Two reports describe serious hyperkalaemia, apparently caused by the concurrent use of trimethoprim and enalapril or quinapril, in association with renal impairment.
Trimethoprim or ACE inhibitors alone can cause hyperkalaemia, particularly with other factors such as renal impairment. Monitor potassium levels if this combin- ation is used in those with renal impairment. Note that co-trimoxazole is a combination preparation containing trimethoprim, and may therefore interact similarly. It has been suggested that patients with AIDS taking an ACE inhibitor for associated nephropathy should probably discontinue this treatment during treatment with high-dose co-trimoxazole.
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