Kanarb Drug Interactions

Potassium supplements and potassium-sparing diuretics: Serum potassium can be increased by Kanarb Tablets and other drugs that exert effects on the renin-angiotensin system when co-administered with potassium-sparing diuretics (e.g., spironolactone), potassium supplements, salt alternatives containing potassium, and drugs that may increase serum potassium (e.g., heparin).
The blood pressure-lowering effect of Kanarb Tablets can be increased when co-administered with other antihypertensive agents, including diuretics. When high doses of diuretics were used previously, leading to a volume-depleted state, excessive blood pressure reduction may occur with the initiation of Kanarb Tablets treatment.
Lithium: Reversible increases in serum lithium levels and toxicities have been reported when lithium was used with angiotensin converting enzyme inhibitors whereas those reactions have been very rarely reported in case that angiotensin II receptor antagonist were co-administered with lithium. Although co-administration of lithium with Kanarb Tablets is not generally recommended, should it be necessary, close monitoring of lithium levels is required.
Non-steroidal anti-inflammatory drugs (NSAIDs): When an NSAID (e.g., aspirin, COX-2 inhibitors) is co-administered, the blood pressure-lowering effect of an angiotensin II receptor antagonist may be reduced. Deterioration of damaged renal function (including acute renal failure, although reversible,) has been reported when an angiotensin II receptor antagonist is co-administered with a COX inhibitor in some patients with renal impairment (e.g., dehydrated patients and renally impaired elderly patients). Therefore, caution needs to be exercised when co-administering Kanarb Tablets with NSAIDs, especially in elderly patients. Adequate hydration is required in this case, and the renal function should be closely monitored.
Hydrochlorothiazide: No significant pharmacokinetic drug interaction between Kanarb Tablets and hydrochlorothiazide was found when co-administered.
Amlodipine: No significant pharmacokinetic drug interaction between Kanarb Tablets and amlodipine was found when co-administered.
Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. In general, avoid combined use of RAS inhibitors. Do not co-administer aliskiren with Kanarb Tablets in patients with diabetes or renal impairment (GFR <60 mL/min). Co-administer ACE inhibitor with Kanarb Tablets is not recommended and avoids use of ACE inhibitor with Kanarb Tablets in patients with diabetic nephropathy.
The effects of other drugs on Kanarb Tablets: Ketoconazole: The systemic exposure of Kanarb Tablets, as measured by the area under the concentration-time curve (AUC), was increased approximately by two times when co-administered with ketoconazole. Caution needs to be exercised when Kanarb Tablets is co-administered with ketoconazole.
Rifampicin or other OATP1B1 transporter inhibitors: Kanarb Tablets is a substrate of OAT1 and OATP1B1. When Kanarb Tablets is co-administered with rifampicin (OATP1B1 inhibitor), the AUC of Kanarb Tablets was increased approximately by 4.6-fold. Therefore, co-administration of Kanarb Tablets with rifampicin is not recommended. When co-administered with other OATP1B1 transporter inhibitors (e.g., cyclosporine), the systemic exposure of Kanarb Tablets may increase, and caution is required.
The effects of Kanarb Tablets on other drugs: Warfarin: The pharmacokinetics and pharmacodynamics of warfarin were not significantly affected by co-administered Kanarb Tablets.
Atorvastatin: The AUC's of atorvastatin and its active metabolite were not affected by co-administered Kanarb Tablets. Maximum plasma concentrations (Cmax) of atorvastatin and its active metabolite were increased by 1.9-fold and 2.5-fold, respectively.
Digoxin: The pharmacokinetics and creatinine clearance of digoxin was not affected by co-administered Kanarb Tablets. Cmax of digoxin was increase by 30%. Close monitoring of digoxin level may be required when co-administered with Kanarb Tablets.
Other drug interactions: Kanarb Tablets does not inhibit or induce the CYP450 enzymes.