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Because of the risk of hypokalaemia the concomitant administration of hydrochlorothiazide and medicinal products that induce torsades de pointese.gsome antiarrhythmicssome anti-psychotics and other drugs known to induce torsades de pointesshould be used with caution.
Thiazides should be used with caution in patients with impaired hepatic function or progressive liver diseasesince minor alterations of fluid and electrolyte balance may precipitate hepatic comasee section 4.3RarelyACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant necrosis andsometimesdeathThe mechanism of this syndrome is not understoodPatients receiving lisinopril/hydrochlorothiazide who develop jaundice or marked elevations of hepatic enzymes should discontinue lisinopril/hydrochlorothiazide and receive appropriate medical follow-up.
The diuretic therapy should be discontinued for 2-3 days prior to initiation with lisinopril/hydrochlorothiazideIf this is not possibletreatment should be started with lisinopril alonein a 5 mg dose.
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