Warnings for special population
Pregnancy
This medicine is not recommended for use in pregnant women except in life-threatening conditions. All the risks and benefits should be discussed with the doctor before taking this medicine. Your doctor may prescribe a safer alternative based on your clinical condition.
Breast-feeding
This medicine is not recommended for use in breastfeeding women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine. Your doctor may advise you to discontinue breastfeeding or to discontinue the drug based on your clinical condition.
General warnings
Hypotension
Symptomatic hypotension may occur in patients with volume depletion or patients who are treated with high doses of diuretics. It is advised to correct the condition before beginning treatment with this medicine.
Hyperkalemia
This medicine may increase the potassium levels in the blood (hyperkalemia). This may cause serious side effects such as fatal cardiac rhythm irregularities. It is advised to avoid potassium-rich foods (potatoes, bananas) and other medicines that may increase potassium levels (potassium-sparing diuretics and potassium supplements) during treatment with this medicine.
Impaired liver function
This medicine should be used with caution in patients suffering from liver diseases due to the increased risk of serious adverse effects. Close monitoring of liver function is recommended during treatment with this medicine. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Pediatric population
This medicine is not recommended for use in children since the safety and efficacy of use are not clinically established.
Major surgery
This medicine should be used with extreme caution in patients undergoing a major surgery due to the increased risk of severe adverse effects. Close monitoring of heart function is recommended for such patients. An appropriate anesthetic agent should be chosen to minimize the interaction as well as side effects.
Heart failure
This medicine should be used with caution in patients suffering from heart diseases due to the increased risk of heart failure. Close monitoring of heart function is recommended for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required based on the clinical condition.
Ischemic heart disease
This medicine is not recommended for use in patients with ischemic heart disease unless specified by the doctor. Since the risk of significant adverse effects is high in such patients on abrupt discontinuation of this medicine, your doctor will determine the appropriate course based on your clinical condition.
Lung diseases
This medicine is not recommended for use in patients suffering from obstructive lung diseases such as bronchial asthma, bronchospasm, or Chronic Obstructive Pulmonary Disease since it may worsen the patient's condition. Replacement with a suitable alternative should be considered under your doctor's supervision.
Diabetes
This medicine should be used with caution in patients suffering from diabetes due to the increased risk of very low blood sugar levels. Close monitoring of blood sugar levels is recommended for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.
Hyperthyroidism
This medicine should be administered with caution in patients suffering from hyperthyroidism since it may mask some of the patient's symptoms. Report any unusual symptoms to the doctor immediately. Close monitoring of thyroid hormone levels is recommended for such patient. Replacement with a suitable alternative may be required based on the clinical condition.
Peripheral vascular diseases
This medicine should be used with caution in patients suffering from peripheral vascular diseases since it may worsen the patient's condition. Report any unusual symptoms to the doctor immediately. Replacement with a suitable alternative may be required in some cases based on the clinical condition.
Other medicines
This medicine may interact with many other medicines and may cause serious adverse effects. It is advised that you report to the doctor all your current medicines including any herbs and supplements before beginning treatment with this medicine.
Impaired renal function
This medicine should be used with caution in patients suffering from kidney diseases due to the increased risk of serious adverse effects. Close monitoring of kidney function is recommended during treatment with this medicine. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Driving and operating machines
This medicine may cause dizziness or drowsiness in some patients. It is advised that you do not perform any activities that require high mental alertness like driving a vehicle or operating machinery if you experience these symptoms during treatment with this medicine.