benazepril and hydrochlorothiazide, Lotensin HCT (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
There have been reports that aspirin and other NSAIDs such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and many others), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.
When taken with lithium (Eskalith, Lithobid), benazepril can increase lithium to toxic levels in the blood.
Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including benazepril. Hydrochlorothiazide reduces the elimination of lithium (Lithobid, Eskalith) by the kidneys and can lead to lithium toxicity. Nonsteroidal anti-inflammatory drugs, for example, ibuprofen, may reduce the blood pressure lowering effects of hydrochlorothiazide. Blood sugar levels can be elevated by HCTZ necessitating adjustments in the doses of medications that are used for treating diabetes.
Combining HCTZ with corticosteroids may increase the risk for low levels of blood potassium and other electrolytes. Low blood potassium can increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by 43% to 85%.
PREGNANCY: When used in the second or third trimester of pregnancy ACE inhibitors can cause injury and even death to the fetus. Lotensin HCT should not be used during pregnancy.
NURSING MOTHERS: Both benazepril and HCTZ are excreted in breast milk and may potentially affect nursing infants.
SIDE EFFECTS: Lotensin HCT has side effects of its individual components. The most common side effects are dizziness, fatigue, low blood pressure, rash, muscle pain, stomach upset, sexual dysfunction, and decreased or increased potassium blood levels.
A dry, persistent cough has been reported with the use of benazepril and other ACE inhibitors. Coughing resolves after discontinuing the medication.
In rare instances, liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors. Benazepril should not be taken by people with a known allergy to ACE inhibitors. Swelling of the facial tissues and even the upper airways has been reported with ACE inhibitors on very rare occasions, and can lead to serious breathing difficulties.
Benazepril may reduce kidney function in some patients and should not be used by patients who have bilateral renal artery stenosis (narrowing of both arteries supplying the kidneys). Rare cases of rhabdomyolysis (muscle breakdown), reduced number of platelets, and pancreatitis have been reported. Hydrochlorothiazide may increase blood glucose levels.
Reference: FDA Prescribing Information
Last Editorial Review: 11/12/2012
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