Substances that deplete blood volume, such as diuretics, or which vasodilate, such as angiotensin-converting enzyme (ACE) inhibitors, may contribute to lowering systemic blood pressure. This may result in pre-renal uraemia (azotaemia). Renal function should be monitored both before and seven days after commencement of treatment with ACE inhibitors. This also applies when the dosage of an ACE inhibitor or of a concurrently administered diuretic is increased. It is advisable to periodically monitor renal function throughout treatment.

At the start of treatment with ACE inhibitors or after a dosage increase, reduced blood pressure can occur in rare cases, which may manifest itself by fatigue, lethargy or ataxia. In such cases treatment should be discontinued until the patient’s condition has returned to normal and then resumed with 50% of the original dose. As high doses of diuretics can also lead to a fall in blood pressure, the concurrent administration of diuretics in the early phase of treatment with ACE inhibitors should be avoided in these patients.

If signs of hypotension occur, treatment with Vasotop should be suspended until fluid and electrolyte status is corrected. Treatment with Vasotop should then be continued at 50% of the original dose. In patients at risk of hypotension, it is advisable to introduce Vasotop gradually over one week (starting with half the therapeutic dose).

Diuretics and a low sodium diet both potentiate the effect of ACE inhibitors by activating the renin-angiotensin-aldosterone system. High doses of diuretics and a low sodium diet should therefore be avoided during treatment with ACE inhibitors to prevent hypotension (with clinical signs such as apathy, ataxia, rarely syncope or acute renal failure). In patients treated concurrently with Vasotop and furosemide, the dose of diuretic can be reduced to achieve the same diuretic effect as with furosemide alone.

The concomitant administration of ACE inhibitors with non-steroidal anti-inflammatory drugs (NSAIDS) leads to poor autoregulation of the glomerular blood pressure and can therefore trigger acute renal failure.

No data are available thus far on the use of the drug in bitches during pregnancy and lactation. In the absence of such data, prudence suggests that Vasotop should not be used in pregnant or lactating bitches.

Not to be used in clinical cases of vascular stenosis (e.g. aortic stenosis) or obstructive hypertrophic cardiomyopathy.

Do not administer potassium-sparing diuretics.

Not applicable

For animal treatment only. Keep out of reach and sight of children.