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Dual blockade of the renin-aldosterone system (RAAS): The combination of telmisartan with aliskiren is contraindicated in patients with diabetes mellitus or renal impairment (GFR<60ml/min/1.73m2) and is not recommended in other patients.
Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin converting enzyme inhibitors. Rare cases have also been reported with angiotensin II receptor antagonists. Co-administration of lithium and Telmisartan and Hydrochlorothiazide tablets is not recommended. If this combination proves essential, careful monitoring of serum lithium level is recommended during concomitant use.
Digitalis glycosides: Thiazide-induced hypokalaemia or hypomagnesaemia favours the onset of digitalis-induced arrhythmia.
Non-steroidal anti-inflammatory medicinal products: NSAIDs (i.e., acetylsalicylic acid at anti-inflammatory dosage regimens, COX-2 inhibitors and non-selective NSAIDs) may reduce the diuretic, natriuretic and antihypertensive effects of thiazide diuretics and the anti-hypertensive effects of angiotensin II receptor antagonists.
Beta-blockers and diazoxide: The hyperglycaemic effect of beta-blockers and diazoxide may be enhanced by thiazides.
Anticholinergic agents (e.g., atropine, biperiden) may increase the bioavailability of thiazide- type diuretics by decreasing gastrointestinal motility and stomach emptying rate. Furthermore, orthostatic hypotension may be aggravated by alcohol, barbiturates, narcotics or antidepressants.
