MajorAngiotensin-converting enzyme inhibitors (ACEi)×Angiotensin II receptor blocker (ARB)
Updated · Methodology
Mechanism
Dual RAAS blockade – increased hyperkalaemia, hypotension, and acute kidney injury without outcome improvement (ONTARGET).
Symptoms
Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.
Management
The combination is not prescribed. Choose one: ACE-I (enalapril) if tolerated, ARB (telmisartan) if there is a dry cough.
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
- ONTARGET Investigators: Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events (2008)– N Engl J Med 2008;358(15):1547–1559
- EMA: Ficha técnica: Telmisartán (EU/1/98/090), sección 4.5 (2026)– EMA SmPC vía AEMPS CIMA, nº 98090002 (EU/1/98/090), sección 4.5, consultado 10/2026
- AEMPS: Ficha técnica: Enalapril (nº registro 63355), sección 4.4 (2025)– AEMPS, CIMA, nº registro 63355, revisión 08/2025, sección 4.4