MajorAngiotensin-converting enzyme inhibitors (ACEi)×Angiotensin II receptor blockers (ARBs)
Updated · Methodology
Mechanism
Dual RAAS blockade (ACE-I + ARB). Proven in ONTARGET and VA NEPHRON-D trials: increased hyperkalaemia, hypotension, and acute kidney injury without cardioprotection.
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 (valsartan) if there is a dry cough or intolerance.
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
- KDIGO: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD (2024)– Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024;105(4S):S117-S314.
- AEMPS: Ficha técnica: Enalapril (nº registro 63355), sección 4.4 (2025)– AEMPS, CIMA, nº registro 63355, revisión 08/2025, sección 4.4