of several other ACEIs in the UK have given similar warnings and advice.
References:
[1]Duchin KL, McKinstry DN, Cohen AI, Migdalof BH. Pharmacokinetics of captopril in healthy subjects and in patients with cardiovascular diseases. Clin Pharmacokinet (1988) 14, 241C59.
[2]Samanta A,Burden AC.Fever,myalgia,and arthralgia in a patient on captopril and allopurinol.Lancet(1984)i,679.
[3]Ahmad S. Allopurinol and enalapril. Drug induced anaphylactic coronary spasm and acute myocardial infarction. Chest(1995) 108,586.
[4]Capoten(Captopril).E.R.Squibb&Sons Ltd.UK Summary of product characteristics,September 2008.
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Author: Red Oil Chili Sauce
Editor in charge: Wang Hang
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