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● Never combine angiotensin converting enzyme inhibitors with angiotensin receptor blockers (more hypotensive episodes, hyperkalemia, renal failure), or cardio-prevalent calcium channel blockers such as verapamil with beta blockers (two cardiodepressive drug classes). Do not combine thiazide diuretics with potassium-sparing drugs such as triamterene or amiloride in normokalemic patients co-treated with (likewise potassium-sparing) angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Avoid combining beta blockers with thiazide diuretics, especially in obese, pre- and diabetic patients (two diabetogenic drug classes).
● Beta blockers can be combined with vaso-prevalent calcium channel blockers such as amlodipine to control vasodilation-induced and baroreflex-mediated tachycardia. Other useful combinations are: angiotensin converting enzyme inhibitors or angiotensin receptor blockers with calcium channel blockers, as these drugs are non-diabetogenic and angiotensin converting enzyme inhibitors and angiotensin receptor blockers ameliorate peripheral (usually ankle) edema caused by vaso-prevalent calcium channel blockers. A similar amelioration can be achieved by supplementing calcium channel blockers with thiazide diuretics.
≣ Fig. 4