Cimetidine tagamet ; clonidine catapres ; digitalis digoxin, lanoxin ; dobutamine dobutrex ; haloperidol haldol ; isoproterenol isuprel ; a blood thinner such as warfarin coumadin, jantoven ; an antidepressant such as amitriptyline elavil, vanatrip, limbitrol , clomipramine anafranil , desipramine norpramin , imipramine janimine, tofranil , and others; an mao inhibitor such as furazolidone furoxone , isocarboxazid marplan , phenelzine nardil , rasagiline azilect , selegiline eldepryl, emsam, zelapar , or tranylcypromine parnate ; aspirin or other nsaids non-steroidal anti-inflammatory drugs such as ibuprofen advil, motrin , naproxen aleve, naprosyn, naprelan, treximet , celecoxib celebrex , diclofenac arthrotec, cambia, cataflam, voltaren, flector patch, pennsaid, solareze , indomethacin indocin , meloxicam mobic , and others; doxazosin cardura , prazosin minipress , terazosin hytrin ; heart or blood pressure medicine such as amlodipine norvasc, caduet, exforge, lotrel, tekamlo, tribenzor, twynsta, amturnide , diltiazem cartia, cardizem , nifedipine nifedical, procardia , reserpine serpasil , verapamil calan, covera, isoptin, verelan , and others; amiodarone cordarone, pacerone , propafenone rythmol , quinidine quin-g ; or an ace inhibitor such as benazepril lotensin , captopril capoten , fosinopril monopril , enalapril vasotec , lisinopril prinivil, zestril , moexipril univasc , perindopril aceon , quinapril accupril , ramipril altace , or trandolapril mavik .
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In patients with congestive heart failurehypotension occurred in 5.2and syncope occurred in 1.7of patientsHypotension and dizziness were causes for discontinuation of therapy in 1.7of these patients.
Human DataIt is not known whether exposure limited to the first trimester of pregnancy can adversely affect fetal outcomeThe use of ACE inhibitors during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury including hypotensionneonatal skull hypoplasiaanuriareversible or irreversible renal failureand deathOligohydramnios has also been reportedpresumably resulting from decreased fetal renal functionoligohydramnios in this setting has been associated with fetal limb contracturescraniofacial deformationand hypoplastic lung developmentPrematurity and patent ductus arteriosus have also been reportedalthough it is not clear whether these occurrences were due to the ACE inhibitor exposure.
If oligohydramnios is observedlisinopril should be discontinued unless it is considered lifesaving for the motherA non-stress testNSTand/or a biophysical profilingBPPmay be appropriatedepending upon the week of pregnancyIf concerns regarding fetal well-being still persista contraction stress testingCSTshould be consideredPatients and physicians should be awarehoweverthat oligohydramnios may not appear until after the fetus has sustained irreversible injury.
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