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Chronic administration of NSAIDselective cyclooxygenase-2 inhibitorsacetylsalicylic acid3 g/day and non-selective NSAIDsmay reduce the antihypertensive and diuretic effect of ACE inhibitors and thiazide diureticsNSAID and ACE inhibitors may exert an additive effect on the increase in serum potassium and may result in a deterioration of renal functionThese effects are usually reversibleRarelyacute renal failure may occurespecially in patients with compromised renal function such as the elderly or dehydrated.

Thiazides may decrease arterial responsiveness to noradrenalinebut not enough to preclude effectiveness of the pressor agent for therapeutic use.

Hydrochlorothiazide and lisinopril can pass into breast milk and may harm a nursing babyTell your doctor if you are breast-feeding a baby.

In some patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidneywho have been treated with ACE inhibitorsincreases in blood urea and serum creatinineusually reversible upon discontinuation of therapyhave been seenThis is especially likely in patients with renal insufficiencyIf renovascular hypertension is also present there is an increased risk of severe hypotension and renal insufficiencyIn these patientstreatment should be started under close medical supervision with low doses and careful dose titrationSince treatment with diuretics may be a contributory factor to the aboverenal function should be monitored during the first few weeks of lisinopril/hydrochlorothiazide therapy.

Thiazide induced hypokalaemia can increase the risk of sotalol induced arrhythmia.

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