Indomethicin and other NSAIDs may blunt antihypertensive effect.

Diuretics enhance antihypertensive effect.

Increase lithium levels and may cause lithum toxicity

Hyperkalemia with K and K sparing diuretics.

Risk of bone marrow suppression due to enalapril increased with concomittant use of immunosuppressives

Refractory hypertension

Angioneurotic odema, nausea, headache,

cough, dizziness, fatigue, palpitations,

chest pain, fatigue, rash, Increase in BUN ,

serum K and creatinine levels may occur. Neutropenia,

Hypersentivity to drug or components

history of angioedema, related to exposure to ACE inhibitor

Pregnancy

Special precautions-

Lactation

Renal & hepatic disease.

Congestive heart failure,

comcomittant K supplements & pot -conserving diuretics

Hypovalenic shock, diuretic therapy Periodic blood count monitoring to proclude neutropenia or agranulocytosis.

Indication

Refractory hypertension

Dosage

1 tab contains enalapril mal 5mg & amlodipine besyl 5mg- start with 1 tablet daily increase gradually acoording to response.

Elderly- 1/2 tab to start with and built up gradually with caution

Diuretics should be withheld forv2-3 days before starting combination.

Take with or without food
 

Take with or without food
 

Use contraindicated during pregnancy and lactation