Renitec Plus

Renitec Plus - Precautions | Dosage | Use

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Renitec Plus contains two active substances: enalapril and hydrochlorothiazide. It is used to treat hypertension in patients in whom monotherapy with enalapril (Renitec) or hydrochlorothiazide is not sufficient. Enalapril belongs to the ACE inhibitors while hydrochlorothiazide is a diuretic. These drugs can be used separately in the treatment of hypertension, but their combination induces more powerful blood pressure reductions compared to monotherapy.

Enalapril increases blood potassium levels while hydrochlorothiazide decreases blood potassium levels, therefore this combination showed a low risk for developing hypo / hyperkalemia.


Renitec Plus is contraindicated in patients:

  • Who have a history of the angioedema caused by the use of drugs
  • Who have hereditary angioedema
  • Who have idiopathic angioedema
  • Who have an anuria
  • Who have hypersensitivity to enalapril, hydrochlorothiazide or sulphonamides
  • In pregnant and breastfeeding women


Caution should be exercised in patients who:

  • Have impaired kidney function
  • Have hypertrophic cardiomyopathy
  • Have a renal artery stenosis
  • Have aortic stenosis
  • Have cardiogenic shock
  • Have obstruction of the left ventricle
  • Have elevated levels of blood potassium
  • Have impaired liver function
  • Suffer from gout
  • Suffer from systemic lupus erythematosus
  • Have high uric acid levels
  • Suffer from diabetes
  • Have dehydration

Patients undergoing surgical procedure must inform their surgeon that they are taking Renitec Plus because this medicine can cause hypotension during the surgery.

This medicine can also cause hypomagnesaemia and hypercalcemia, and should be used cautiously in patients with thyroid hormone disorders.

Renitec Plus and its use during pregnancy and breastfeeding

If you are pregnant or intend to become pregnant, immediately inform your doctor that you're taking this medication. US FDA places this drug in pregnancy category D, which means that the embryo-fetal toxicity of this drug has been confirmed in clinical studies. This drug slows down fetal development of lungs and kidneys, which may have a fatal outcome.

It should not be used while breastfeeding.


Renitec Plus exists in the form of tablets containing 20 mg of enalapril and 6 mg of hydrochlorothiazide.Renitec Plus exists in the form of tablets containing 20 mg of enalapril and 6 mg of hydrochlorothiazide.

The recommended dose is one Renitec Plus 20/6 mg tablet taken in the morning, on an empty stomach or during the meal. Food intake does not appear to affect the efficacy of this medicine. The maximum daily dose is two tablets (equivalent to 40 mg of enalapril and 12 mg of hydrochlorothiazide).

The tablet should be taken in the morning, as it causes frequent urination. If you take it later in the day, then you'll have often have to get up in the night to go to the toilet.


Inform your doctor if you are taking any of the following medicines:

  • Oral hypoglycaemic drugs, such as:
    • glyclazide
    • glimepiride
    • pioglitazone
    • glyburide
    • empagliflozin
    • metformin
    and others. Renitec Plus may increase the effects of these medicines, and the dose of oral hypoglycaemic drugs should be adjusted.
  • Insulin - dose adjustment is required.
  • Direct renin inhibitor, such as: aliskerin.
  • Medicines used to treat pain and inflammation, such as:
    • etoricoxib
    • celecoxib
    • indomethacin
    • sulindac
    • diclofenac
    • flurbiprofen
    • ibuprofen
    • naproxen
    • ketoprofen
    These medicines reduce the antihypertensive efficacy of Renitec Plus.
  • Cholestyramine and colestipol - medicines used to treat high cholesterol.
  • Gold preparations used for the treatment of arthritis.
  • Allopurinol, colchicine and probenecid - medicines used to treat gout.
  • Sympathomimetics, such as:
    • adrenaline
    • dopamine
    • ephedrine
    • naphazoline
  • Opioid analgesics, such as:
    • tramadol
    • morphine
    • codeine
    • oxycodone
    • hydrocodone
    • pentazocine
  • Cyclosporine - a medicine used to treat rheumatoid arthritis and other immunosuppressive diseases.
  • Potassium-sparing diuretics, such as: triamterene, amyloid and spironolactone.
  • Potassium preparations.
  • Lithium. Renitec Plus increases the risk of toxic effects of lithium.
  • Phenobarbitone - anticonvulsant. Simultaneous administration increases the risk of orthostatic hypotension.

Side effects

According to the FDA, the most commonly reported side effects of Renitec Plus are dizziness (affects 8.8% of patients), headache (5.5%), fainting (3.9%) and cough (3.5%). In addition, Renitec Plus often causes the following side effects:

  • Muscle cramps (2.7%)
  • Nausea (2.5%)
  • Chronic fatigue/weakness, lack of energy and drowsiness (2.4%)
  • Orthostatic hypotension (2.3%)
  • Impotence (2.2%)
  • Diarrhea (2.1%)

Less common side effects of Renitec Plus are:

  • Palpitations and tachycardia
  • Chest pain
  • Paresthesia
  • Pancreatitis
  • Insomnia
  • Nervousness
  • Flatulence
  • Cold hands and feet
  • Constipation
  • Angioedema (1.1%). The risk of this side effect is greater in black patients.
  • Allergy


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