Hyperkalaemia may occur especially in elderly, patients w/ renal insufficiency & diabetic. Concomitant use w/ K-sparing diuretics, salt substitutes containing K or other medical products that may increase K level (eg, ACE inhibitors, AIIAs, NSAIDs, heparin, immunosuppressives, trimethoprim). Renovascular HTN. Symptomatic hypotension in vol &/or Na-depleted patients. Dual blockade of renin-angiotensin-aldosterone system (eg, adding ACE inhibitor or direct renin-inhibitor aliskiren to ARBs) is not recommended. Other conditions w/ stimulation of the renin-angiotensin-aldosterone system (eg, patients w/ severe CHF or underlying renal disease, including renal artery stenosis). Not recommended in patients w/ primary aldosteronism. Patients suffering from aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy, diabetic patients treated w/ insulin or antidiabetics. Patients w/ rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Possible MI or stroke in patients w/ ischaemic cardiopathy or CV disease due to excessive reduction of BP. Not to be given in patients w/ cholestasis, biliary obstructive disorders & severe hepatic impairment. Periodically monitor K & creatinine serum levels in patients w/ impaired renal function. Mild to moderate hepatic impairment. Not recommended during pregnancy (1st trimester) & lactation. Less effective in lowering BP in black people.
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