This warning is issued to doctors in the BNF:
Concomitant use of drugs affecting the renin-angiotensin system
The MHRA has issued new guidance that combination therapy with two drugs that affect the renin-angiotensin system (ACE inhibitors, angiotensin-II receptor antagonists, and aliskiren) is not recommended due to an increased risk of hyperkalaemia, hypotension, and renal impairment, compared to use of a single drug. There is some evidence that the benefits of combination use of an ACE inhibitor with candesartan or valsartan may outweigh the risks in selected patients with heart failure for whom other treatments are unsuitable, however, the concomitant use of this combination, together with an aldosterone antagonist or a potassium-sparing diuretic is not recommended. For patients currently taking combination therapy, the need for continued combined therapy should be reviewed.
Derek, does that just apply to Candesartan and Valsartan as in the headingin the MHRA warning? Is it a recent warning?
If I've read it correctly, I'm very concerned. I'm on Losartan plus the potassium sparing diuretic, Indapamide, and I have reduced kidney function. I am under a renal consultant for my blood pressure but not due to see him until September. Have only just started the diuretic so now wondering if I should stop it. Decisions, decisions!
It is in the August edition of BNF. It does not mention Losartan so that should be OK.
It would just be the combination of drugs like perindopril, captopril, enalapril, lisinopril, and ramipril with Candesartan and Valsartan.
Thanks so much for your reply with the reassurance, Derek - haven't much time to research it myself at the moment - very busy for the next week or so. Thanks so much for posting this information in the first place. Good to be forewarned.
Derek. Can you please tell me if the information you gave applies to my husband's prescription for the combination of Losartan and Felodipine for high blood pressure. Fortunately no diuretic .He also takes Pantoprazole and Simvastatin. Quite a cocktail! Thank you.
Slightly concerned wife
Losartan and Felodipine are not mentioned in the BNF warning so would be OK.
Anyway, Felodipine an oral calcium- channel blocker.
I just quoted the warning so that any on the combination could check with their pharmacist or GP.
Thanks for your speedy reply. One doesn't quite know what drug does what these days! Thanks again.
Have a look at the British Heart Foundation site. They have a lot of helpful publications.
https://www.bhf.org.uk/