hlorothiazide concomitantly with carbamazepine may develop hyponatraemia. Such patients should therefore be advised about the possibility of hyponatraemic reactions, and should be monitored accordingly.
Cholestyramine and cholestipol resins
Absorption of thiazide diuretics, including hydrochlorothiazide, is decreased by cholestyramine and other anionic exchange resins.
Ciclosporin
Concomitant treatment with ciclosporin may increase the risk of hyperuricaemia and gout-type complications.
Cytotoxic agents (e.g. cyclophosphamide, methotrexate)
Thiazides, including hydrochlorothiazide, may reduce the renal excretion of cytotoxic agents (e.g. cyclophosphamide, methotrexate) and potentiate their myelosuppressive effects.
Digitalis glycosides
Thiazide-induced hypokalaemia or hypomagnesaemia may occur as unwanted effects, favouring the onset of digitalis-induced cardiac arrhythmias.
Iodine contrasting agents
In case of diuretic-induced dehydration, there is an increased risk of acute renal failure, especially with high doses of iodine products. Patients should be re-hydrated before the administration.
Medicinal products affecting potassium (kaliuretic diuretics, corticosteroids, laxatives, ACTH, amphotericin, carbenoxolone, penicillin G, salicylic acid derivatives)
The hypokalaemic effect of hydrochlorothiazide may be increased by kaliuretic diuretics, corticosteroids, laxatives, adrenocorticotropic hormone (ACTH), amphotericin, carbenoxolone, penicillin G and salicylic acid derivatives. If these medicinal products are to be prescribed with the amlodipine /valsartan /hydrochlorothiazide combination, monitoring of potassium plasma levels is advised.
Medicinal products used in the treatment of gout (probenecid, sulfinpyrazone and allopurinol)
Dose adjustment of uricosuric medicinal products may be necessary as hydrochlorothiazide may raise the level of serum uric acid. Increase of dose of probenecid or sulfinpyrazone may be necessary.
Co-administration of thiazide diuretics, including hydrochlorothiazide, may increase the incidence of hypersensitivity reactions to allopurinol.
Methyldopa
There have been isolated reports of haemolytic anaemia occurring with concomitant use of hydrochlorothiazide and methyldopa.
Non-depolarising skeletal muscle relaxants (e.g. tubocurarine)
Thiazides, including hydrochlorothiazide, potentiate the action of curare derivatives.
Pressor amines (e.g. noradrenaline, adrenaline)
The effect of pressor amines may be decreased.
Vitamin D and calcium salts
Administration of thiazide diuretics, including hydrochlorothiazide, with vitamin D or with calcium salts may potentiate the rise in serum calcium.
No interaction
Exforge HCT individual component
Known interactions with the following agents
Effect of the interaction with other medicinal products
Valsartan
Others
(cimetidine, warfarin, furosemide, digoxin, atenolol, indometacin, hydrochlorothiazide, amlodipine, glibenclamide)
In monotherapy with valsartan, no interactions of clinical significance have been found with the following substances: cimetidine, warfarin, furosemide, digoxin, atenolol, indomethacin, hydrochlorothiazide, amlodipine, glibenclamide.
Some of these substances could interact with the hydrochlorothiazide component of Exforge HCT (see interactions related to HCT).
4. |
