An Overview of Clinically Imperative and Pharmacodynamically Signifi-cant Drug Interactions of Renin-Angiotensin-Aldosterone System (RAAS) Blockers

Introduction: Hypertension is a leading cause of cardiovascular disease and chronic kidney disease, resulting in premature death and disability. The Renin-Angiotensin-Aldosterone System (RAAS) blockers, including Angiotensin-Converting Enzyme (ACE) inhibitors or Angio-tensin Receptor Blockers (ARBs), are used as first-line antihypertensive therapy to treat hyperten-sive patients with comorbidities, including diabetes, ischemic heart disease, heart failure, and chronic kidney disease. The use of RAS blockers is associated with the risks, such as hyperkale-mia, angioedema, etc. The drugs potentiating them interact pharmacodynamically, resulting in adverse consequences. This review article focuses on the clinically important drug interactions of RAAS blockers. Materials and Methods: The electronic databases, such as Medline/PubMed Central/PubMed, Google Scholar, ScienceDirect, Cochrane Library, Directory of Open Access Journals (DOAJ), Embase, and reference lists were searched to identify relevant articles. Results: The risk of hyperkalemia may be enhanced potentially in patients receiving a RAS block-er and potassium-sparing diuretics, potassium supplements, trimethoprim, adrenergic beta-blockers, antifungal agents, calcineurin inhibitors, pentamidine, heparins or an NSAID, concomi-tantly. The patients taking ACE inhibitors and mTOR inhibitors, DPP4 inhibitors, alteplase, or sacubitril/valsartan concurrently may be at increased risk of developing angioedema. Conclusion: Clinicians, pharmacists, and other healthcare practitioners should be accountable for medication safety. To avoid adverse implications, prescribers and pharmacists must be aware of the drugs that interact with RAAS blockers.