ALPHA BLOCKERS AND ANGIOTENSIN II RECEPTOR ANTAGONISTS

Severe first-dose hypotension, and synergistic hypotensive effects have occurred in patients given alpha blockers with ACE inhibitors. Angiotensin II receptor antagonists are predicted to interact similarly.
Acute hypotension (dizziness, fainting) sometimes occurs unpredictably with the first dose of some alpha blockers (particularly alfuzosin, prazosin and terazosin), and this can be exaggerated by other antihypertensives. Angiotensin II receptor antagonists would be expected to have a similar effect. Minimise the risk by starting with a low dose of alpha blocker, preferably given at bedtime, and escalate the dose slowly over a couple of weeks. Patients should be warned to lie down if symptoms such as dizziness, fatigue or sweating develop, and to remain lying down until symptoms abate.
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