ModerateAngiotensin-converting enzyme inhibitors (ACEi)×Loop diuretics
Updated · Methodology
Mechanism
Additive antihypertensive effect; in hypovolaemic patients it can trigger acute kidney injury. The triad of ACE inhibitor + diuretic + NSAID is especially dangerous (the "triple whammy").
Symptoms
Decreased urine output, rising creatinine, oedema, nausea, fatigue. Higher risk in older patients and in dehydration.
Management
On starting the combination, begin enalapril at the lowest dose (2.5 mg). Check creatinine and potassium at 1–2 weeks, then every 3 months. In older patients with acute illness and dehydration, both drugs are temporarily stopped until volume is restored.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)– Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)– Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024
- AEMPS: Ficha técnica: Furosemida (nº registro 68077), sección 4.5 (2024)– AEMPS, CIMA, nº registro 68077, revisión 09/2024, sección 4.5
- AEMPS: Ficha técnica: Enalapril (nº registro 63355), sección 4.4 (2025)– AEMPS, CIMA, nº registro 63355, revisión 08/2025, sección 4.4