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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.

Other drugs may interact with hydrochlorothiazide and lisinoprilincluding prescription and over-the-counter medicinesvitaminsand herbal productsTell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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

In some patients with heart failure who have normal or low blood pressureadditional lowering of systemic blood pressure may occur with lisinoprilThis effect is anticipated and is not usually a reason to discontinue treatmentIf hypotension becomes symptomatica reduction of dose or discontinuation of lisinopril-hydrochlorothiazide may be necessary.

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