Moderate
Enalapril × Prednisolone
Angiotensin-converting enzyme inhibitors (ACEi)×Glucocorticoids
Mechanism
Glucocorticoids retain sodium and water via mineralocorticoid effect, blunting the ACE inhibitor's antihypertensive effect. Both can also cause hyperkalaemia (prednisolone via muscle catabolism, ACE inhibitor via aldosterone suppression).
Symptoms
Return or rise of blood pressure, leg oedema. Hyperkalaemia symptoms in CKD: Weakness, fatigue, paraesthesias, arrhythmia. Symptoms develop at potassium above 5.5 mmol/L; life-threatening above 6.5 mmol/L.
Management
For short prednisolone pulses (3–7 days), no specific adjustment needed. For long-term therapy, check BP weekly in the first month; if it rises, increase enalapril or add a diuretic. Potassium and creatinine every 2 weeks in the first month.
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.