Edad: 66 aos Sexo: mujer Peso: 72kg Diagnostico: hipertensin Diabetes Osteoporosis Reflujo gastroesofagico Hiperlipidemia RAM: edema

en las piernas Enrojecimiento en el cuello Dolor abdominal Exmenes: ultrasonido venoso bilateral: trombosis no oclusiva en la vena popltea izquierda Terapia medicamentosa: Nifedipino 50mg 1 vez al dia Enalapril 1omg una vez al dia Hidroclorotiazida 50mg una vez al dia Carbonato de calcio 2500mg una vez al dia Glipizida de liberacin controlada 5mg 1 vez al dia Metformina 500mg una vez al dia Otros: Trioval en forma irregualr durante 2 semanas 1 caja completa Disminuyo la dosis de metformina de 2 a 1 vez al dia sin indicacin medica por molestias gastricas

Efecto adversos:

Enalapril : Get emergency medical help if you have any of these signs of an allergic
reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

feeling light-headed, fainting; urinating more or less than usual, or not at all; fever, chills, body aches, flu symptoms; pale skin, easy bruising or bleeding;

fast, pounding, or uneven heartbeats; chest pain; or swelling, rapid weight gain.

Less serious side effects may include:

cough; loss of taste sensation, loss of appetite; dizziness, drowsiness, headache; sleep problems (insomnia); dry mouth; nausea, vomiting, diarrhea; or mild skin itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088. hydrochlorothiazide (Microzide)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

dry mouth, thirst, nausea, vomiting; feeling weak, drowsy, restless, or light-headed; fast or uneven heartbeat; muscle pain or weakness; numbness or tingly feeling; a red, blistering, peeling skin rash; or nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

diarrhea; mild stomach pain; constipation; or blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800FDA-1088. of nifedipine (Adalat CC)?

If you experience any of the following serious side effects, stop taking nifedipine and contact your doctor immediately or seek emergency medical treatment:

an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); unusually fast or slow heartbeats; severe dizziness or fainting; psychosis; yellowing of the skin or eyes (jaundice); or swelling of the legs or ankles.

Other, less serious side effects may be more likely to occur. Continue to take nifedipine and talk to your doctor if you experience

headache, fatigue, or tiredness; flushing; insomnia; vivid or abnormal dreams; nausea or constipation; or increased urination.

glipizide (Glucotrol)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Hypoglycemia, or low blood sugar, is the most common side effect of glipizide. Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, trouble concentrating, confusion, or seizure (convulsions). Watch for signs of low blood sugar. Carry a piece of non-dietetic hard candy or glucose tablets with you in case you have low blood sugar. Stop taking glipizide and call your doctor at once if you have a serious side effect such as:

easy bruising or bleeding (nosebleeds, bleeding gums), feeling tired or short of breath, rapid heart rate; pale or yellowed skin, dark colored urine, fever, confusion; or throbbing headache, severe nausea and vomiting, fast or pounding heartbeats, sweating or thirst, feeling like you might pass out.

Less serious side effects may include:

nausea, stomach pain; diarrhea, constipation; dizziness, drowsiness; or skin rash, redness, or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088. metformin (Fortamet)? Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Stop using metformin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

feeling short of breath, even with mild exertion; swelling or rapid weight gain; or fever, chills, body aches, flu symptoms.

Less serious side effects may include:

headache or muscle pain; weakness; or mild nausesa, vomiting, diarrhea, gas, stomach pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800FDA-1088. Carbonato de calico :

Adverse Effects
Most Frequent: Abdominal Swelling, Dysgeusia, Flatulence Less Frequent: Acute Abdominal Pain, Constipation, Nausea Rare: Alkalosis, Anorexia, Fecal Impaction, Hypercalcemia, Kidney Stone, Swelling of Ankles or Feet

pseudoephedrine? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using this medication and call your doctor at once if you have any of these serious side effects:

fast, pounding, or uneven heartbeat; severe dizziness, anxiety, restless feeling, or nervousness; easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms; or increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious side effects may include:

mild loss of appetite; warmth, tingling, or redness under your skin; feeling excited or restless; sleep problems (insomnia); or skin rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088. chlorpheniramine? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop taking chlorpheniramine and call your doctor at once if you have a serious side effect such as:

urinating less than usual or not at all; confusion, extreme drowsiness; severe dizziness, anxiety, restless feeling, nervousness; or weak or shallow breathing.

Less serious side effects may include:

mild dizziness, drowsiness; blurred vision; dry mouth; nausea, stomach pain, constipation; problems with memory or concentration; or restlessness or excitability (especially in children).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088. You may report side effects to FDA at 1-800-FDA-1088.

acetaminophen? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

low fever with nausea, stomach pain, and loss of appetite; dark urine, clay-colored stools; or jaundice (yellowing of the skin or eyes).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088.

