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Patients receiving ACE inhibitors during desensitisation treatmente.ghymenoptera venomhave sustained anaphylactoid reactionsIn the same patientsthese reactions have been avoided when ACE inhibitors were temporarily withheld but they reappeared upon inadvertent rechallenge.

Chronic administration of NSAIDselective cyclooxygenase-2 inhibitorsacetylsalicylic acid3 g/day and non-selective NSAIDsmay reduce the antihypertensive and diuretic effect of ACE inhibitors and thiazide diureticsNSAID and ACE inhibitors may exert an additive effect on the increase in serum potassium and may result in a deterioration of renal functionThese effects are usually reversibleRarelyacute renal failure may occurespecially in patients with compromised renal function such as the elderly or dehydrated.

Thiazides should be used with caution in patients with impaired hepatic function or progressive liver diseasesince minor alterations of fluid and electrolyte balance may precipitate hepatic comasee section 4.3RarelyACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant necrosis andsometimesdeathThe mechanism of this syndrome is not understoodPatients receiving lisinopril/hydrochlorothiazide who develop jaundice or marked elevations of hepatic enzymes should discontinue lisinopril/hydrochlorothiazide and receive appropriate medical follow-up.

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