Drug General Information (ID: DDI1NHX3JW)
Drug Name			Eprosartan		Drug Info		Captopril		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antihypertensive Agents				Antihypertensive Agents
Structure

Mechanism of Eprosartan-Captopril Interaction (Severity Level: Major)
Increased risk of hyperkalemia Click to Show/Hide Mechanism Graph
Drug Name		Eprosartan				Captopril
Mechanism		Hyperkalemia				Hyperkalemia
Key Mechanism Factor 1
		Factor Name		Hyperkalemia
		Factor Description		Hyperkalemia is a condition in which the level of potassium in the blood is higher than normal. While mild cases may not produce symptoms, severe hyperkalemia can lead to fatal arrhythmias if left untreated.
Mechanism Description		Increased risk of hyperkalemia by the combination of Eprosartan and Captopril

Recommended Action
Management		Dual blockade of the renin-angiotensin-aldosterone system by adding an ACE inhibitor to an angiotensin II receptor antagonist is not recommended, especially in patients with diabetic nephropathy. Routine monitoring of electrolytes and renal function may be indicated in the elderly or patients with worsening heart failure or a risk for dehydration. Potassium supplementation should generally be avoided unless it is closely monitored, and patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, and irregular heartbeat.

References
1	Product Information. Diovan (valsartan). Novartis Pharmaceuticals, East Hanover, NJ.
2	Product Information. Micardis (telmisartan). Boehringer-Ingelheim, Ridgefield, CT.
3	ONTARGET Investigators, Yusuf S, Teo KK, et al "Telmisartan, ramipril, or both in patients at high risk for vascular events." N Engl J Med 358 (2008): 1547-59. [PMID: 18700309]
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5	National Kidney Foundation "KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 update." Am J Kidney Dis 60 (2012): 850-86. [PMID: 23067652]
6	Jacobsen P, Andersen S, Rossing K, Jensen BR, Parving HH "Dual blockade of the renin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy." Kidney Int 63 (2003): 1874-80. [PMID: 12675866]
7	MHRA. Medicines and Healthcare Regulatory Agency "Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function--new warnings.".
8	Product Information. Atacand (candesartan). Astra Pharmaceuticals, Wayne, PA.
9	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
10	EMA. European Medicines Agency "PRAC recommends against combined use of medicines affecting the renin-angiotensin (RAS) system: recommendation will now be considered by CHMP for final opinion." .
11	Laverman GD, Navis G, Henning RH, De Jong PE, De Zeeuw D "Dual renin-angiotensin system blockade at optimal doses for proteinuria." Kidney Int 62 (2002): 1020-5. [PMID: 12164886]
12	Pfeffer MA, McMurray JJ, Velazquez EJ, et al. "Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both." N Engl J Med 349 (2003): 1893-1906. [PMID: 14610160]
13	McMurray JJ, Ostergren J, Swedberg K, et al. "Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial." Lancet 362 (2003): 767-71. [PMID: 13678869]
14	Jacobsen P, Andersen S, Jensen BR, Parving HH "Additive effect of ACE inhibition and angiotensin II receptor blockade in type I diabetic patients with diabetic nephropathy." J Am Soc Nephrol 14 (2003): 992-9. [PMID: 12660333]
15	Guthrie RM "Review of ONTARGET: treating patients at high risk for vascular events with telmisartan, ramipril, or both. Commentary." Postgrad Med 121 (2009): 202-4. [PMID: 19332981]
16	Mann JF, Schmieder RE, McQueen M, et al. "Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial." Lancet 372 (2008): 547-53. [PMID: 18707986]