Warnings for special population
Pregnancy
This medicine is not recommended for use in pregnant women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine.
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.
General warnings
Hypotension
This medicine should be used with extreme caution in patients suffering from aortic stenosis due to the increased risk of very low blood pressure. Close monitoring of blood pressure is recommended for such patients. An alternative treatment option should be considered in some cases based on the clinical condition.
Liver Disease
This medicine should be used with extreme caution in patients having an impaired liver function due to the increased risk of adverse effects. Regular monitoring of liver function tests is necessary for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Use in Children
This medicine is not recommended for use in patients below 18 years of age since the safety and efficacy of use are not clinically established.
Heart attack
This medicine should be used with caution while starting or increasing the dose in patients with coronary artery diseases as it may worsen the symptoms of a heart attack.
Drug Withdrawal
Abrupt discontinuation of this medicine may increase the risk of increased chest pain (angina). A gradual dose reduction is recommended to avoid these reactions. Do not stop the use of this medicine without consulting your doctor.
Ischemic Heart Disease
This medicine should not be discontinued abruptly in patients with Ischemic heart disease. The dosage should be gradually reduced over a period of 1 to 2 weeks.
Pheochromocytoma
This medicine should be administered with extreme caution in patients suffering from pheochromocytoma, a condition which results in an excess of a substance that controls heartbeat and blood pressure. Appropriate corrective measures, dose adjustments, or replacement with a suitable alternative may be necessary based on the clinical condition.
Major surgery
This medicine should be given with caution to patients who are going to undergo major surgery. The dose should be very carefully monitored in such cases both before and after the surgical procedure.
Diabetes and Hypoglycemia
This medicine should be administered with caution in patients having elevated blood sugar levels. This medicine may mask certain symptoms of hypoglycemia which may cause serious adverse effects.
Thyrotoxicosis
This medicine should be administered with caution in patients having elevated thyroid hormone levels. Some adverse effects may not be evident in these cases and abrupt stopping of this medicine may cause an abnormal rise in thyroid hormones.
Peripheral Vascular Diseases
This medicine should be used with caution in patients having narrowed blood vessels in the body due to any underlying reason. Dose adjustment and safety monitoring might be required in such cases.
Other Medicines
This combination medicine may interact with many other medicines and may cause severe adverse effects. Hence, it is advised that you inform the doctor about all your current medicines including any herbs and supplements before beginning treatment with this medicine.
Sports
It is advised to not indulge in certain sports while this medicine is consumed. Archery, racing, shooting and other high-risk sports should be avoided. Sports-persons should refer to the list of medicine published by World Anti-Doping Agency which is not to be taken while participating in specific sports events.
Hyperkalemia
This medicine may increase 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 (ACE inhibitors and potassium supplements) during treatment with this medicine. Appropriate corrective measures, dose adjustments, or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Driving or Operating machinery
Use of this medicine may cause drowsiness or dizziness in some patients. It is advised that you do not perform any activities that require high mental alertness like driving a vehicle or operating heavy machinery if you experience any of these symptoms during treatment with this medicine.