Drug Interactions Results

Drug interactions for the following 8 drug(s):

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Drug List: caso 1

calcium carbonate chlorpheniramine enalapril glipizide hydrochlorothiazide metformin nifedipine Pseudoephedrine Sinus (acetaminophen/pseudoephedrine)

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Interactions between your selected drugs

pseudoephedrine metformin
Applies to: Pseudoephedrine Sinus (acetaminophen/pseudoephedrine), metformin MONITOR: The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and other diuretics, corticosteroids,

estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimetic amines, protease inhibitors, phenytoin, megestrol, danazol, isoniazid, asparaginase, pegaspargase, diazoxide, temsirolimus, sucralfate oral suspension, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, newonset diabetes mellitus, and/or exacerbation of preexisting diabetes. MANAGEMENT: Close clinical monitoring of glycemic control is recommended if these drugs are coadministered with antidiabetic agents. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen. Dose adjustments of the hypoglycemic agent may be required.

hydrochlorothiazide metformin
Applies to: hydrochlorothiazide, metformin MONITOR: Diuretic-induced renal impairment and dehydration may increase the risk of lactic acidosis in patients who are concomitantly taking metformin. In addition, thiazides and other diuretics may interfere with glucose control by causing hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes. MANAGEMENT: Close clinical monitoring is recommended if diuretics are coadministered with antidiabetic agents. Patients should be advised to monitor their blood glucose and to promptly notify their doctor if they experience possible signs of lactic acidosis (such as malaise, myalgia, respiratory distress, hyperventilation, slow or irregular heartbeat, somnolence, abdominal upset) or loss of glycemic control. Dose adjustments of metformin may be required. Likewise, patients should be observed for hypoglycemia if diuretics are withdrawn from their therapeutic regimen.

nifedipine metformin
Applies to: nifedipine, metformin MONITOR: Nifedipine may increase plasma concentrations of metformin by increasing the extent of absorption. Increased metformin levels may increase the risk of lactic acidosis. MANAGEMENT: If nifedipine and metformin must be used together, cautious titration of metformin dosage is recommended. Increased metformin levels may increase the risk of lactic acidosis. Patients should be advised to monitor their blood glucose and to promptly notify their physician if they experience possible signs of lactic acidosis such as malaise, myalgia, respiratory distress, hyperventilation, slow or irregular heartbeat, somnolence, abdominal upset, or other unusual symptoms.

enalapril metformin
Applies to: enalapril, metformin MONITOR: Limited data suggest that ACE inhibitors may potentiate the hypoglycemic effects of oral antidiabetic drugs, including metformin. The mechanism is unknown. Symptomatic and sometimes severe hypoglycemia has occurred. MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if ACE inhibitors are coadministered with metformin, particularly in patients with advanced age and/or renal impairment. Dosage adjustments may be required if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their physician if it occurs. Patients should be observed for loss of glycemic control when ACE inhibitors are withdrawn.

glipizide pseudoephedrine
Applies to: glipizide, Pseudoephedrine Sinus (acetaminophen/pseudoephedrine) MONITOR: The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and other diuretics, corticosteroids, estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimetic amines, protease inhibitors, phenytoin, megestrol, danazol, isoniazid, asparaginase, pegaspargase, diazoxide, temsirolimus, sucralfate oral suspension, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, newonset diabetes mellitus, and/or exacerbation of preexisting diabetes. MANAGEMENT: Close clinical monitoring of glycemic control is recommended if these drugs are coadministered with antidiabetic agents. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen. Dose adjustments of the hypoglycemic agent may be required.

hydrochlorothiazide calcium carbonate

Applies to: hydrochlorothiazide, calcium carbonate MONITOR: Coadministration of thiazide diuretics with high dosages of calcium and/or vitamin D has been associated with reports of hypercalcemia in some patients. Thiazide diuretics inhibit the renal excretion of calcium and may also enhance responsiveness of bone and renal tubule to parathyroid hormone, thus concurrent use of large amounts of calcium or vitamin D can lead to excessively high plasma levels of calcium. Patients who are particularly susceptible include those with hyperparathyroidism, those being treated for osteoporosis, and those receiving high dosages of vitamin D for hypoparathyroidism. Metabolic alkalosis

and the milk-alkali syndrome have been reported during prolonged therapy with thiazide diuretics and calcium. MANAGEMENT: Patients receiving thiazide diuretic therapy should be cautioned against self-treatment with calcium and vitamin D supplements without first talking to their healthcare provider. Serum calcium should be monitored if thiazide diuretics are coadministered with high dosages of calcium and/or vitamin D. Patients should be advised to seek medical attention if they experience signs and symptoms of hypercalcemia such as dizziness, weakness, lethargy, headache, myalgia, anorexia, nausea, vomiting, and seizures.

