57
Table 17. Pharmacodynamic Drug-Drug Interactions With
Antihypertensive Medications
Drug Combinations Clinical Effect
Cautionary interactions
Any antihypertensive
medication
NSAIDs Reduced BP lowering via sodium
retention
Sympathomimetic
(eg, pseudoephedrine,
dextroamphetamine)
Reduced BP lowering
Venlafaxine Reduced BP lowering
Nondihydropyridine
CCB
Beta blockers Bradycardia or atrioventricular block
ACEi ARBs AKI, hyperkalemia
Potassium-
sparing diuretics
(Spironolactone,
eplerenone,
triamterene, amiloride)
Hyperkalemia
Sulfamethoxazole/
trimethoprim
Hyperkalemia
Potassium supplements Hyperkalemia
NSAIDs (eg,
ibuprofen, naproxen)
AKI
Clonidine, methyldopa,
guanfacine
CNS depressants (eg,
zolpidem, alprazolam)
Sedation
Clonidine Noncardioselective
BB (eg, nadalol or
propranolol)
Unopposed alpha agonism upon BB
withdrawal leading to hypertensive crisis
Advantageous interactions
Dihydropyridine CCB RAS inhibitor Reduced risk of dihydropyridine
CCB-induced lower leg swelling
RAS inhibitors Diuretics Balanced effects on serum potassium
levels with diminished possibility
for hypokalemia (with diuretic) or
hyperkalemia (with RAASi)
RAS inhibitors Potassium binder Lowers risk of hyperkalemia from the
RAS inhibitor
Diuretic Potassium supplement Lowers risk of hypokalemia from the
diuretic
AKI, acute kidney injury; CNS, central nervous system; RAASi, renin-angiotensin aldosterone
inhibitor; and RAS, renin-angiotensin system.
Modified with permission from Fravel et al. Copyright © 2021 Springer Nature.
