Major
Captopril × telmisartan
ACE inhibitor×Angiotensin II receptor blocker (ARB)
Mechanism
Dual RAAS blockade (ACE-I + ARB). The ONTARGET trial showed increased hyperkalaemia, hypotension, and acute kidney injury without outcome improvement. Contraindicated in most clinical situations.
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 (captopril) if tolerated, ARB (telmisartan) if there is a dry cough.
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.
Sources
- ONTARGET Investigators: Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events (2008)– N Engl J Med 2008;358(15):1547–1559