nifedipine calcium carbonate

Applies to: nifedipine, calcium carbonate MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity. MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

glipizide hydrochlorothiazide
Applies to: glipizide, hydrochlorothiazide MONITOR: The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and other diuretics, corticosteroids, estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimetic amines, protease inhibitors, phenytoin, megestrol, danazol, isoniazid, asparaginase, pegaspargase, diazoxide, temsirolimus, sucralfate oral suspension, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, newonset diabetes mellitus, and/or exacerbation of preexisting diabetes. MANAGEMENT: Close clinical monitoring of glycemic control is recommended if these drugs are coadministered with antidiabetic agents. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen. Dose adjustments of the hypoglycemic agent may be required.

enalapril hydrochlorothiazide
Applies to: enalapril, hydrochlorothiazide MONITOR: Although they are frequently combined in clinical practice, diuretics and angiotensin converting enzyme (ACE) inhibitors may have additive effects. Coadministration makes hypotension and hypovolemia more likely than does either drug alone. Some ACE inhibitors may attenuate the increase in the urinary

excretion of sodium caused by some loop diuretics. Some patients on diuretics, especially those on dialysis or a dietary salt restriction, may experience acute hypotension with lightheadedness and dizziness after receiving the first dose of the ACE inhibitor. In addition, ACE inhibitors may cause renal insufficiency or acute renal failure in patients with sodium depletion or renal artery stenosis. MANAGEMENT: Monitoring of blood pressure, diuresis, electrolytes, and renal function is recommended during coadministration. The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor, or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor. Alternatively, the patient may remain under medical supervision for at least two hours after the first dose of the ACE inhibitor, or until blood pressure has stabilized.

enalapril glipizide
Applies to: enalapril, glipizide MONITOR: The hypoglycemic effect of insulin secretagogues (e.g., sulfonylureas, meglitinides) may be potentiated by certain drugs, including ACE inhibitors, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs), nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinine, quinidine, and ginseng. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, fibrates, ginseng); stimulating insulin secretion (salicylates, NSAIDs, disopyramide, quinine, quinidine, MAOIs, ginseng); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor); slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin analogs). Or, they may increase plasma concentration of insulin secretagogues by displacing them from plasma protein binding sites and/or inhibiting their metabolism (fibrates, NSAIDs, salicylates, sulfonamides). Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases. MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin secretagogues, particularly in patients with advanced age and/or renal impairment. The oral antidiabetic dosage(s) may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their doctor if it occurs. Patients should be observed for loss of glycemic control when these drugs are withdrawn.

enalapril calcium carbonate

Applies to: enalapril, calcium carbonate Coadministration with antacids may decrease the oral bioavailability of captopril and other angiotensin converting enzyme (ACE) inhibitors due to delayed gastric emptying and/or elevated gastric pH. In 10 healthy volunteers, 50 mL of an antacid suspension decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of captopril (50 mg single oral dose) by 50% and 42%, respectively, compared to administration after fasting. The relative bioavailability of captopril was 0.66 with antacid, although its hypotensive activity did not seem to be affected. Based on available data, the clinical significance of this interaction appears to be minor. As a precaution, patients may want to consider separating the administration times of ACE inhibitors and antacids or oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution) by 1 to 2 hours.

enalapril nifedipine
Applies to: enalapril, nifedipine Calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors may have additive hypotensive effects. While these drugs are often safely used together, careful monitoring of the systemic blood pressure is recommended during coadministration, especially during the first one to three weeks of therapy.

No other interactions were found between your selected drugs.

Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with

calcium carbonate interacts with more than 100 other drugs. chlorpheniramine interacts with more than 200 other drugs. enalapril interacts with more than 200 other drugs. glipizide interacts with more than 300 other drugs. hydrochlorothiazide interacts with more than 300 other drugs. metformin interacts with more than 200 other drugs. nifedipine interacts with more than 300 other drugs. Pseudoephedrine Sinus (acetaminophen/pseudoephedrine) interacts with more than 100 other drugs.

Interactions between your selected drugs and food

enalapril food
Applies to: enalapril GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-

aldosterone-angiotensin (RAA) system. MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

nifedipine food
Applies to: nifedipine GENERALLY AVOID: The consumption of grapefruit juice may be associated with significantly increased plasma concentrations of some calcium channel blockers (CCBs) when they are administered orally. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. This interaction has been reported with the dihydropyridine CCBs (in roughly decreasing order of magnitude) felodipine, nisoldipine, nifedipine, and nimodipine, often with a high degree of inter-individual variability. Grapefruit juice resulted in more than twofold increases in felodipine, nifedipine, and nisoldipine AUCs. MANAGEMENT: The manufacturers of nifedipine and nisoldipine recommend avoiding grapefruit juice. Patients treated orally with other calcium channel blockers should be advised to avoid consumption of large amounts of grapefruits and grapefruit juice to prevent any undue fluctuations in serum drug levels. Increased effects on blood pressure may persist for up to 4 days after the consumption of grapefruit juice. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

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