OBJECT DRUGS
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec, etc.)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, etc.)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
PRECIPITANT DRUGS
Comment:
Patients on ACEI have developed severe hypotension after starting tizanidine therapy. Tizanidine, like the antihypertensive drug clonidine, is an alpha-2 adrenergic agonist, and may have additive hypotensive effects with ACE inhibitors.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative: In patients taking ACEI, consider using muscle relaxants other than tizanidine (that are not alpha-2 adrenergic agonists). Some other muscle relaxants can also cause hypotension, but the risk is probably less than for tizanidine.
- Monitor: If tizanidine is used in a patient taking an ACEI, monitor cardiovascular status carefully for evidence of an acute hypotensive reaction.