Contraindications and Precautions
The ACE inhibitors are contraindicated in patients with:
- Previous angioedema associated with ACE inhibitor therapy
- Renal artery stenosis (bilateral, or unilateral with a solitary functioning kidney)
- Hypersensitivity to ACE inhibitors
ACE inhibitors should be used with caution in patients with:
- Impaired renal function
- Aortic valve stenosis or cardiac outflow obstruction
- Hypovolemia or dehydration
- Hemodialysis with high-flux polyacrylonitrile membranes
ACE inhibitors are ADEC pregnancy category D, and should be avoided in women who are likely to become pregnant. In the U.S., ACE inhibitors are required to be labeled with a "black box" warning concerning the risk of birth defects when taken during the second and third trimester. Their use in the first trimester is also associated with a risk of major congenital malformations, particularly affecting the cardiovascular and central nervous systems.
Potassium supplementation should be used with caution and under medical supervision owing to the hyperkalemic effect of ACE inhibitors.
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