Editing ACE inhibitor (section)

==Contraindications and precautions==
The ACE inhibitors are contraindicated in people with:{{citation needed|date=August 2024}}
* Pregnancy or breastfeeding
* Previous [[angioedema]] associated with ACE inhibitor therapy
* Bilateral renal artery stenosis<ref>{{cite web |title=ACE I |url=https://www.cvpharmacology.com/vasodilator/ACE |website=cvpharmacology}}</ref><ref name="ACEI contraindications">{{cite web |title=ACEI contraindications |url=https://www.openanesthesia.org/ace-i_contraindication/ |website=Open Anesthesia}}</ref>
* Hypersensitivity to ACE inhibitors<ref name="ACEI contraindications"/>

ACE inhibitors should be used with caution in people with:{{citation needed|date=August 2024}}
* Impaired renal function
* [[Aortic valve stenosis]] or cardiac outflow obstruction
* [[Hypovolemia]] or [[dehydration]]
* [[Hemodialysis]] with high-flux polyacrylonitrile membranes

A combination of ACE inhibitor with other drugs may increase effects of these drugs, but also the risk of adverse effects.<ref name="Sidorenkov & Navis 2014"/> The commonly reported adverse effects of drug combination with ACE inhibitor are acute renal failure, hypotension, and hyperkalemia. The drugs interacting with ACE inhibitor should be prescribed with caution. Special attention should be given to combinations of ACE inhibitor with other RAAS blockers, [[diuretics]] (especially potassium-sparing diuretics), NSAIDs, [[anticoagulants]], [[cyclosporine]], [[DPP-4 inhibitors]], and [[potassium supplements]].

Potassium supplementation should be used with caution and under medical supervision owing to the [[hyperkalemia|hyperkalemic]] effect of ACE inhibitors.<ref name="pmid11044229">{{cite journal | vauthors = Bakris GL, Siomos M, Richardson D, Janssen I, Bolton WK, Hebert L, Agarwal R, Catanzaro D | title = ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group | journal = Kidney International | volume = 58 | issue = 5 | pages = 2084–2092 | date = November 2000 | pmid = 11044229 | doi = 10.1111/j.1523-1755.2000.00381.x | doi-access = free }}</ref>

Concomitant use with [[cyclooxygenase inhibitor]]s tends to decrease ACE inhibitor's hypotensive effect.<ref name="Sear 2019 pp. 535–555">{{cite book |  vauthors = Sear JW | title=Pharmacology and Physiology for Anesthesia | chapter=Antihypertensive Drugs and Vasodilators | publisher=Elsevier | year=2019 | isbn=978-0-323-48110-6 | doi=10.1016/b978-0-323-48110-6.00026-0 | pages=535–555| s2cid=220688413 |quote=Coadministration of nonsteroidal anti-inflammatory drugs (NSAIDs [cyclooxygenase inhibitors]) can reduce the hypotensive effects of ACE inhibitors. ACE inhibitors can inhibit the excretion of lithium and can result in lithium toxicity. Because these drugs do not affect the breakdown of kinins (as is seen with the ACE inhibitors), patients do not develop episodes of coughing and rarely develop angioneurotic edema.}}</ref><ref name="Byrd Ram Lerma 2019 pp. 477–482 II">{{cite book | vauthors = Byrd JB, Ram CV, Lerma EV | title=Nephrology Secrets | chapter=Pharmacologic treatment of hypertension | publisher=Elsevier | year=2019 | isbn=978-0-323-47871-7 | doi=10.1016/b978-0-323-47871-7.00078-2 | pages=477–482 | s2cid=263490929 | quote=Angioedema (0.7%) can also occur via pathobiology that remains obscure, and its occurrence can be life-threatening.  ...their efficacy is reduced by dietary or other sources of sodium, and renal function may be further threatened if given with NSAIDs.}}</ref>