Ace and arb used together?

[icekitsune]

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Have you guys seen lisinopril and losartan used together.I saw two different md write for it and pt had it before. I just find it weird. I can't find anything on it being used together, but the patient had both at the same time in prior fills. not sure if a call is needed.

 

[owlegrad]

Pharmacist Letter has an excellent article about this topic as I recall. Basically no, there is no evidence for their use together. There might have been very specific circumstances that merit consideration, I don't recall.

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[PharmDBro2017]

Duplicate therapy, no.

Yes, you need to call and explain.

 

[CetiAlphaFive]

Have you guys seen lisinopril and losartan used together.I saw two different md write for it and pt had it before. I just find it weird. I can't find anything on it being used together, but the patient had both at the same time in prior fills. not sure if a call is needed.

Owl is right.
You have to consider Risk to Benefit ratio. If the benefit to taking both at the same time is ZERO, what can you conclude?

The pharmacists that ignored ACE + ARB will more than likely ignore it when the physician adds on HCTZ, and they develop Nuclear Kidney Syndrome, it'll all be pinned on YOOOUUUU

 

[mik30102]

Definitely not, study was stopped early as the patients on both had increased risk of death.

 

[zelman]

ARB manufacturers were pushing this for a little while (I believe it was in diastolic hypertension, specifically). After some docs going with it for a bit, the data just didn't support continuing the practice.

A friend of mine likened the practice to shooting a horse (ACE-I) and then building a fence around it (ARB) to keep it from running away.

 

[pharmrx33]

OnTarget trial if you need ammo. Telmisartan and Ramipril. Had reduced proteinuria, but as aforementioned increase mortality.

 

[Rockinacoustic]

Have you guys seen lisinopril and losartan used together.I saw two different md write for it and pt had it before. I just find it weird. I can't find anything on it being used together, but the patient had both at the same time in prior fills. not sure if a call is needed.

How can you not find any info on this topic? There are numerous studies let alone articles that pop up from a simple google search.

I hope you are an intern.

 

[ldiot]

Probably a PCP trying to manage CKD... and even in that case the combo is still not appropriate. Increased side effects at no benefit, just the ACE-I is good. I'd just ask the patient. I can't think of any reason to use it for HTN either.

 

[PharmDBro2017]

How can you not find any info on this topic? There are numerous studies let alone articles that pop up from a simple google search.

I hope you are an intern.

Don't give us interns a bad name brah.

 

[Pharmacy Kid]

Probably an old-school doctor writing for it. I remember when I was a student back in the day nephrologists would write for ACE + ARB. Then after the VA NEPHRON-D trial, it basically stopped.

 

[sosoo]

does the pt has any adverse reactions? how is his blood pressure going? this is more important then calling a clueless MD. ... Remember, theres a chance when his BP spike n he needs to take both meds! other times he may usually just take 1.

 

[Old Timer]

does the pt has any adverse reactions? how is his blood pressure going? this is more important then calling a clueless MD. ... Remember, theres a chance when his BP spike n he needs to take both meds! other times he may usually just take 1.

Until he dies. There is no proof of greater efficacy and you have good, large well controlled studies that show higher mortality with this combination. It works well until they die. I tend to err on the side of anything that increased mortality does not get my recommendation.....

 

[ldiot]

does the pt has any adverse reactions? how is his blood pressure going? this is more important then calling a clueless MD. ... Remember, theres a chance when his BP spike n he needs to take both meds! other times he may usually just take 1.

If BP is the sole reason he's on the combo (which I doubt, probably CKD) then put him on an ACE-I + CCB/Thiazide... or just increase the dose of the ACE-I. If he has CKD and controlled BP just get rid of the ARB and re-evaluate BP in 2-4 weeks.