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Do not use altace hctz ramipril if you have allergies to ramipril or to any other ace inhibitor, such as benazopril lotensin , fosinopril monopril , enalapril vasotec , lisinopril prinivil, zestril , moexipril univasc , perindopril aceon , captopril capoten , quinapril accupril , or trandolapril mavik .

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Such possibility should be considered as part of the differential diagnosis of the cough.

Neutropenia/AgranulocytosisAgranulocytosis and bone marrow depression have been caused by angiotensin converting enzyme inhibitorsSeveral cases of agranulocytosis and neutropenia have been reported in which a causal relationship to lisinopril cannot be excludedCurrent experience with the drug shows the incidence to be rarePeriodic monitoring of white blood cell counts should be consideredespecially in patients with collagen vascular disease and renal disease.

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.

Lisinopril may rarely cause seriouspossibly fatalliver problemsGet medical help right away if you have any symptoms of liver damagesuch asnausea/vomiting that doesn’t stoploss of appetitestomach/abdominal painyellowing eyes/skindark urine.

Agents Increasing Serum PotassiumSince lisinopril decreases aldosterone productionelevation of serum potassium may occurPotassium sparing diureticssuch as spironolactonetriamterene or amilorideor potassium supplements should be given only for documented hypokalemia and with caution and with frequent monitoring of serum potassium since they may lead to a significant increase in serum potassiumPotassium-containing salt substitutes should also be used with caution.

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